Even one day of stomach cramping or diarrhea is too many. But diseases like ulcerative colitis inflame your bowels and make daily pain commonplace. Understanding the disease and its triggers can help. Here are answers to your top 10 questions about ulcerative colitis and suggestions for easing discomfort...
1. What is ulcerative colitis? I’ve heard it mentioned with irritable bowel syndrome and Crohn’s disease. Are they all the same thing?
No, but they do share some symptoms. Ulcerative colitis (UC) causes inflammation along the lining of the lower gastrointestinal (GI) tract: the colon and the rectum. The inflammation kills cells that line those parts, resulting in ulcers that may bleed and ooze pus.
The result is abdominal pain and cramping, diarrhea and even bloody, pus-laden stool.
It may affect only the last portion of the colon and rectum, known as ulcerative proctitis. If it affects only the lower colon, it’s called limited, or distal, colitis. Pancolitis affects the entire colon.
Crohn’s disease, like ulcerative colitis, also causes GI inflammation: both are inflammatory bowel diseases (IBD).
But Crohn’s disease can affect any part of the GI tract, from the mouth to the anus, although its target is most commonly the ileum, the last portion of the small intestine. (That’s why it’s sometimes called ileitis or enteritis.)
Crohn’s disease differs from ulcerative colitis in several ways:
It may inflame all the bowel’s layers, not just the top layer as UC does.
It may affect any area of the GI tract; UC most often affects the colon only.
Crohn’s disease may skip portions of the GI tract, interspersing healthy and diseased bowel; UC usually spreads
along the bowel without skipping sections.
Treatments for the two diseases differ too. So do some complications. The most common complication of Crohn’s, for example, is intestinal blockage, which isn’t common in UC.
Unlike UC and Crohn’s, irritable bowel syndrome (IBS) doesn’t involve GI inflammation. Instead, IBS results from abnormal contractions of the GI tract.
Although IBS causes some similar symptoms, such as diarrhea and abdominal cramping, it doesn’t damage the bowel or lead to serious illness such as cancer, which UC and Crohn’s do (see Question #10).
The confusion between IBS and the inflammatory bowel diseases UC and Crohn’s may also come from having such similar acronyms: IBS and IBD.
2. Are certain people more likely to get UC than others?
UC affects men and women equally. People who have a close relative – a parent or sibling – with UC or Crohn’s disease are also more likely to get UC. And UC occurs more frequently in Caucasians and in people of Eastern European Jewish descent (Ashkenazi Jews).
UC can affect all ages, but most commonly starts between the ages of 15 and 30. Nobody knows why, although it’s thought that genetics play a role. However, UC is not just hereditary: Many people get it without having a genetic predisposition, and not everyone with a predisposition gets it.
3. What causes it?
No one knows. Some studies link abnormalities in the body’s immune system with UC, but it’s unclear whether those are a cause or result of the disease. Other studies suggest that both Crohn’s and UC stem from an abnormal reaction of the body’s immune system to normal bacteria in the GI tract.
Specific genes are probably involved too, since the disease runs in families and certain population groups.
4. What symptoms should I look for?
UC symptoms include any or all of the following:
Profound fatigue
Scant appetite
Weight loss
Bloody diarrhea
Abdominal cramping
Nausea
Vomiting
Joint pain
Eye inflammation
Skin lesions
For severe UC, you may see recurrent bouts of fever along with abdominal symptoms, including rectal bleeding. Flare-ups may come and go but rarely disappear.
Acute GI infections, such as salmonella or giardia, can have many of the same abdominal symptoms but usually resolve on their own without recurring. Talk to your doctor if symptoms last longer than a week or if they are severe and accompanied by high fever.
5. Is it a stress-related disease?
UC isn’t initially caused by emotional stress, but distress – including the anxiety of having the disease – may worsen symptoms and trigger flare-ups.
Massage therapy, meditation, deep breathing, yoga and cognitive behavioral therapy (which allow patients to explore and rid themselves of negative thoughts and attitudes) may help manage stress.
6. Can medications trigger it?
Yes, some drugs can be tough on the UC gut. Nonsteroidal anti-inflammatories (NSAIDs), such as ibuprofen (Advil), have been linked to UC flare-ups.
Antibiotics may also worsen symptoms and should be taken only if absolutely necessary.
Stopping or skipping doses of UC medication may also lead to flare-ups.
7. Can diet, like spicy or high-fiber foods, aggravate it?
Yes, but no one food triggers a flare-up for every UC patient. High-fiber foods such as bran, beans, nuts, seeds and popcorn may increase diarrhea and gas in some people with UC, as can spicy and greasy foods.
You may have to go easy on caffeine and liquor too.
Some people with UC can’t eat any type of pepper – raw or as seasoning.
The trick is to find out which foods trigger your UC flare-ups and avoid them while trying to eat a well-balanced, nutritious diet.
Some doctors recommend “the specific carbohydrate diet,” which is free of grains, milk products and sugar. Instead, it’s loaded with fresh fruits and vegetables, meats, fish and natural cheeses and yogurt.
The theory is that carbohydrate sugars may fuel the growth of bacteria and yeast in the intestines, which interfere with digestion and produce toxins that could harm the small intestine.
Researchers are also exploring the benefits of probiotics – live beneficial bacteria available in some yogurts and as supplements – and anti-inflammatory omega-3 fatty acids found in fatty fish like tuna and salmon, as well as in walnuts, flaxseeds and soybeans.
8. Is UC curable? Or is it a life-long condition?
Ulcerative colitis is usually life-long, although some people may be cured by having their colon and rectum removed. Surgery isn’t commonly recommended for people with mild UC cases – infrequent flare-ups, perhaps even years apart – and flare-ups that are easily treated with medications.
But it may be recommended for some patients with frequent flare-ups and severe symptoms.
Even with surgery, some symptoms – especially those outside the GI tract like joint pain – may not go away. And the surgery can have long-term complications, such as blockage, stool leakage and even infertility.
If the lower colon is severely affected, a surgeon may have to close off the rectum, leaving the patient with a permanent ostomy - an opening in the abdomen through which feces empty (into a collection bag).
About 25%-40% of UC patients eventually have their colons removed because they rupture. Or they need this surgery because of massive bleeding from the rectum, the risk of colon cancer, or illness so severe that medications can no longer control it.
9. What are medication options?
The types of medication used to treat UC include:
Those that relieve symptoms, such as anti-diarrheal medications, pain relievers and anti-fever medications like acetaminophen (Tylenol)
Those that help control bowel damage by decreasing inflammation, such as aminosalicylates, which include aspirin and corticosteroids
Those that suppress the body’s immune system, such as azathioprine (Imuran) and cyclosporine (Sandimmune)
Your symptoms determine which drug or combination of drugs is recommended. Your doctor may also prescribe anti-anxiety meds or antidepressants to help lower your stress levels.
10. Can UC lead to cancer?
The risk of developing colon cancer increases with the severity and duration of the disease.
For example, in a patient whose UC involves the entire colon, the risk of developing colon cancer can be 32 times higher than normal. About 5% of UC patients develop colon cancer.
Because of the high risk, the American Cancer Society recommends a colonoscopy with biopsies every one to two years if you have had IBD throughout the colon for eight years or more, or for those who have had IBD for 12-15 years in their lower colon only.
No comments:
Post a Comment