Ulcerative Colitis

Everything you need to know

What is Ulcerative Colitis?

Ulcerative colitis, otherwise known as Colitis, UC or Ulcerosa is one of the two major types of inflammatory bowel disease (IBD), the other being Crohn's Disease. Both Crohn’s disease and ulcerative colitis are believed to be autoimmune diseases, where the body reacts against its own tissue.​

IBD affects over 28,000 people in New Zealand and is growing.

The main difference between the two conditions is that, Crohn’s disease can affect any part of the digestive tract, ulcerative colitis affects only the large bowel and the rectum.

While Crohn’s disease can affect all layers of the bowel wall, ulcerative colitis only affects the lining of the colon.

Ulcerative colitis causes inflammation of the cells that line the rectum and colon (large intestine / large bowel). This inflammation can lead to sores called ulcers which may bleed and interfere wth digestion.

The immune system mistakes food, bacteria, and other materials in the intestine for foreign or invading substances. When this happens, the body sends white blood cells into the lining of the intestines, where they produce chronic inflammation and ulcerations.

​Colitis can mimic the symptoms of bowel cancer and some reports suggest up to 15% of IBD patients go on to develop bowel cancer later in life.

Have a look at this quick 4-minute video explaining ulcerative colitis...

Symptoms of Ulcerative Colitis

Symptoms vary in frequency and severity. Approximately half of all sufferers will experience only mild symptoms. However, for others, symptoms will be more severe. The severity of the symptoms tends to be related to how much of the colon is affected.

Ulcerative colitis is characterised by episodes where symptoms are problematic called “flare-ups” and episodes where symptoms are absent called "remissions".

There is also an increased risk of bowel or colorectal cancer in patients who have had extensive ulcerative colitis for 8 years or more.

Symptoms include:

  • Diarrhoea, with an urgency to go up to 20 times a day.
  • Rectal bleeding with mucus
  • stomach pain often described as cramping, your tummy may be sore to touch.
  • Constipation, although this is much less common than diarrhoea.
  • Fever
  • Weight loss, loss of appetite. Ongoing diarrhoea can also lead to weight loss.
  • Anaemia Bloody stools or intestinal inflammation can lead to low red blood cells or anaemia
  • Malnutrition caused by the inability to absorb all the nutrients from food
  • Fatigue
  • Bloating of the abdomen
  • Joint pain or soreness

Who is at risk?

Ulcerative colitis can begin at any age but most commonly occurs in young adults between the ages of 15 and 30 years.

The condition also has an increased incidence between the ages of 50 and 70 years. Children are rarely affected and women are more commonly affected by the condition than men.

Effects of Ulcerative Colitis

The effects of ulcerative colitis include:

  • Ulcers in the mouth
  • Inflammation of the iris (eye)
  • Eye ache when you look at bright lights
  • Arthritis
  • Skin lesions
  • Blood clots
  • Anaemia
  • Joint pain or soreness

Effects of ulcerative colitis in Children

​Ulcerative colitis can delay growth and development in children. It is believed to be a gene inherited from a close family member but the line of inheritance is not clear.

It is reported that only a small percentage of the children of those with colitis will actually develop colitis themselves.

The Children's Hospital of Wisconsin have put together some great cartoon videos to help explain to children what a colonoscopy or an endoscopy looks like and what they will go through when looking for signs of ulcerative colitis.

Click to view here.

Camp Purple Live - helping children

Crohn's and Colitis NZ are an amazing support organisation for people with Crohn's disease and ulcerative colitis. Bowel Cancer Foundation Trust works with this wonderful charity who have developed a camp for kids and teens called Camp Purple Live.

The camp allows kids with inflammatory bowel condition the ability to interact with other kids facing similar challenges and is not made to feel different because of their disease.

Their camp gives children and teenagers a chance to experience fundamental elements of childhood – the ability to play outdoors, to learn independence, nourish self-esteem, challenge themselves physically, and be proud of their accomplishments and know they are not alone.

Have a look at this 10-minute video on Camp Purple Live:

Mental health and Ulcerative Colitis

There are reported connections between ulcerative colitis and mental health conditions like depression, but the reasons for this link aren’t fully understood.

Living with ulcerative colitis brings challenges that can lead to negative thoughts, which may exacerbate symptoms of depression or anxiety about the frequency of bathroom trips in people with these conditions.

In some people with ulcerative colitis, being diagnosed with the disease can bring about feelings of frustration or sadness, and cause them to become withdrawn.

​Other people may be worried about specific aspects of the condition, such as having bouts of gas, diarrhoea, or pain in a social situation or public place. This can directly bring about anxiety or lead them to become isolated, which may in turn cause feelings of loneliness and despair and contribute to depression.

According to an article published in April 2012 in the journal Gastroenterology Research and Practice, the rate of anxiety and depression may be as high as 29 to 35% during remission, and as high as 80% for anxiety and 60% for depression during flares.

EverydayHealth.com reports that psychological stress has been shown to increase the permeability of the intestines — how easy it is for nutrients and other particles to pass through. This can reduce the effectiveness of the mucosal lining as a barrier to various harmful substances.

There’s also evidence that stress can change the activity of cytokines, molecules in the immune system that may play a role in the onset of ulcerative colitis and its associated inflammation.

Inflammatory cytokines may also play a role in the onset of mental health issues, contributing to anxiety when their levels go up due to intestinal inflammation.

Taking steroids to treat symptoms of ulcerative colitis can also have psychological effects, contributing to feelings of stress and anxiety.

Finally, anxiety can result in a stronger perception of symptoms of ulcerative colitis which can in turn, further increase psychological distress.

Diagnosing Ulcerative Colitis

It can be hard to distinguish between Crohn's disease and ulcerative colitis as they often have similar symptoms but are in fact treated quite differently.

Ulcerative colitis may be suspected when a person has experienced symptoms of rectal bleeding, intermittent diarrhoea and abdominal pain.

As part of the diagnosis, the doctor will take a full medical history and conduct a physical examination. The doctor may request that blood tests and specimens of the bowel motion (poo samples) are taken.

In ulcerative colitis, blood test results will often indicate anaemia and signs of inflammation in the body. Samples of bowel motions will often indicate the presence of blood, pus and mucus.

If ulcerative colitis is suspected, endoscopy may be recommended. Endoscopy is the most important diagnostic test used to diagnose ulcerative colitis.

During this test, a small flexible tube (an endoscope) with a fibre-optic camera at its tip is passed into the rectum and colon.

The doctor is able to see the lining of the rectum and colon on a television screen and can look for signs of inflammation and ulceration that may indicate ulcerative colitis. Small tissue samples (biopsies) from the lining of the colon and rectum can be taken for testing.

Ulcerative colitis can be diagnosed by the characteristic abnormalities of this tissue.

Ulcerative colitis most commonly affects the rectum and the lower part of the colon (the sigmoid colon).

X-ray tests using barium (a chalky liquid that is able to be seen on X-rays) can be helpful in determining how much of the colon is affected by ulcerative colitis.

The barium is administered into the rectum and colon via a tube inserted through the anus. A series of X-rays are taken, showing the outline of the inside of the colon and highlighting any abnormalities.

Treatments for Ulcerative Colitis

The aim of treatment is to reduce symptoms and prevent complications of the condition by reducing inflammation and maintaining periods of remission. Also, this gives your gut time to heal.

The type of treatment recommended will depend on the extent and severity of the condition. A person’s age, general health, lifestyle and personal choice will also be considered.

In very mild cases, diet changes and stress reduction may be all that are required to effectively manage symptoms. However, in severe cases, surgery to remove the colon and rectum may be required.

There are five treatment options:

#1. Stress reduction:

While stress does not cause ulcerative colitis, it can worsen symptoms in some people and trigger flares. Developing techniques to reduce stress can be helpful in managing the condition.

#2. Diet:

There is no evidence to support any specific diet as a treatment for ulcerative colitis. Some foods, however, can worsen symptoms in some people and trigger flares.

Keeping a food diary can be helpful in identifying which foods are problematic. Try and avoid spicy foods or those with high fibre content. You may find you are dairy or lactose intolerant as well as wheat intolerant. Everyone seems to be different.

Once identified, these foods should be avoided.

It may be recommended that vitamin and mineral supplements, such as iron and calcium, are added to the diet.

Increase in Fruit Consumption

​A new study released in November 2019 showed that eating more fruit changed the gut bacteria enough to reduce incidents of pouchitis in ulcerative colitis (UC) patients.

Researchers from the Oxford Academic Journal of Crohn’s and colitis reported that UC patients who had undergone a surgery to remove their large bowel and commonly developed pouch inflammation (pouchitis) as a result, benefited from eating at least 2 portions of fruit a day.

The FODMAP diet

Scientists from Monash University in Melbourne have found that a low FODMAP diet can help with the symptoms of IBS. They have found a way to monitor your tolerance to FODMAP-rich foods and finding a diet that suits you and your symptoms.

#3. Alternative therapies - Frankincense:

Frankincense oil comes from the resin of the Boswellia tree and helps speed up wound healing, controls bleeding, improves uterine and oral health as well as fights inflammation.

It’s this inflammatory effect that has researchers excited.

The National Centre for Complementary and Integrative Health (NCCIH) studied patients with osteoarthritis and found they had better pain relief than those who used a placebo.

Long term inflammatory conditions such as arthritis, bronchial asthma, Crohn’s disease and ulcerative colitis can lead to health issues that can be reduced by the use of Frankincense.

It’s long term inflammatory conditions such as Crohn’s and colitis that can lead to bowel cancer if left untreated.

Frankincense contains boswellic acid that fights inflammation by targeting free radicals and cytokines in the body responsible for inflammation.​

Currently, Frankincense is available in New Zealand as an essential oil, capsules, a tincture or Boswellia Serrata Extract as a supplement powder. They can be found at My Natural Health.

To read more click here

#4. Medications:

Initial treatment for flare-ups is usually the administration of steroids such as prednisone. These fight the infections in your intestines and give them a chance to heal.

Treatment for ulcerative colitis usually involves the use of anti-inflammatory medications containing 5-aminosalicylic acid (5-ASA). Examples of these medications include sulfasalazine, mesalazine and olsalazine.

These medications reduce inflammation in the colon and rectum leading to a reduction in symptoms. They are usually taken on a long-term basis and can help prevent flare-ups.

Severe flare-ups of ulcerative colitis may require hospitalisation. Corticosteroid medications, such as budesonide and prednisone may be required and can be given by mouth, through a drip (intravenously) or into the rectum (as an enema or suppository). Due to side effects, corticosteroids are not usually given long term.

Medications to suppress the immune system may be recommended and are often used in combination. Examples of these medications include azathioprine and cyclosporin.

Infliximab, adalimumab and golimumab - new types of medication known as biologics that modify immune system function - are available for people with active ulcerative colitis whose symptoms are not adequately controlled with 5-ASA and corticosteroid medications.

However, use of these medications may be restricted by their high cost.

Dehydration caused by profuse diarrhoea may need to be treated by giving fluids through a drip. Medications to relieve pain and diarrhoea may also be given. Antibiotics may be required if an infection is present in the colon.

Loss of blood through the rectum over a long period of time can lead to anaemia. Iron tablets may be prescribed to correct the anaemia and prevent its recurrence. In cases of severe blood loss, blood transfusions may be required.

#5. Surgery

In severe cases, where medication and supportive treatment have not been successful in controlling the condition, or where the side effects of medications are intolerable, surgery may be required.

Surgery may also be recommended if a growth has been found or to avoid colon cancer risk in patients who have experienced colitis for 8 years or more or who have had severe damage of their colon.

Surgery has come on in leaps and bounds over the past few years and may only require a laparoscopic procedure. If you are a suitable candidate, the whole bowel can be removed via keyhole surgery.

There are three main surgical techniques for the treatment of ulcerative colitis.

Total proctocolectomy and ileostomy

This involves removing the entire colon and rectum. The end of the small intestine is brought out onto the wall of the abdomen. A collection bag or ostomy bag is placed over the opening and faecal matter will pass into it.

The bag is emptied by the person as required. The ileostomy is permanent. This type of surgery offers a permanent cure for ulcerative colitis.


Sub-total colectomy and ileorectal anastomosis

This is where some or most of the colon is removed, but the rectum is retained. The lower end of the small intestine is joined to the upper end of the rectum.​

Ileoanal anastomosis (“J-Pouch operation”)

This involves removing the entire colon and rectum. A section of the small intestine is used to make a small pouch in the form of a "J" where faecal matter can be stored.

The pouch is then attached to the anus. This surgical technique does not require a permanent ileostomy. There will be two surgeries a couple of months apart.

​If you want to know what it's like to have your colon removed read our patient story here.

Ulcerative Colitis After Care

You will be placed under the care of your colorectal surgeon and a colorectal nurse to monitor your health moving forward.

You should also be required to have ongoing check-ups and 'pouch reviews' depending on the surgery you have had, to ensure you do not have any continued flare-ups of colitis in any portion of the colon that may remain.

While your risk of bowel cancer has been reduced significantly when your colon is removed, you will be required to undergo annual pouch reviews as the surgery join site can still have the ability to develop bowel cancer at a later stage.

With a pouch or an ostomy bag you can still have intimate relations, play sports and do most things you did before surgery.

If you need to look after your ostomy bag you'll get advice from your medical team about how to care for it and the stoma. You can empty or throw out the bags when you need to. Irrigating the stoma can help you control the timing of bag changes.

To prevent leaks, the pouch system that connects the stoma to the bag needs to be changed every few days. Call your doctor if you notice a change in colour, bleeding, or swelling.

Blockage or bowel obstruction to the stoma

You may also experience blockages or bowel obstruction after surgery.

​Signs to look out for are severe cramping, nausea and vomiting.

Pouchitis

You may experience "Pouchitis" a disruption of bacteria in the pouch that cause inflammation. Signs to look out for are diarrhoea, frequent bowel movements, stomach cramps and pain, fever, joint pain, and soreness around the anus.

This can be treated with antibiotics such as ciprofloxin.

There are ways to reduce the instances of pouchitis. Usual triggers can be too much processed sugar.

​The use of probiotics such as Vivomixx, specifically designed for ulcerative colitis and Crohn's sufferers will keep your pouch bacteria at an optimum level if taken on a regular basis.

Also eating 2 portions of fruit a day has been proven to reduce incidents of pouchitis in UC patients.

Causes of Ulcerative Colitis

Studies indicate that the inflammation in IBD involves a complex interaction of factors with the three main ones being...

  1. ​The genes the person has inherited
  2. ​The immune system
  3. Something in the environment

Environment:

Foreign substances (antigens) in the environment may be the direct cause of the inflammation, or they may stimulate the body's defences to produce an inflammation that continues without control.

The Immune System:

Researchers believe that once the IBD patient's immune system is "turned on," it does not know how to properly "turn off" at the right time. As a result, inflammation damages the intestine and causes the symptoms of IBD. That is why the main goal of medical therapy is to help patients regulate their immune system better.

Heredity:

A person's genes are believed to be a contributory factor and are generally passed down through families but there is no clear pattern of inheritance. Up to 20% of people will have a close family member with ulcerative colitis and seems to affect mainly white Europeans or those from Jewish descent.

Research sponsored by the Crohn's & Colitis Foundation in America has led many scientists to believe that ulcerative colitis may be the result of an interaction of a virus or bacterial infection of the colon and your body’s natural immune system response.

Normally, your immune system will cause temporary inflammation to combat an illness or infection, and then the inflammation will be reduced as you regain health.

In people with ulcerative colitis, however, this inflammation can persist long after your immune system should have finished its job.

Support Groups:

There are two good support groups to check out...

Crohn's and Colitis NZ(click here)

A Facebook Patient Support Group (click here)

Charity Achievements

Key milestones reached by Bowel Cancer Foundation Trust

$1.1million

Dollars distributed in the last 12 months to fund research and provide equity of care and better patient outcomes

195

Bowel cancer survivors rehabilitated after gruelling treatment helping to reduce cancer re-occurrence

109+

Bowel screening kits provided to Kiwi’s who do not qualify for free public screening to detect bowel cancer early

7+

Years we've been making a difference for bowel cancer patients in New Zealand