Ulcerative Colitis : 101

     I know I have blogged about my story with colitis, but now it's time to explain. I always get questions about what exactly ulcerative colitis is and honestly there is too much to tell. I've always been told not to look up a medical issue is online because they say the worst of the worst and cause paranoia to those who don't have it. Here, I will filter what is, but be cautious of disgusting content, be thankful you don't live with it, but if you do... I understand and I am sorry. However, if you or someone you love has colitis is it about time you start learning what it is. If you understand what it is, it will help you understand what they go through. When someone with colitis is complaining about their stomach hurting, you better believe it is. The pain is almost indescribable.

What Is It?
     Ulcerative colitis is a chronic disease of the large intestine, also known as the colon, in which the lining of the colon becomes inflamed and develops tiny open sores, or ulcers, that produce pus and mucous. The combination of inflammation and ulceration can cause abdominal discomfort and frequent emptying of the colon. Patients with UC have a higher chance of getting colon cancer. 

What Causes It?
There is not a known cause for ulcerative colitis, but there are three factors that play into it. 

1. Genetic Predisposition 
2. Immune System
3. Environmental Triggers (viruses and bacteria)    

What it Feels Like 
     I will try not to make this morbid. But ladies, imagine having menstrual cramping after almost every time you ate. That's what UC feels like. Sometimes people with UC will go to the bathroom and pass nothing but blood. Other times, they will go without bowel movement for weeks. UC is humiliating when starting out with rectal exams and dealing with flare ups in public. Not to mention taking suppositories every night. Increased stress levels cause bowel movements to become even more abnormal than usual and that happens often. 


Signs and Symptoms 

• bowel movements become looser and more urgent
• persistent diarrhea accompanied by abdominal pain and blood in the stool
• stool is generally bloody
• crampy abdominal pain - stronger on the left side (where the colon is) 
• loss of appetite and loss of weight 
• low energy and fatigue 
• As the intestinal lining becomes more inflamed and ulcerated, it loses its ability to absorb water from the waste material that passes through the colon. That leads to a progressive loosening of the stool - diarrhea. The damaged intestinal lining may be producing a lot of mucus in the stool. Ulceration in the lining also causes bleeding. That loss of blood may lead to a low red blood cell count, called anemia.
• urgency to have to use the restroom 

Signs Outside the GI Tract 

• eyes (redness, pain, and itchiness)
• mouth (sores)
• joints (swelling and pain)
• skin (tender bumps, rashes)
• bones (osteoporosis)
• kidney stones

People with ulcerative colitis (UC) typically do not experience all of these symptoms. 

Treatments

 There are very effective treatments available that may control UC and even place it into remission. Remission? I thought that was just for people with cancer. False. In between flares, people may experience no distress at all. These free periods, remission, can span months or even years, although symptoms typically do return eventually. Let's get one thing straight; there is no "One size fits all" treatment. Treatment is altered based on the individual because each person's disease is different. 

• Aminosalicylates - These are drugs that work on the lining of the GI tract to decrease inflammation. 
• Corticosteriods - Medications that affect the body's ability to launch and maintain an inflammatory process. They also work to keep the immune system in check. These medications do come with many side effects so they are not used for long-term or to maintain the disease. 
• Immunomodulators - These medications regulates the body's immune system response so it cannot cause ongoing inflammation. These are used when the first two medications are not effective. However, they may take a while to begin working. 
• Biologic therapies - 

1. Remicade (Infliximab) - This can help with lasting symptom control and healing of intestinal lining as early as 8 weeks. Now that all sounds fabulous, but there are many risks and side effects. This can act like chemotherapy in the sense that it lowers the ability to fight simple infections. 
2. Natalizumab (Tysabri) - This is also inserted into the body through an IV. It is an antibody thought to inhibit types of white blood cells that are involved in the inflammatory process. It is given every 4 weeks. 

This is getting boring. There are many treatment options for a patient with UC. 

     Food and Nutrition 

     If you are close with someone that has UC it is important for you to know what is good and what is bad for someone with UC. There are some things that trigger bowel movements and aching that others don't. If you have UC, it is important to find what works best for you (special diets) and what hurts your stomach. 

• Reduce the amount of greasy/fried foods. These may cause diarrhea and gas.
• Eat smaller meals at more frequent intervals.
• Limit consumption of milk products
• Avoid carbonated beverages - causes gas
• Restrict caffeine when one has diarrhea - caffeine can act as a laxative. 
• Restrict your intake of certain high-fiber foods (nuts, seeds, corn, and popcorn) They may cause diarrhea. 

Diets 

• low-salt - during corticosteroid therapy to reduce water retention
• low-fiber - avoid stimulating bowel movements
• low-fat 
• lactose-free 
• high-calorie - for those who are experiencing weight loss
• gluten-free 

     It is recommended that someone with UC keeps a food diary. By doing so, one will figure out what foods help and hurt bowel movements. It is also effective to keep a calender that one would record their bowel movements on. By doing so, it helps one to explain to their doctor what is wrong and how they are feeling. It will help determine what treatment is appropriate. 

     Surgery is an option for people that have severe UC or to take care of various complications. These include severe bleeding from deep ulcerations, rupture of the bowel, and toxic megacolon. Surgery is mostly only used when the treatments involving medicine did not work. 

     During surgery, the patient's colon will be removed and that means that the patient is cured of UC! However, since UC is an autoimmune disease, some symptoms that were occurring before surgery will still happen after surgery. The buzz kill about surgery is that after surgery the patient will have an external pouch that waste is emptied into that is attached to the abdominal wall. 

     The thing that people don't understand is that UC is a chronic disease, meaning that one will have it forever. There will be times of remission, but UC does not go away without the removal of the colon. UC still doesn't have a cure. Studies have been done, but none have succeeded. UC is not an easy thing to live with.