COLITIS, ULCERATIVE (Granulomatous Colitis)

General Information

DEFINITION--A serious, chronic, inflammatory disease of the colon characterized by ulceration and episodes of bloody diarrhea. The ulcerated areas are inflamed and may form abscesses in the lining of the large intestine. Ulcerative colitis may be confused with some bacterial infections of the colon.

BODY PARTS INVOLVED--Rectum; large bowel.

SEX OR AGE MOST AFFECTED--May occur at any age, but most common in women between ages 15 and 40.

SIGNS & SYMPTOMS

Early symptoms include:

• Pain in the left side of the abdomen that improves after bowel movements.
• Episodes of bloody diarrhea with mucus, alternating with symptom-free intervals.

During an acute attack:

• Increased bloody diarrhea (up to 10 to 20 bowel movements a day).
• Severe cramps and pain around the rectum.
• Sweating; dehydration.
• Nausea; appetite and weight loss.
• Bloated abdomen.
• Fever as high as 104F (40C).

CAUSES--Unknown. Genetic, infectious, immunologic and psychologic factors have all been suggested.

RISK INCREASES WITH

• Family history of ulcerative colitis.
• Stress, alcohol and certain diets seem to aggravate symptoms.

HOW TO PREVENT--No specific measures.

What To Expect

DIAGNOSTIC MEASURES--

• Medical history and exam by a doctor.
• Laboratory stool and blood studies.
• X-ray of the colon (barium enema).
• Sigmoidoscopy (See Glossary).
• Biopsy of the colon lining.

APPROPRIATE HEALTH CARE

• Self-care after diagnosis.
• Doctor's treatment.
• Psychological counseling.
• Surgery to remove the diseased colon (some-times). See Colostomy (in Surgery section.
• Hospitalization during worst episodes.

POSSIBLE COMPLICATIONS

• Life-threatening blood loss, ulceration through the intestinal wall or peritonitis during acute attacks.
• Malnutrition, wasting of the body or chronic disability.
• Inflammation of joints, eyes and skin.
• Colon cancer; the risk is greater in persons with ulcerative colitis.

PROBABLE OUTCOME--Often curable with counseling and medical treatment or surgery. If not curable, symptoms can be controlled with treatment.

How To Treat

GENERAL MEASURES--

• To reduce cramps, apply a hot-water bottle, warm moist towels or heating pad to the abdomen or try taking a hot bath.
• Quit smoking. Ask your doctor for recommendations for cessation program.
• Try to reduce stress (see How to Cope With Stress in Appendix).
• See Resources for Additional Information.

MEDICATION--

• Don't use aspirin. It increases bleeding risk.
• Your doctor may prescribe: Antidiarrhea medication for minimal symptoms. Sulfa drugs, such as sulfasalazine, for moderate symptoms. Medicated enemas (usually with hydrocortisone). Cortisone drugs for severe disease.

ACTIVITY--Bed rest may be necessary during acute attacks. However, resume normal activity as soon as symptoms improve.

DIET--

• Vitamin and mineral supplements may be needed.
• If abdominal cramping, eat canned or cooked fruits and vegetables (skin on foods can be abrasive). Avoid raw fruits and vegetables.
• If diarrhea present, avoid roughage in diet and intestinal irritants (spicy foods, caffeine, alcohol).
• Iron replacement may be necessary.
• Avoid milk products if you have a lactose intolerance.
• Keep a food diary to discover which foods may trigger symptoms. Don't eat those foods.

Call Your Doctor If

• You have symptoms of ulcerative colitis.
• Fever and chills develop.
• Frequency of bowel movements or bleeding increases.
• Abdomen becomes distended.
• Jaundice (yellow eyes and skin and dark urine) develops.
• Vomiting begins or abdominal pain increases.