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Inflammatory Bowel Disease - Ulcerative Colitis 

Introduction
Ulcerative colitis is a type of inflammatory bowel disease (IBD). It causes inflammatory damage in the lining of the rectum and colon. The primary symptoms of ulcerative colitis include abdominal pain, rectal bleeding, and diarrhea. The cause of ulcerative colitis is unknown. It is a chronic condition, and repeated episodes can be expected. Ulcerative colitis is treated with medications and/or surgery.

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Anatomy
Your body absorbs nutrients and removes waste products via your digestive system. Whenever you eat and drink, food travels through your digestive system for processing. As water from the waste product is absorbed, the product becomes more solid and forms a stool or feces. It is eventually eliminated from your body when you have a bowel movement.
 
After you swallow food, it moves through your esophagus and into your stomach. Chemicals in your stomach break down the food into a liquid form. The processed liquid travels from your stomach to your small intestine. Your small intestine breaks down the liquid even further so that your body can absorb the nutrients from the food you ate. The remaining waste products from the small intestine travel to the large intestine.

Your large intestine, also called the large bowel or colon, is a tube that is about 5 feet long and 3 or 4 inches around. The lower GI tract is divided into sections, including the cecum, ascending colon, transverse colon, descending colon, sigmoid colon, rectum, anal canal, and anus. The appendix is located on the cecum, but it does not serve a purpose in the digestive process. 
 
The first part of the colon absorbs water and nutrients from the waste products that come from the small intestine. As the colon absorbs water from the waste product, the product becomes more solid and forms a stool. The large intestine moves the stool into the sigmoid colon, where it may be stored before being traveling to the rectum.
 
The rectum is the final 6-inch section of your digestive tract. No significant nutrient absorption occurs in the rectum or anal canal. From the rectum, the stool moves through the anal canal. It passes out of your body through your anus when you have a bowel movement. 

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Causes
Ulcerative colitis is a type of inflammatory bowel disease (IBD). It causes inflammatory damage to the lining of the intestinal tissue. Ulcerative colitis originates in the rectum but can involve the entire large intestine. It usually develops in the sigmoid colon as well. 
 
Ulcerative colitis that predominantly affects the rectum is called proctitis. Extensive colitis or pancolitis refers to ulcerative colitis that extends throughout the entire colon. Generally, severity is associated with the amount of the colon that is affected. 
 
The cause of ulcerative colitis is unknown. Researchers suspect that in select people, the immune system overreacts to normal bacteria in the intestine and causes inflammation. Further, researchers suspect that bacterial or viral diseases may contribute to the development of ulcerative colitis.
 
It appears that the cause may involve an inherited genetic factor. In particular, it occurs more commonly in people of Jewish ancestry. Ulcerative colitis is more common in people between the ages of 15 and 25, and between the ages of 55 and 65, although it may occur at any age. 

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Symptoms
Ulcerative colitis is a chronic condition, and repeated episodes may be expected.  Symptoms may appear gradually or suddenly. The primary symptoms of ulcerative colitis include diarrhea, rectal bleeding, and abdominal pain. Your pain may go away after a bowel movement. There may be blood and mucus in your diarrhea. In severe cases, some people have very frequent diarrhea.
 
You may experience tenesmus. Tenesmus is a condition that causes persistent nonproductive spasms of the rectum and bladder. It can cause you to feel like you need to urinate or have a bowel movement. You may also develop a fever, lose weight, and lose your appetite. Nausea, joint pain, and skin rashes may also occur. 
 
Repeated episodes of ulcerative colitis can lead to the development of scar tissue and a thickened lining of the colon and rectum. Eventually tissue may die or become infected.
 
People with ulcerative colitis have an increased risk of colon cancer. The risk for colon cancer increases with each decade that the ulcerative colitis is present.

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Diagnosis
Your doctor can start to diagnose ulcerative colitis after reviewing your medical history and by conducting a physical examination. You should tell your doctor about your symptoms and risk factors.
 
Your doctor may order blood tests, stool tests, and imaging tests to help confirm the diagnosis and rule out other conditions with similar symptoms. Imaging tests may include a colonoscopy and barium enema. Ulcerative colitis can be confirmed with a tissue sample biopsy.
 
A colonoscopy is a procedure that uses a colonoscope to view the inside lining of the entire colon. A colonoscope is a long thin tube with a light and a viewing instrument that sends images to a monitor. The colonoscope allows a doctor to examine the inside of your colon for cancer, polyps, and disease. A tissue sample or biopsy can be taken with the colonoscope. You will receive medication to relax you prior to the test.  The biopsy is a painless procedure.
 
A lower gastrointestinal (GI) series or barium enema test provides a series of X-ray images of the large intestine. A barium enema is commonly used to screen for colon cancer and bowel diseases. 
 
Prior to taking X-rays, barium, a chalky substance, and air are used to fill and expand the colon. The barium reveals the bowel’s shape and position on the X-ray images. A barium enema is a procedure that is performed at a doctor’s office or a hospital’s radiology department.  

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Treatment
The treatment goals for ulcerative colitis are aimed at controlling current episodes, preventing future episodes, reducing inflammation, and healing the colon. There are several medication options your doctor may offer. 
 
Mild ulcerative colitis may be controlled with medications or simply changes to your diet. Moderate to severe cases may require prescription medications or a hospital stay. In some unresponsive cases, surgery may be offered to remove the colon. The procedure eliminates the ulcerative colitis and chance of developing colon cancer.
 
If the colon is removed, an opening is created in the abdomen for the collection of fecal matter or the small intestine is connected to the anus to achieve normal bowel functioning.
 
The experience of ulcerative colitis can be an emotional process for people with the condition and their loved ones. It is important that you receive support from a positive source.
 
Some people find comfort in their family, friends, co-workers, and church. Support groups are another good option. They can be a good source of information and support from people who understand what you are experiencing. Ask your doctor for support group locations in your area.

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Prevention
Because the cause of ulcerative colitis is unknown, prevention is also unknown.  However, because ulcerative colitis can lead to colon cancer, people with the condition should be screened for colon cancer on a regular basis as determined by their physician.

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Am I at Risk

Because the cause of ulcerative colitis is unknown, specific risk factors are difficult to identify. It appears that ulcerative colitis may have an inherited component in select families. It appears to occur more frequently in people of Jewish ancestry and less commonly in African Americans. You should tell your doctor about your possible risk factors and discuss your concerns.

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Complications
There are several complications associated with ulcerative colitis. Repeated episodes of ulcerative colitis can lead to the development of scar tissue and a thickened lining of the colon and rectum. Eventually tissue may die or become infected.
 
In severe cases, inflammation and thickening causes the colon wall to expand to beyond its normal size. This condition is called toxic megacolon and requires emergency medical treatment. Other complications associated with ulcerative colitis include joint pain, eye lesions, mouth ulcers, skin rashes, and liver disease.
 
People with ulcerative colitis have an increased risk of colon cancer. The risk for colon cancer increases with each decade the ulcerative colitis is present. You should establish regular screening for colon cancer. 

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This information is intended for educational and informational purposes only. It should not be used in place of an individual consultation or examination or replace the advice of your health care professional and should not be relied upon to determine diagnosis or course of treatment.

The iHealthSpot patient education library was written collaboratively by the iHealthSpot editorial team which includes Senior Medical Authors Dr. Mary Car-Blanchard, OTD/OTR/L and Valerie K. Clark, and the following editorial advisors: Steve Meadows, MD, Ernie F. Soto, DDS, Ronald J. Glatzer, MD, Jonathan Rosenberg, MD, Christopher M. Nolte, MD, David Applebaum, MD, Jonathan M. Tarrash, MD, and Paula Soto, RN/BSN. This content complies with the HONcode standard for trustworthy health information. The library commenced development on September 1, 2005 with the latest update/addition on April 13th, 2016. For information on iHealthSpot’s other services including medical website design, visit www.iHealthSpot.com.