What is ulcerative colitis?

Most people with ulcerative colitis have a healthy pregnancy and deliver a healthy baby. But if your disease isn't well controlled, you can have a higher risk of pregnancy problems. Work with your doctor to find treatments that are safe to use during pregnancy.

Ulcerative colitis may be mild, moderate, or severe.

Most people have periods of remission (when the condition is not active) that may last months or years. During these periods, people may sometimes have flare-ups with moderate symptoms. Some people have symptoms all the time.

Children may have the same symptoms that adults have. Also, children with the disease may grow more slowly than normal and go through puberty later than expected.

The main symptoms of ulcerative colitis are belly pain or cramps, diarrhea, and bleeding from the rectum. In severe cases, people may have diarrhea 10 to 20 times a day. Some people also may have a fever, not feel hungry, and lose weight. In most people, the symptoms come and go.

Medicines can help reduce your symptoms and help you avoid new flare-ups. If you have severe symptoms and medicines don't help, you may need surgery to remove your colon. This cures ulcerative colitis.

Over time, some people who have ulcerative colitis need surgery to remove the large intestine (colon). Surgery can cure the disease. It may help problems that the disease causes outside the colon, such as slowed growth in children.

You may need surgery for different reasons. For example, you may need it when other treatment isn't working, when holes form in the large intestine, or if dysplasia is found during colonoscopy or biopsy. Some people choose surgery if the medicines used to treat ulcerative colitis are causing serious side effects.

These are the two most common types of surgery.

Ileoanal anastomosis.

The surgeon removes some or all of the large intestine and the lining of the rectum. Then the end of the small intestine (the ileum) is connected to the anal canal. This allows you to have bowel movements without an ostomy. This is the most common type of surgery.

Proctocolectomy and ileostomy.

The surgeon removes the large intestine and rectum but leaves the lower end of the small intestine. The surgeon sews the anus closed. Then the surgeon makes a small opening called a stoma in the skin of the lower belly. The ileum is connected to the stoma. This creates an opening to the outside of the body. After this surgery, you'll need an ostomy. This surgery may be done for people who can't tolerate anesthesia for a long time.

You may be able to schedule surgery when it's most convenient for you. Emergency surgery usually isn't needed. But it may be needed if you have a flare-up that causes toxic megacolon, severe uncontrolled bleeding, or a rupture in the intestine.

To diagnose ulcerative colitis, a doctor will ask about your symptoms, do a physical exam, and do a number of tests. These tests may include colonoscopy, blood tests, and stool sample testing. Testing can help rule out other problems that can cause similar symptoms, such as Crohn's disease and irritable bowel syndrome.

Medicines are the main treatment for ulcerative colitis. They are used to control inflammation in the intestines and then keep it from coming back. Your doctor will talk to you about your choices.

For mild or moderate cases of the disease when there is little risk of needing surgery, most people use aminosalicylates or steroid medicines. These can be taken as a pill, suppository, rectal foam, or enema.

For moderate or severe cases of the disease when there is a high risk of needing surgery, you will need medicines (such as biologics) to prevent inflammation. These are given intravenously (I.V.) or as a shot. Many people also need aminosalicylates, steroid medicines, or other medicines to calm down the immune system.

If you are pregnant or planning to become pregnant, talk to your doctor about which medicines are safest.

Health professionals who can diagnose ulcerative colitis include:

• Family medicine physicians.
• Internists.
• Gastroenterologists.

For the treatment and management of ulcerative colitis, you are likely to be referred to a gastroenterologist.

To be evaluated for surgery, you may be referred to a:

• Surgeon.
• Colon and rectal surgeon.

• Call your doctor if you think your child is having a problem with a medicine.
• Do not give your child anti-inflammatory medicines unless the doctor says it is okay. These include aspirin, ibuprofen (Advil, Motrin), and naproxen (Aleve). They may make symptoms worse.
• Talk to your doctor before you give your child any other medicines or herbal products.
• Make sure your child eats enough protein and drinks plenty of fluids. During a flare-up, avoid foods that make your child's symptoms worse. This may include foods that are high in fiber or high in fat. It may also include foods and drinks that have lactose, like dairy products.
• Talk to a dietitian to make sure your child is getting the nutrition, including vitamins and minerals, that they need.

Surgery that removes the large intestine (colon) can cure ulcerative colitis. It may help problems that the disease causes outside the colon, such as slowed growth in children.

People need surgery for different reasons. For example, it may be needed when treatment isn't working or when holes form in the large intestine.

These are the two most common types of surgery.

Ileoanal anastomosis.

The surgeon removes some or all of the large intestine, and the lining of the rectum. Then the surgeon connects the small intestine to the anal canal. After this surgery, you can have bowel movements without an ostomy.

Proctocolectomy and ileostomy.

The surgeon removes the large intestine and rectum. Then the surgeon sews the anus closed and creates an opening to the outside of the body. After this surgery, you'll need an ostomy.

What is ulcerative colitis?

Ulcerative colitis is a disease that causes parts of the digestive tract to become inflamed and form deep sores. These sores are called ulcers. The disease can affect the colon and the rectum. It can cause belly pain and diarrhea.

In many cases, medicines may ease inflammation and control symptoms. But sometimes they don't work.

This information will help you decide between having surgery and using medicines.

What are key points about this decision?

• Most people who have mild colitis can control their symptoms with medicine. In most cases, surgery is not done when the disease is mild.
• The only cure for ulcerative colitis is surgery to remove the colon and the lining of the rectum. After the most common type of surgery, you will still be able to have bowel movements. After the less common type of surgery, you will wear an ostomy bag to remove body waste.
• Your risk of colon cancer may start to go up after 8 to 10 years. Your risk is highest if a lot of your colon is involved. Surgery almost completely removes the risk of colon cancer.
• In most cases, surgery works well. But it does have risks. Your small intestine could get blocked. Or you might leak stool.

Why might you choose surgery?

• You have severe symptoms that medicines do not control.
• Surgery cures ulcerative colitis.
• You are worried about colon cancer. Surgery almost completely removes the risk of colon cancer. And it can cure it if the cancer has not spread beyond the colon.
• You don't want to take medicine for the rest of your life.
• You are having serious side effects from your medicines.

Why might you choose medicine?

• Your symptoms don't bother you very often or very much.
• You don't mind trying different types of medicines until you find one that works for you.
• You understand the side effects of the medicines. You feel that you can deal with them.
• You worry about the risks of surgery.

Your decision

Thinking about the facts and your feelings can help you make a decision that is right for you. Be sure you understand the benefits and risks of your options, and think about what else you need to do before you make the decision.

Problems from ulcerative colitis can include:

• Narrowed areas of the intestine (strictures). They can make it hard to pass stools.
• Increased risk of cancer of the colon and rectum. Your risk may start to go up after 8 to 10 years. Your risk is highest if a lot of your colon is involved.
• Problems outside the digestive tract. These include joint pain, skin problems, eye problems, or liver disease.
• The colon swelling to many times its normal size. This is called toxic megacolon. It's rare, but it needs treatment right away.
• Other rare problems, such as scarring of the bile ducts and the pancreas.
• Increased risk of melanoma, a serious type of skin cancer. Your doctor may recommend regular screening by a dermatologist.

Irritable bowel syndrome

Some people who have ulcerative colitis also have irritable bowel syndrome (IBS). It isn't as serious as ulcerative colitis. IBS causes belly pain along with diarrhea or constipation.

Experts aren't sure what causes ulcerative colitis. It might be caused by the immune system overreacting to normal bacteria in the digestive tract. Or other kinds of bacteria and viruses may cause it. You are more likely to get it if other people in your family have it.

Ulcerative colitis is a disease that causes inflammation and sores (ulcers) in the lining of the large intestine, or colon. It usually affects the lower section and the rectum. But it can affect the entire colon. In general, the more of the colon that's affected, the worse the symptoms will be.