Ulcerative colitis is an inflammatory bowel disease (IBD) that affects the large intestine, limited to the rectum and colon.

Learn more about the disease and measures you can take to manage the symptoms.

You have just been to the doctor and received the diagnosis of ulcerative colitis, so what’s next?

There are often many questions that come up when dealing with a new diagnosis and this post will cover the basic questions and give you key information about ulcerative colitis and what to expect for the future.

The more informed you are, the better you will be able to deal with your symptoms.

Causes of Ulcerative Colitis

The exact cause of ulcerative colitis is unknown and unfortunately, this makes it very difficult to predict how the disease will affect each individual.

Some people have regular flare-ups while others can go for years without displaying any symptoms.

These symptoms can be managed and minimised using various medications, diets, and alternative treatment methods, however, it is certain that ulcerative colitis is an incurable and chronic condition.

Diagnosing Ulcerative Colitis

The only way to definitively diagnose ulcerative colitis is via an endoscopic procedure with a tissue biopsy.

Your doctor may use other less invasive types of tests beforehand to rule out other forms of inflammatory bowel disease, such as Crohn’s disease.

One or more of the following diagnostic tests may be performed to help confirm a diagnosis:

Lab tests

• Blood Tests to check for anemia (a condition in which there aren’t enough red blood cells to carry adequate oxygen to your tissues) or signs of infection.
• Stool Studies to look for the presence of white blood cells or certain proteins in your stool which can be indicative of ulcerative colitis. This test may also be used to eliminate other possible diagnoses, such as infections caused by bacteria, viruses, and parasites.

Imaging Procedures

• X-ray Imaging may be taken of your abdomen to rule out serious complications, such as a perforated colon.
• CT scanning your abdomen or pelvis may be performed if your doctor suspects a complication from ulcerative colitis. If you do have ulcerative colitis, a CT scan may also reveal how much of the colon is inflamed.
• Computerized tomography (CT) Enterography and Magnetic Resonance (MR) Enterography are non-invasive tests that can be used to exclude any inflammation in the small intestine as they are more sensitive for finding inflammation in the bowel than are conventional imaging tests.

Endoscopic Procedures

• Colonoscopy examinations allow your doctor to look at your entire colon using a thin, flexible, lighted tube with a camera on the end.  A biopsy (taking a small sample of tissue) can be done during this procedure and sent for lab analysis, which is necessary to confirm the diagnosis.

• Flexible Sigmoidoscopy examinations allow your doctor to examine the rectum and sigmoid colon — the lower end of your colon, also using a slender, flexible, lighted tube. If your inflammation of the colon is severe, your doctor may choose to do this test instead of a full colonoscopy.

Treatment and Medication Options

Chronic illnesses are ongoing and long-term, meaning they will always be with you. However, there are ways to cope with the symptoms on a day-to-day basis.

When dealing with UC, there are a variety of medications available that work towards minimising symptoms.

With the use of medications, many people can go long periods without suffering any symptoms. This is called remission.

Medications can also be prescribed early on in the diagnosis which will help to reduce the chance of developing further complications down the line.

There are two goals when it comes to treatment for UC. The first is to achieve remission and the second is to maintain that state.

In the process of achieving remission, the goal is to decrease the severity of symptoms and increase the quality of life until remission can be reached.

Treatment

Ulcerative colitis treatment typically involves either drug therapy or surgery, and only surgery when the disease is very severe.

Depending on the severity of your condition, there are several categories of drugs that may be effective in treating ulcerative colitis.

The condition affects each individual differently, so there is no one-size-fits-all medical option and it may take some trial and error with the support of your doctor to find a medication that helps you.

Anti-Inflammatory Drugs: These are often the first step in the treatment of ulcerative colitis and are appropriate for the majority of people with this condition.

These drugs include 5-aminosalicylates such as Asacol or Pentasa, and corticosteroids. These can be given orally and or rectally.

 Immune system Suppressors: These drugs also work to reduce inflammation, but they do so by suppressing the immune system response that starts the process of inflammation.

In some instances, your doctor may prescribe a combination of these drugs rather than one single medication.

If the immunosuppressant drugs don’t appear to be effective, your doctor may then prescribe Biologics.

 Biologics: These drugs work at a cellular level to decrease the inflammation.

These therapies include Infliximab, adalimumab, Vedolizumab, the former two are also have biosimilars that are currently registered in South Africa for the treatment of Ulcerative Colitis.

The above biologics are given as an infusion or subcutaneous injection.

Tofacitinib is a newly registered in South Africa, for the treatment of Ulcerative Colitis, and it is taken as a twice daily tablet.

Patients that have previously had shingles or blood clots should not be taking Tofacitinib.

 Other Medications: In addition to controlling inflammation, some medications may help relieve symptoms.

Always talk with your doctor before using over-the-counter medications, but they will be able to guide you to the correct symptom relief medications such as antidiarrheals, pain relievers, antispasmodics, or iron supplements.

 Surgery: If medications do not effectively control your symptoms and achieve remission, your Gastroenterologist may recommend surgery.

This can eliminate ulcerative colitis and may involve removing your entire colon and rectum (proctocolectomy).

Surgery is considered to be a last resort, after the other treatment options have not succeeded.

Even with treatment and reaching remission, one can experience flare-ups of inflammation again at any stage. This would indicate that you and your doctor may need to look at changing medications or adjusting doses.

You will need medical care for as long as your Gastroenterologist deems necessary, and regular visits to monitor your condition are recommended.

Managing Your Symptoms

Medications prescribed by your doctors are the most effective way to ensure that you minimise the risk of flare-ups.

However, one can supplement this and speed up the process of healing by dealing directly with some of the symptoms you may be experiencing, while the prescribed medications have a chance to take effect and reach remission.

In between flare-ups, most people feel completely stable and can be tempted to stop taking prescribed medication.

Please continue taking ALL your prescribed medication for as long as your Gastroenterologist deems it necessary.

Even with your prescriptions, you may experience occasional diarrhea, cramping, nausea, and fever – especially early on in your diagnosis.

In these instances, your doctor or pharmacist should be able to direct you to some over-the-counter options that will assist with decreasing the severity of these symptoms.

Eating Habits and UC Diets

There is no single diet or eating plan that can be applied to everyone who suffers from ulcerative colitis.

Once the disease is diagnosed, being conscious of your eating habits may help you to manage and reduce symptoms, replace lost nutrients, and promote overall improved health and healing.

There are no known foods that will specifically aggravate inflammation of ulcerative colitis, but certain foods do have the potential to increase inflammation and worsen symptoms.

If you are unsure of what foods might help or hinder your recovery, it might be valuable to keep a food diary that will allow you to track the relationship between your diet and your symptoms and flare-ups.

The Way Forward

Once you’ve met with a doctor and settled on a treatment programme, it may also be constructive to connect with others who are experiencing the same things as you.

Creating a strong support system could prove helpful, especially if your symptoms are more severe.

Join our current Ulcerative Colitis Trial here to explore your condition and treatment options now!