ulcerative colitis - canadian digestive health foundation
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Understanding ULCERATIVE COLITIS
What is ulcerative colitis?
Ulcerative colitis is a chronic disorder affecting the large
intestine (colon). The digestive system (including the
stomach, small and large intestines) converts food into
nutrients and absorbs them into the bloodstream to fuel
our bodies. The colons main role is to absorb water and
salts from undigested food waste. This action helps to
thicken and solidify the stool, which is then expelled from
the body through the anus.
Ulcerative colitis causes inflammation (redness and
swelling) and ulceration (sores) along the lining of the
colon which can lead to abdominal pain, cramps, bleeding
and diarrhea. The disease usually begins in the rectal
area, which holds stool until you go to the bathroom, and
may involve the entire colon over time. Ulcerative colitis
is classified as an inflammatory bowel disease (IBD), due
to the inflammation that occurs in the intestines. Another
common form of IBD is called Crohns disease. Although
the symptoms of ulcerative colitis are similar to Crohns
disease, the conditions are different in several ways.
While both ulcerative colitis and Crohns disease are
types of IBD, they should not be confused with Irritable
Bowel Syndrome (IBS), a disorder that affects the muscle
contractions and the sensitivity of the colon. Unlike
ulcerative colitis and Crohns disease, IBS does not cause
intestinal inflammation nor damage the bowel.
FEATURE ULCERATIVE COLITIS CROHNS DISEASELocation of inflammation Limited to the large intestine (colon and
Anywhere in the GI tract (from the
gums to the bum)
Pattern of inflammation Inflamed areas are continuous with no
Patches of inflammation can be found
between healthy sections of bowel
Appearance of inflammation Ulcers penetrate the inner lining of the
Ulcers can penetrate the entire thickness
(several layers) of the intestinal lining
Location of pain Typically in the lower left abdomen Typically in the lower right abdomen
Bleeding Common during bowel movements Uncommon
Ulcerative colitis Crohns disease
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Canada has one of the highest rates of IBD in the world. It
is estimated that more than 230,000 Canadians suffer from
IBD with over 4,500 new cases of ulcerative colitis and 5,700
new cases of Crohns disease being diagnosed every year.
The number of people with IBD has been rising, particularly
since 2001, and significantly so in children under the age of
10. An estimated 5,900 Canadian children have IBD and 20-
30% of people diagnosed with IBD develop the condition
before the age of 20.
In Canada, the economic and health-care related costs of
IBD are estimated to be $2.8 billion annually. Direct medical
costs (medications, hospitalizations, physician visits) total
in excess of $1.2 billion per year. Causing frequent work
and school absenteeism, IBD can significantly erode an
individuals productivity and quality of life. Many people
develop IBD during the peak years of productivity and
What are the symptoms of ulcerative colitis?
The most common symptoms of ulcerative colitis are
abdominal pain, diarrhea, blood in the stool and false urges
to have a bowel movement.
Abdominal pain (cramping): Ulcerative colitis pain
can be felt anywhere throughout the abdomen, but it is
typically located in the lower left side.
Diarrhea: Diarrhea (frequent, loose or watery stools)
can range from mild to severe and, in some cases, may
involve as many as 20 or more trips to the bathroom a
Blood and/or mucus in the stool: Ulcers may form
where inflammation has damaged the intestinal lining.
These areas bleed and produce pus and mucus, which
may appear in the stool.
False urges to have a bowel movement: The urge
to have a bowel movement may arise frequently, even
though there is little stool to pass. This urge is caused by
inflammation of the rectum.
Other symptoms of ulcerative colitis may include:
Weight loss Anemia
Ulcerative colitis may also cause inflammation problems
outside of the gut, leading to joint pain, eye irritation, skin
rashes, kidney stones, liver disease, and poor growth in
The symptoms of ulcerative colitis vary, depending on the
extent of inflammation. At times, the pain and discomfort
of ulcerative colitis may be severe and debilitating, and
at other times, symptoms may improve or even disappear
What causes ulcerative colitis?
The exact cause of ulcerative colitis is unknown. However, it
is believed to be due to a combination of factors, including
a persons genes (inherited traits) and triggers in the
environment. This interaction of genetic and environmental
factors activates an abnormal response of the bodys
Normally, the immune system protects the body from
infection. In people with ulcerative colitis, however, the
immune system can mistake microbes (such as bacteria
that are normally found in the intestines), food, and other
material in the intestines, as invading substances. When
this happens, the body
launches an attack,
sending white blood
cells into the lining of the
intestines where they
Illustration of normal intestine (left) and intestine with ulcerative colitis (right)
Normally, the immune system protects the body from infection. With IBD, the immune system can cause serious damage.
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o Flexible sigmoidoscopy:
A slim, flexible tube
with a light and a tiny
camera is guided through
the rectum into the colon.
The sigmoidoscope allows
your doctor to examine
the lining of the lower part
of the colon only.
o Colonoscopy: In a procedure similar to a flexible
sigmoidoscopy, a flexible scope allows your doctor
to view the lining of
both the upper and
lower parts of the colon.
o Barium enema: A small tube is placed in the rectum and filled with barium liquid and air. Barium
coats the lining of the colon and rectum so they can
be seen on an X-ray, allowing your doctor to see
areas of damage or inflammation.
o CT (computerized tomography) scan: A CT scan produces cross-sectional X-ray images of the
abdomen and pelvis to help diagnose ulcerative
colitis and rule out other possible disorders and
o MRI (magnetic resonance imaging) scan: An MRI is similar to a CT scan, but it does not use X-rays
to capture an image. An MRI uses magnetism, radio
waves, and a computer to produce highly-detailed
images of the body. It offers an extremely accurate
method of detecting inflammation and disease in
the colon and throughout the body.
Age: Ulcerative colitis may affect any age group,
although there are peaks at ages 15 to 30 years, and
again at ages 50 to 70 years.
Race/ethnic background: Ulcerative colitis is more
common among whites than non-whites and in people of
Ashkenazi Jewish descent.
Family history: People with a first-degree relative
(parent or sibling) with ulcerative colitis are at greater
risk of developing the condition.
How do I know if I have ulcerative colitis?
Often, symptoms alone can provide doctors with the
information they need to diagnose ulcerative colitis. Your
doctor will perform a physical examination and take a
complete medical history that includes a careful review of
your symptoms. For this reason, it is important to be candid
and specific with your doctor about the problems you are
There is no one specific laboratory test, X-ray or scope to
diagnose ulcerative colitis, however, to help confirm the
condition and rule out other problems, your doctor may
send you to have one or more of the following tests:
Blood tests: Blood tests can help to identify anemia (low
blood count), infection and inflammation.
Stool sample tests: A stool analysis can detect blood in
the stool and rule out infection, malabsorption, parasites
and other digestive problems.
Imaging tests: Your doctor may order tests to see your
lower digestive organs. These safe tests can help to
diagnose ulcerative colitis or Crohns disease and identify
other problems such as ulcers, polyps (growths on the
lining of the intestines) and
colon cancer. A sample of
the lining of the intestine
(biopsy) may be taken to
examine under a microscope.
It is important to
be candid and specific with your doctor.
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How is ulcerative colitis treated?
There is no cure for ulcerative colitis at the present time, however, there are effective treatments available that may control your disease and even place it into remission. Remission means that your symptoms disappear completely. Y