Ulcerative colitis is a chronic inflammation of the tissue lining the large intestine (the colon and rectum). Ulcers, or sores, develop in the outermost layer of the lining but the inflammation does not penetrate into the deeper tissue layers as it does in those with Crohn's Disease.
This condition usually develops in people between the ages of 15 and 40, but occasionally affects children and older people. Once ulcerative colitis develops, it is a chronic, lifelong condition. Most people with ulcerative colitis have periods of remission when they do not experience any symptoms, but symptoms typically return. Some people find that certain foods trigger their symptoms, and they can control the symptoms by avoiding these foods.
Diarrhea, caused by the inflammation of the colon lining, is the most common and distinctive symptom of ulcerative colitis. Ulcers that bleed and produce pus form in areas of the colon where the inflammation has killed the lining cells and can cause blood or pus in the stool.
Mild cases of ulcerative colitis usually cause few symptoms and are associated with fewer than five episodes of diarrhea a day and occasional blood or pus in the stool. More severe cases cause five or more episodes of diarrhea per day, frequent blood and pus in the stool, fever and other complications. Other symptoms include:
- Weight loss
- Loss of appetite
- Rectal bleeding
- Loss of body fluids and nutrients.
Ulcerative colitis may cause a range of other problems such as arthritis, inflammation of the eyes, liver disease, osteoporosis, skin rash, anemia and kidney stones. Ulcerative colitis probably is related to a disorder in the immune system, the body’s natural defense against infection. These complications are believed to be caused by the immune system triggering inflammation in other parts of the body, and they typically disappear when the ulcerative colitis is treated.
The most serious acute complication of ulcerative colitis is toxic megacolon, a condition in which the colon is paralyzed to the point where a bowel movement cannot occur. Left untreated, it can cause the colon to rupture and cause peritonitis, a life-threatening condition requiring emergency surgery. Symptoms of toxic megacolon include abdominal pain and swelling, fever, weakness and disorientation or grogginess.
For mild cases of ulcerative colitis, treatment with medication can be effective in reducing inflammation and controlling symptoms. Surgical removal of the colon can cure more advanced cases and can help individuals whose symptoms can no longer be controlled. An estimated 25 to 40 percent of ulcerative colitis patients eventually need surgery. Cleveland Clinic gastroenterologists work closely with colorectal surgeons to ensure that patients are referred for surgery at the appropriate time.
Cleveland Clinic colorectal surgeons consider the ileal pouch-anal anastamosis (IPAA) the optimal surgical treatment for ulcerative colitis and have performed more than 3,000 of these procedures. The operation involves removing the colon, forming an internal pouch from the small bowel and joining it to the anal muscle. Following surgery and recovery, patients have nearly normal control over bowel movements.
This is an extremely complex surgery that should be performed only by a skilled colorectal surgeon with extensive experience in treating ulcerative colitis. Following this surgery at Cleveland Clinic, the average patient has between six and eight bowel movements per day. More than 97 percent of patients are satisfied with the outcome of their operation, and the majority do not require further medical care related to the surgery, outside of routine post-operative follow-up.
Cleveland Clinic surgeons also are experienced in several other surgical treatments for ulcerative colitis for patients who cannot have the ileal pouch procedure. These options can be discussed between patient and surgeon as needed.