Ulcerative Colitis


Ulcerative colitis is an inflammatory bowel disease (IBD) in which the inner lining of the large intestine (colon or bowel) and rectum become inflamed. Inflammation usually begins in the rectum and lower (sigmoid) intestine and spreads upward to the entire colon. Ulcerative colitis rarely affects the small intestine, except for the lower section, the ileum.

The inflammation causes diarrhea, or frequent emptying of the colon. As cells on the surface of the lining of the colon die and slough off, ulcers (open sores) form and may cause the discharge of pus and mucus, in addition to bleeding.

Although children and older people sometimes develop ulcerative colitis, it most often starts between the ages of 15 and 30. It affects males and females equally and appears to run in some families.

Ulcerative colitis requires long-term medical care. There may be remissions - periods when the symptoms go away - that last for months or even years. However, symptoms usually return. Compliance with maintenance medications and ongoing medical care can significantly decrease the chances for disease recurrences. However, in some instances surgical intervention may be the best option for patients whose disease can not be controlled with conventional medical therapy.

Only in rare cases, when complications occur, can the disease be fatal. The risk of colon cancer is greater than normal in patients with widespread ulcerative colitis, however, especially if not treated appropriately.

Patients can be seen by Texas Children's experts in Inflammatory Bowel Program.

Causes & Risk Factors

Although many theories exist regarding the cause of ulcerative colitis, none has been proven. The cause of ulcerative colitis is unknown, and currently there is no cure, except through surgical removal of the colon. One theory suggests that some agent, possibly a virus or an atypical bacterium, interacts with the body's immune system to trigger an inflammatory reaction in the intestinal wall.

Although much scientific evidence shows that people with ulcerative colitis have abnormalities of the immune system, physicians do not know whether these abnormalities are a cause or result of the disease.

There is little proof that ulcerative colitis is caused by emotional distress or sensitivity to certain foods or food products.

Symptoms & Types

The following are the most common symptoms of ulcerative colitis. Each individual may experience symptoms differently, however. Symptoms may include: 

  • Abdominal pain
  • Bloody diarrhea
  • Fatigue
  • Weight loss
  • Loss of appetite
  • Rectal bleeding
  • Loss of body fluids and nutrients
  • Anemia caused by severe bleeding

Sometimes, symptoms may also include: 

  • Skin lesions
  • Joint pain Inflammation of the eyes
  • Liver disorders
  • Osteoporosis
  • Rashes
  • Kidney stones

The symptoms of ulcerative colitis may resemble other medical conditions or problems. Always consult your doctor for a diagnosis.

Ulcerative colitis is categorized by the extent of colonic involvement:

  • only the very end of the large bowel (rectum), known as proctitis
  • left-sided colitis
  • extensive colitis
  • pan-colitis, when the whole colon is inflamed

Diagnosis & Tests

A thorough physical examination, including blood tests to determine whether an anemic condition exists, or if the white blood cell count is elevated (a sign of inflammation), is part of the diagnostic process. In addition, diagnostic procedures for ulcerative colitis may include the following:

  • Stool culture. Checks for the presence of abnormal bacteria in the digestive tract that may cause diarrhea and other problems. A small sample of stool is collected and sent to a laboratory by the doctor's office. In 2 or 3 days, the test will show whether abnormal bacteria, bleeding, or infection are present. 
  • Esophagogastroduodenoscopy (also called EGD or upper endoscopy). A procedure that allows the doctor to examine the inside of the esophagus, stomach, and duodenum (the first part of the small intestine where the absorption of vitamins, minerals, and other nutrients begins). A thin, flexible, lighted tube called an endoscope is guided into the mouth and throat, then into the esophagus, stomach, and duodenum. The endoscope allows the doctor to view the inside of this area of the body, as well as to insert instruments through a scope for the removal of a sample of tissue for biopsy (if necessary).
  • Colonoscopy. Colonoscopy is a procedure that allows the doctor to view the entire length of the large intestine, and can often help identify abnormal growths, inflamed tissue, ulcers, and bleeding. It involves inserting a colonoscope, a long, flexible, lighted tube, in through the rectum up into the colon. The colonoscope allows the doctor to see the lining of the colon, remove tissue for further examination, and possibly treat some problems that are discovered. 
  • Biopsy. A procedure performed to remove tissue or cells from the lining of the colon for examination under a microscope.
  • Lower GI (gastrointestinal) series (also called barium enema). A procedure that examines the rectum, the large intestine, and the lower part of the small intestine. A fluid called barium (a metallic, chemical, chalky, liquid used to coat the inside of organs so that they will show up on an X-ray) is given into the rectum as an enema. An X-ray of the abdomen shows strictures (narrowed areas), obstructions (blockages), and other problems.

Treatment & Care

Specific treatment for ulcerative colitis will be determined by your doctor based on: 

  • Your child's age, overall health, and medical history
  • Extent of the condition
  • Your child's tolerance for specific medications, procedures, or therapies
  • Expectations for the course of the condition
  • Your opinion or preference 

While there is no special diet for ulcerative colitis, patients may be able to control mild symptoms simply by avoiding foods that seem to upset their intestines. 

When treatment is necessary, it must be tailored for each case, as what may help one patient may not help another. Patients are also given needed emotional and psychological support. Treatment may include: 

  • Drug therapy (aminosalicylates, corticosteroids, or immunomodulators). Abdominal cramps and diarrhea may be helped by medications to reduce inflammation in the colon. Abdominal cramps and diarrhea may be helped by medications to reduce inflammation in the colon. More serious cases may require steroid medications, antibiotics, or medications that affect the body's immune system.
  • Hospitalization. Patients with ulcerative colitis occasionally have symptoms severe enough to require hospitalization to correct malnutrition and to stop diarrhea and loss of blood, fluids, and mineral salts. The patient may need a special diet, intravenous (IV) feedings, medications, or, sometimes, surgery.
  • Surgery. Most people with ulcerative colitis do not need surgery. However, about 25 to 40% of ulcerative colitis patients eventually require surgery for removal of the colon because of massive bleeding, chronic debilitating illness, perforation of the colon, or risk of cancer. Sometimes, removing the colon is suggested when medical treatment fails, or the side effects of steroids or other drugs threaten the patient's health.

There are several surgery treatments, including the following:

  • Proctocolectomy with ileostomy. This is the most common surgery and involves proctocolectomy (removal of the entire colon and rectum) with ileostomy (creation of a small opening in the abdominal wall where the tip of the lower small intestine, the ileum, is brought to the skin's surface to allow drainage of waste).
  • Ileoanal anastomosis. Sometimes, ileoanal anastomosis (also called a pull-through operation), an operation that avoids the use of a pouch, can be performed. The diseased portion of the colon is removed and the outer muscles of the rectum are preserved. The ileum is attached inside the rectum, forming a pouch, or reservoir, that holds waste. This allows the patient to pass stool through the anus in a normal manner, although the bowel movements may be more frequent and watery than usual.

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