What is ulcerative colitis?
Ulcerative colitis (UC) is a type of inflammatory bowel disease (IBD). UC is a condition that causes inflammation in the bowel (also called the large intestine or colon) of your gastrointestinal (GI) tract. Inflammation is when part of your body gets red, swollen and painful.
It is important that both words, "ulcerative" and "colitis" be used, when speaking to a health care provider. The term ulcerative is used because there are small breaks, called ulcers, in the lining of the colon when the disease is active. Colitis refers to inflammation of the colon. When a child has active UC, symptoms like diarrhea, rectal bleeding and abdominal pain can result.
The other main type of IBD is called Crohn's Disease (CD). CD and UC are very similar, but are not exactly the same. In CD, inflammation can happen anywhere along the GI tract, from the mouth to the anus. Symptoms depend on which part of the GI tract is inflamed. Your doctor will ask you questions and perform certain tests in order to tell the difference between CD and UC, and will suggest treatments based on which form of IBD you have. You can get either type of IBD at any age.
There are over 5,900 children under 18 years old in Canada with IBD right now. When it is too difficult to tell whether a patient has CD or UC, their IBD is classified as IBD-U. The "U" stands for unclassified; IBD-U may also be called indeterminate colitis.
Where does ulcerative colitis happen?
UC occurs only in the colon. In UC, inflammation is continuous. This means that ulcers occur consistently in part of the colon. UC can occur as pancolitis (the entire colon), left sided (rectum, rectum to sigmoid or rectum to descending colon) or right sided (ascending colon). Knowing where you have inflammation can help you and your doctor to understand your symptoms and choose the right treatment.
What does ulcerative colitis feel like?
Someone with UC can have many different symptoms, like stomach pain, diarrhea, blood passed from the anus, urgency to go to the bathroom, weight loss, fatigue and decreased appetite. They can less commonly have fevers, joint pain, certain skin rashes and redness of the eyes. Some people may have just a few of these symptoms while others may experience them all.
UC is a chronic condition; this means that it is for life. Although there is currently no cure, there are a lot of treatment options. When you find one that helps to keep your UC under control, you can be in remission (that means symptom-free) for a long time.
What causes ulcerative colitis?
Even though there have been many scientific studies, researchers do not yet know what causes UC. They do know that it can run in families. You are more likely to get UC if one of your first-degree relatives, like a brother or sister, has it. You are even more likely to get it if that brother or sister is your identical twin. Anyone can get UC at any age. In children, it occurs slightly more often in boys. In teens, it occurs more often in girls.
Researchers think UC is caused by a combination of three things:
- Genetics: Some people may have genes in their body that increase their chances of getting UC. Studies have shown that there are over 30 genes that may be linked with IBD.
- Environment: Our environment includes anything our body comes in contact with. Infections and food are the most common types of environmental "triggers" that may contribute to disease, but there may be others.
- Immune system: Our immune system protects us from harmful bacteria and viruses, but in some people, it can cause inflammation in the body (like in the GI tract).
What kinds of treatments are there?
There are five classes of medicines used to treat the symptoms of UC (see below). These medicines can come in the form of pills, liquids, intravenous, and suppository or enema. Check with your child's health care provider to learn more about their medications. Some people might also consider UC surgery.
The different types of medication used to treat UC are:
- 5-aminosalicylic Acid (5-ASA): Used for milder forms of UC, 5-ASA decreases inflammation in the intestinal tract. It can be taken orally (by mouth) or rectally.
- Immunomodulators: Used for long-term treatment, these drugs work by suppressing the immune system to help reduce inflammation. Immunomodulators may also help patients stay in remission. They are not intended for acute flare-ups. Immunomodulators are given orally.
- Steroids: These drugs are used for moderate-to-severe UC for a short period of time to help decrease the amount of inflammation in the body. They can be taken orally, intravenously or rectally.
- Antibiotics: Antibiotics are generally effective for UC patients with an abscess, a fistula or an infection. They can be given orally or intravenously.
- Biologics: These drugs inhibit specific substances in the body to reduce inflammation. They are often administered intravenously. Anti-TNFs are a type of biologic drug.