All About UC

As discussed briefly in this previous post, Ulcerative Colitis (UC) is the less severe form of IBD, and generally affects only the inner lining of the large intestine, i.e. the colon and rectum. Essentially, UC causes the lining of the large bowel to become inflamed and develop small sores or ulcers, as discussed here. The main symptoms of UC include diarrhoea, abdominal pain, blood in the stool, loss of appetite, and fatigue.

This week, I would like to discuss UC in more detail and draw comparisons to Crohn’s Disease, and in turn share some of what I have recently learned myself about both of these conditions.

DIFFERENT TYPES OF UC

In my research, I have recently come across some information that surprised me: there are actually four different types of UC. These are ulcerative proctitis, proctosigmoiditis, left-sided colitis, and pan-ulcerative or total colitis. Ulcerative proctitis affects only the lining of the rectum, and is milder than the other types. Ulcerative proctitis is the most common form of UC, as approximately 30% of people with UC have this type. Proctosigmoiditis involves inflammation of the rectum and sigmoid colon, and symptoms include bloody diarrhoea, cramps (particularly on the lower left side of the abdomen) and a sense of urgency with bowel movements.

Similarly, left-sided colitis also includes pain in the left side of the abdomen, and this is because with this type of UC, the inflammation extends from the rectum and up the left side of the colon, up to the spenic fixture. Left-sided colitis is the next severe form of UC, with additional symptoms such as loss of appetite and weight loss. Finally, pan-ulcerative or total colitis is the most severe form of UC, as it affects the entire colon. This type is also the most dangerous, as it can lead to massive bleeding and a condition called toxic megacolon. With pan-ulcerative colitis, people can experience severe abdominal pain and extensive weight loss, and may require surgery.

From the descriptions I have read, I believe that I have ulcerative proctitis, as my symptoms are generally quite mild, and I have not had any pain in my left side.

Do you know which type of UC you have? Comment below.

SOME OTHER FACTS ABOUT UC

Here is a list of other interesting facts about UC that I have read about recently:

• Diagnosis of UC: Apart from a colonoscopy, UC can also be diagnosed using a barium enema, but this method is less accurate.
• UC and sleep: Studies have shown that it is important to have the right amount of sleep and a good sleep schedule to prevent flares. According to an April 2014 study, women who have less than six hours or more than nine hours of sleep are more at risk of having UC flares.
• UC and pregnancy: Although fertility rates may be reduced after having a colectomy, pregnancy is still possible after surgery, and the pregnancy can actually help improve symptoms. This is something that I was very glad to read about, as it is something I worry about occasionally, especially as children could be a reality for me in the next 5 years. However, if you have had a colectomy, it is suggested that you wait a year before conceiving, as this will help avoid post-surgery complications.
• UC and genetics: Studies have shown that there are genetic links with UC: It can run in families, and is more common in certain ethnic groups. I have tried to work out if there are links to IBD in my family, and may have found some tenuous links in my father’s side of the family.
• UC and food: Although some foods can make UC worse, diet does not cause UC. Instead, researchers believe that UC can be caused by a combination of genetics and environmental triggers, but this is still uncertain.
• Other symptoms of UC: UC can also manifest in other areas of the body, with symptoms including eye inflammation, inflammation of the liver, bone thinning, kidney stones, joint pain, skin rashes and mouth ulcers. You can read more about these symptoms here and here. This was interesting for me, as I do have trouble with mouth ulcers quite regularly, despite increasing my vitamin C intake, and I now wonder if my life-long struggle with dermatitis could also be connected to my UC in some way.
• UC and smoking: Studies have shown that in fact UC is more common in non-smokers, suggesting that there may be something in cigarettes that can prevent the development of UC. Disclaimer: Please do not take this as an endorsement for smoking.
• UC and colon cancer: There is a greater risk of contracting colon cancer after 8-10 years of living with UC, particularly in those that have pan-ulcerative colitis. However, less than 10% of people with IBD develop colon cancer, so there is still a very low risk – phew!
• UC and anti-inflammatory medications: Non-steroidal anti-inflammatory drugs (NSAIDs) like ibuprofen and naproxen sodium can cause inflammation and intestinal bleeding, so it is recommended that people with IBD avoid these medications. I have actually found that ibuprofen is most effective for me when I have headaches, and have not noticed any effect on my bowel, but I will try to be more careful of this in future.
• UC and stress: Researchers in the past believed that there was a psychological component to the development of IBD, however these studies have not been confirmed. Stress can exacerbate UC symptoms, but is clearly not a cause of UC.

COMPARISON TO CROHN’S DISEASE

Based on my research, I have put together the following table to compare UC and Crohn’s Disease. I have used information from here, here and here. Note that while the causes and symptoms can be similar, there are also some very significant differences between UC and Crohn’s Disease, so it is important not to confuse the two or treat them as one condition.

Also, it is possible to have a combination of both UC and Crohn’s Disease, which is called indeterminate colitis. You can read more about this here. About 10% of cases are found to be indeterminate colitis.

*More information here: granulomas, 5-ASA medications, corticosteroids, Cimzia, Humira.