Ulcerative colitis is a long-term inflammatory condition where the large intestine (colon) and rectum become inflamed. Small ulcers can develop on the colon’s lining and can bleed and produce pus^1,2.

UC is characterised by relapsing and remitting mucosal inflammation, starting in the rectum and extending to proximal segments of the colon³.

UC is thought to be an autoimmune condition. This means the immune system mistakenly attacks healthy tissue. The exact cause of UC is unknown, but most experts think it is a combination of genetic, and environmental factors¹.

Genetics
UC tends to run in families, suggesting that genetics have a role in this disease. However, only about 10 to 25 percent of people with UC have a first-degree relative with inflammatory bowel disease⁴.

Risk factors
When a person with a genetic susceptibility is exposed to a trigger, the immune system can be activated⁴.

When this happens, the immune system recognises the lining of the colon as foreign and attacks it, leading to inflammation. In addition, UC can present after a person quits smoking. However, no single factor has been proven to be a known trigger in all situations⁴.

Clinical presentation might vary on the basis of disease extent³:

The severity of the symptoms varies, depending on how much of the rectum and colon is inflamed and how severe the inflammation is. The main symptoms of UC are diarrhoea, which may contain blood or mucus, abdominal pain (cramps), and an urgent need to empty the bowels^1,5.

Other symptoms may include increased frequency of bowel movements, inability to defecate despite urgency, loss of appetite, weight loss, fatigue and fever^1,3.

• Abdominal pain (cramps)
• Diarrhoea
• Urgency
• Fatigue

The symptoms of UC can be mild, moderate or severe, and can fluctuate over time. Periods of active symptoms are called “flares”⁴.

To diagnose UC, doctors review medical and family history, perform a physical exam, and order medical tests.

Doctors order laboratory studies, endoscopies, biopsies and imaging to exclude other health problems (such as infections, irritable bowel syndrome, or Crohn’s disease), confirm the diagnosis of UC and find out how severe it is and how much of the large intestine is affected^2,5

Endoscopies in UC

There are two types of endoscopy, both permit a doctor to directly observe the severity and extent of inflammation ^1,5.

• Sigmoidoscopy
  A doctor uses a thin, flexible tube containing a camera that is inserted into your rectum to view the lining of the rectum and the lower colon. A sigmoidoscopy can also be used to remove a small sample of tissue from the bowel (biopsy) so it can be tested in a laboratory^1,5.
• Colonoscopy
  If your UC has affected more than the colon, another examination will be required. This is known as a colonoscopy which allows the entire colon to be examined. A biopsy sample can also be taken^1,5.

Treatment choice for patients with UC is based on both the extent of the disease and the severity.
Rectal application of medical therapy, via suppository or enema, is usually appropriate for isolated distal disease (proctitis); however, a rectal application is usually used in combination with systemic therapy to help target the distal colon and therefore decrease tenesmus²

UC medicines that reduce inflammation include ⁵

• Aminosalicylates: to treat mild or moderate UC or to help people stay in remission.
• Corticosteroids: to treat moderate to severe UC and to treat mild to moderate UC in people who don’t respond to aminosalicylates.
• Immunosuppressants, biologics and related agents: to treat moderate to severe UC and help them stay in remission.

There are a few things you can do to help keep symptoms of UC under control and reduce your risk of complications such as1:

Stress relief
Although stress does not cause UC, successfully managing stress levels may reduce the frequency of symptoms.

The following advice may help¹:

• Exercise
• Relaxation techniques
• Communication

Emotional impact
Living with a long-term condition that’s as unpredictable and potentially debilitating as UC can have a significan emotional impact. In some cases, anxiety and stress caused by UC can lead to depression. If you think you might be depressed, contact your health care provider for advice¹

Dietary advice
While there is no specific type of diet that has been proven to relieve symptoms, some changes to your diet can help control the condition¹:

Eat small meals
Eating 5 or 6 smaller meals a day, rather than 3 main meals, may help control your symptoms.

Low-fibre diet
Examples of foods that can be eaten as part of a low-residue diet include white bread, white rice, nonwholegrain cereals and pasta, eggs or lean meat and fish.

Drink plenty of fluid
You can lose a lot of fluid through diarrhoea; water is the best source of fluids. Avoid caffeine, alcohol, and fizzy drinks.

Take food supplements