Signs And Symptoms Of Ulcerative Colitis - A Disorder Of Large Intestines
Ulcerative colitis is a chronic, recurrent disease characterized by diffuse inflammation of the inner lining of the colon or the large intestines. It invariably involves the rectum, and may extend backwards in a continuous fashion to involve part or whole of the colon. It results in friability of the large intestines and erosions of the inner lining, that frequently cause bleeding. It is more common than the related Crohn's disease and is characterized by periods of flare-ups with severe symptoms and remissions. The disease affects both males and females equally and occurs more commonly between the ages of 15 and 35 years.
Ulcerative Colitis is a chronic, recurrent disorder of large intestines
Causes Of Ulcerative Colitis
The exact cause of this condition is not known, but certain factors that occur in varying combinations, are believed to increase the overall risk of this disease. These predisposing factors include the following:
- Digestive tract infection
- Defective self-immunity
- Psychological factors and mental stress
Three basic processes occur in Ulcerative Colitis that are responsible for the damage caused. These include the following:
- A severe immunological reaction and inflammation of the inner lining of large intestines (not the entire thickness of the intestinal wall, very unlike Crohn's disease).
- A weakened intestinal barrier to infections due to reduced body immunity.
- Defective metabolism and a decrease in the level of butyrates, the short-chain fatty acids that nourish and repair the inner lining of large intestines.
The Disease Process
Ulcerative colitis is a disease confined to the inner lining of large intestines. The rectum is the most frequently involved portion (90-95% times) of the bowel. It is the earliest site of involvement, from where the disease spreads upwards and backwards to affect the large intestines. In more than half of the instances, the entire colon is diseased. In 10% of the situations, small intestines are also involved due to backwashing from the colon when the ileocaecal valve is incompetent. This is known as backwash ileitis. The diseased surface is in continuity, and there are no disease free islands or skip lesions.
In long standing disease, inflammatory polyps or finger-like projections arise from the inner lining of large intestines. With time, the inflammatory changes become severe and precancerous changes can develop.
Symptoms of Ulcerative Colitis
What are the major symptoms of Ulcerative Colitis?
Signs And Symptoms Of Ulcerative Colitis
In its mild form, the condition presents as one or two semi-formed stools per day, containing little blood. In its full-fledged form, the colitis causes blood filled diarrhea, abdominal pain, fever and weight loss. Those suffering from a very severe type of ulcerative colitis may have frequent liquid stools containing blood and pus, complain of severe cramps and may develop dehydration, anemia from chronic blood loss and fever. With predominantly rectal involvement, constipation occurs, with severe pain during defecation (tenesmus). On certain occasions, intestinal symptoms may be overshadowed by fever and weight loss. Abdomen is distended, with its lower part being tender to touch. Fever, increased heart rate and low blood pressure, especially on standing up from lying down or sitting position (postural hypotension) occur in a more severe form of the disease.
Variants Of Ulcerative Colitis
The common variants of Ulcerative Colitis include the following:
- Chronic and continuous type: The disease is slow in onset, with gradually worsening diarrhea. Lower abdominal cramps are present in the early phases, but when the intestines become thickened and shortened, the cramping is less marked. Cramping is followed by urgency and painful passage of small watery stools consisting of mucus, blood, and pus. Later on, cramping may not be present to warn of impending defecation. At this stage, the defecation occurs unexpectedly, and the sufferer gets insecure and embarrassed. Gradually there is weight loss and malnutrition.
- Chronic -relapsing-remitting: This is the commonest variant. It is characterized by unexpected exacerbations and remissions. Recurrences are associated with emotional stress and other acute illness, and in women, during menstruation and pregnancy. Blood filled diarrhea is the main symptom during the active phase of the disease.
- Acute fulminant: This type is characterized by recurrent episodes of unrelenting diarrhea, preceded by severe lower abdominal cramps, that occur day and night. There is a severe pain on defecation and urgency is marked. Around 30-40 watery stools containing mucus, blood and pus are passed every day. Severe toxicity occurs, along with fever. Extreme dehydration, reduced blood calcium levels, anemia, reduced protein levels in the body (hypoalbuminemia) and marked weight loss, are features of this form. The facies are gaunt, with sunken eyeballs. The risk of perforation and hemorrhage is present in this variant.
Factors That Signify A Bad Outcome
- A severe initial attack.
- Disease involving the entire colon.
- Increasing age, especially after 60 years.
Severity of disease
Rectal bleeding or diarrhea, with 4 or fewer motions per day, and absence of other signs
More than 4 motions per day, but no systemic signs
More than 4 motions a day, with one or more signs of systemic illness, such as fever over 37.5 degrees Celsius, heart rate more than 90 per minute, weight loss more than 3 kg and reduced albumin levels
Ulcerative Colitis is a spectral disease
Progression of the disease
Most people suffer a relapse within one year of the first attack, reflecting the recurrent nature of this disease. There may, however, be prolonged periods when the disease remains quiescent, with only minimal symptoms. The severity of symptoms reflects the extent of involvement of intestines and the intensity of inflammation. Ulcerative colitis is a spectral disease. At one end of the spectrum, are people with mild to moderate disease of intermittent nature who can manage their problem at home. At the other end, are those who suffer from the fulminating form of disease involving entire colon, and present with severe blood filled diarrhea and severe bodily symptoms. These people are at risk of developing toxic dilatation and perforation of the colon, that is a medical emergency.
Risk of colon cancer
When ulcerative colitis involves the whole of large intestines, there is a markedly increased risk of developing cancer colon. In individuals suffering from colitis for more than 10 years, the risk of developing colon cancer proportionately increases every year. Taking folic acid tablets (1 mg/day) has a protective effect. People suffering from extensive colitis should undergo colonoscopies with multiple random biopsies every 1-2 years, beginning 8-10 years after ulcerative colitis has been diagnosed.