Ulcerative Colitis: What It Is, Its Causes, Symptoms, and Treatment

Our intestines are referred to as the second brain of our body and are of great importance to our health.

​​​​​​Our intestines are referred to as the second brain of our body and are of great importance to our health. Ulcerative colitis is a disease that occurs due to inflammation affecting our intestines. This disease has many different symptoms, and it can flare up at times or remain dormant at other times.

What is Ulcerative Colitis?

Ulcerative Colitis is a type of inflammatory bowel disease (IBD). It is a gastrointestinal disease that causes long-term inflammation and ulcers (sores) in the colon, also known as the large intestine. This disease is present when inflammation in the large intestine leads to the formation of ulcers.

It is a condition that severely affects the quality of life and requires constant monitoring, as it can lead to weakness and even death. It affects the mucosa on the inner surface of the colon.

It is often confused with less severe conditions like Irritable Bowel Syndrome (IBS) and Crohn’s disease. However, there is a fundamental difference between ulcerative colitis and Crohn’s disease: ulcerative colitis only affects the large intestine, while Crohn’s disease can affect both the small and large intestines.

Ulcerative colitis affects both men and women equally. It can occur at any age. Genetic factors may slightly increase the risk of developing this disease.

What are the Types of Ulcerative Colitis?

Ulcerative colitis can be categorized according to the sections of the bowel it affects:

• Ulcerative Proctitis: In this type of ulcerative colitis, inflammation is located near the rectum (anus) and is known to be the mildest form of the disease.
• Proctosigmoiditis: This type affects the rectum and the lower part of the colon (sigmoid colon). Common symptoms include abdominal cramps, bloody diarrhea, and a feeling of needing to go to the bathroom but being unable to do so.
• Distal Ulcerative Colitis or Simply Distal Colitis: In this type, the inflammation caused by ulcerative colitis affects the left side of the colon, up to the spleen. It can cause cramps in the abdominal area, especially on the left side, bloody diarrhea, and weight loss.
• Pancolitis: This type typically affects the entire colon. Symptoms such as abdominal cramps, bloody diarrhea, and weight loss are more severe in this form.
• Fulminant Colitis: This type is rare but can be life-threatening. Symptoms include severe pain, diarrhea, bleeding, fever, and an inability to eat. Severe diarrhea can lead to dehydration and sometimes shock.

What Are the Causes of Ulcerative Colitis?

The exact cause of ulcerative colitis is unknown, but it is not a contagious disease. Ulcerative colitis can be classified as an autoimmune disease. Autoimmune diseases occur when the body’s immune system attacks healthy tissues. Although the exact cause of this immune response is not fully understood, many factors are thought to contribute to it. Poor diet plays a significant role in the development of ulcerative colitis, and acid reflux caused by poor nutrition can also be a contributing factor. Environmental factors, especially in industrial cities, have an impact on ulcerative colitis. Other contributing factors include a stressful lifestyle, excessive medication use, pregnancies, frequent infections, and immune system-related diseases.

What Are the Symptoms of Ulcerative Colitis?

As with every disease, the symptoms may vary depending on the patient's condition and the area affected by the disease. The most common symptoms include:

• Abdominal pain and cramping
• Bloating in the abdomen
• Anemia
• Loss of appetite and resulting weight loss
• Various bowel-related issues such as diarrhea or constipation
• Constant urge to defecate, but sometimes being unable to do so
• Mucus in stool
• Presence of blood in stool
• Fever and chills
• Weakness
• Vomiting
• Discharge from the anus
• Rectal pain
• Skin rashes
• Liver function impairment
• Redness and burning sensation in the eyes
• Inflammation of the outer layer of the eye (Episcleritis)
• Inflammation of the eye lens (Iritis)
• Joint pain and swelling (Erythema nodosum)

What Are Other Diseases That Ulcerative Colitis Can Cause?

It is known that untreated or delayed treatment of ulcerative colitis increases the risk of colon cancer.

• Thickening of the colon wall
• Formation of holes in the colon wall
• Bleeding in the intestine, sometimes visible in the stool
• Excessive water loss due to diarrhea
• Sepsis, caused by bacteria or toxins in the bloodstream, negatively affecting the immune system
• Certain liver disorders
• Increased risk of clotting
• Inflammation of the joints located between the spinal vertebrae

How Is Ulcerative Colitis Diagnosed?

If symptoms appear, it is necessary to consult the relevant doctor. The doctor will take the patient's medical history and perform a physical examination. Afterward, the doctor may request certain tests if deemed necessary. Some possible tests include:

• Blood tests: These tests help determine whether the patient has anemia or inflammation.
• Stool sample tests: These detect bleeding that might not be visible in the stool but occurs in the intestines. This test allows the doctor to detect different infections or parasites in the colon for treatment.
• Flexible sigmoidoscopy: This procedure involves inserting a light and imaging camera through the rectum to view the lower part of the colon. If necessary, a small sample may be taken for biopsy from the lower section of the colon.
• Colonoscopy: Unlike flexible sigmoidoscopy, this method allows the examination of the entire colon, not just the lower part. During this procedure, a blue dye may be sprayed to identify areas affected by ulcerative colitis. This procedure is called chromoendoscopy.
• X-rays: Although rarely used in the diagnosis of ulcerative colitis, X-rays may be employed. Before an X-ray, the patient's intestines must be cleared with a barium enema for better imaging accuracy.

How Is Ulcerative Colitis Treated?

The treatment for ulcerative colitis, like other diseases, may vary depending on the type of disease, the severity of its course, the symptoms, the patient's current health condition, medications previously used and currently being used, potential side effects of the medications to be used, the patient's preference, and the cause of the disease. The goal of this treatment is to alleviate the symptoms and prolong the remission period, known as the quieter phase of the disease.

Ulcerative Colitis Medications: Depending on the severity of the disease, these medications can be used alone or in combination. The treating physician decides on the appropriate treatment method.

• Corticosteroids: These reduce inflammation in the colon caused by the disease, helping to alleviate symptoms.
• Corticosteroid enemas and foams: These help reduce adverse effects in the rectum area.
• Sulfasalazine: This medication has some side effects, including skin rashes, headaches, stomach pain, nausea, and anemia. In men, it may temporarily reduce sperm count. Therefore, if the patient plans to have children, it is important to inform the doctor.
• 5-ASA group medications: Side effects such as diarrhea, headaches, and skin rashes may occur, but these are very rare.
• Azathioprine: This affects the immune system and prevents the disease from becoming active again in the long term.
• Antibiotics: Certain antibiotics are effective in treating inflammation in the areas surrounding the rectum.