Life with Ulcerative Colitis: 4 Things to Know

A disease causing inflammation and sores in the large intestine, ulcerative colitis can seriously disrupt a person's life.

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That's because the main symptoms of ulcerative colitis include cramps, diarrhea and rectal bleeding — all of which can be severe. Symptoms can flare periodically, or they can occur nearly constantly.

"The main goal I have for my patients is to get control of their disease, control of their intestines and control of their life back," says Peter Higgins, M.D., Ph.D., M.Sc., director of the IBD program at Michigan Medicine.

Ulcerative colitis is one of the most common forms of inflammatory bowel disease. Its causes aren't known, though ties to immune system malfunction or heredity are suspected. Caucasians and those younger than 30 represent the populations most at risk for developing ulcerative colitis.

Higgins explains more about the disease, which affects about 600,000 people in the United States:

What is ulcerative colitis?

Higgins: Ulcerative colitis starts in the rectum and can affect the entire colon or only part of it. It may be called proctitis if only the rectum is affected and left-sided colitis if only the lower half of the colon is affected. If most of the colon is affected, it may be called pancolitis.

The inflammation is continuous, which means that it does not stop and then start again in a different part of the colon. Inflammation can spontaneously increase, often unpredictably, leading to an increase in symptoms that are commonly called flares. The inflammation is chronic, which means that it is always present, although the symptoms may come and go.

How is ulcerative colitis different from Crohn's disease?

Higgins: Ulcerative colitis and Crohn's disease are both forms of IBD, which occur on a spectrum. Some people have very typical ulcerative colitis, others have very typical Crohn's disease, and other people are in between the two.

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Typical ulcerative colitis causes inflammation of the inner lining of the colon, without causing the blockages or fistulas seen in Crohn's disease. Ulcerative colitis is also different from irritable bowel syndrome, infectious colitis and ischemic colitis because it is caused by chronic immune-mediated inflammation.

How is ulcerative colitis diagnosed and treated?

Higgins: It is diagnosed by taking biopsies of the colon during a colonoscopy and examining these biopsies under a microscope. Evidence of chronic damage differentiates ulcerative colitis from infectious causes of colitis.

Ulcerative colitis is a lifelong, chronic condition, so it can't be cured. A few patients find their disease becomes milder or "burned out" after age 60, but many do not. Therapies to reduce the activity of the immune system in the gut can include sulfasalazine, 5-aminosalicylates, thiopurines, methotrexate and biologic therapies.

Do I need to see a specialist for ulcerative colitis?

Higgins: It is a good idea for any IBD patient to visit with an IBD specialist at least once in the first year after diagnosis, and periodically thereafter, to make sure you are up to date in treatment, preventive health and information about ulcerative colitis.

Fortunately, our understanding of IBD is advancing rapidly and new treatments are being tested in clinical trials and reaching patients at a rapid pace in recent years.