Ulcerative Colitis

	Topic Overview
	Health Tools
	Cause
	Symptoms
	What Happens
	What Increases Your Risk
	When To Call a Doctor
	Exams and Tests
	Treatment Overview
	Prevention
	Home Treatment
	Medications
	Surgery
	Other Treatment
	Other Places To Get Help
	Related Information
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What is ulcerative colitis?

Ulcerative colitis is an inflammatory bowel disease (IBD) that causes inflammation and sores (ulcers) in the lining of the large intestine . Though it usually affects the left side of the colon (sigmoid colon) and the rectum, the extent of the disease can vary from affecting mainly the rectum (proctitis) to affecting the entire colon (extensive colitis or pancolitis).

The amount of the colon affected usually predicts the severity of the disease. Extensive colitis tends to cause more severe symptoms than proctitis, but some people have a large amount of the colon affected without having severe symptoms.

The most common inflammatory bowel diseases are ulcerative colitis and Crohn's disease.

What causes ulcerative colitis?

The cause is not known. The immune system may overreact to normal intestinal bacteria and cause inflammation. Or disease-causing bacteria and viruses may play a role in triggering ulcerative colitis. In a small number of cases, ulcerative colitis is believed to run in the family.

What are the symptoms?

The main symptoms are abdominal pain, rectal bleeding, and diarrhea or urgency to have a bowel movement. Ulcerative colitis usually causes bloody diarrhea or mucus in stools. In severe cases, people may have diarrhea 10 to 20 times per day. Constipation, fever, and loss of appetite also may occur. Factors that may cause ulcerative colitis to flare up include medicines, infections, hormonal changes, and lifestyle changes, including increased stress.

Ulcerative colitis can lead to complications, such as inflammation and scarring of the bile ducts (primary sclerosing cholangitis). In rare cases, severe inflammation and ulceration can stretch the colon's walls. The colon may swell to many times its normal size, a condition known as toxic megacolon. This is an emergency that requires immediate treatment.

In some cases, complications such as joint pain, eye problems, skin rash, or liver disease develop.

People with ulcerative colitis have an increased risk of colorectal cancer compared with the general population. The risk rises after you have had ulcerative colitis for 8 years or longer.¹ Regular screening can sometimes detect cancer early and may improve the likelihood of successful treatment.

How is ulcerative colitis diagnosed?

Ulcerative colitis can be relatively easy to diagnose because it affects only the colon and rectum and normally causes an obvious symptom such as the frequent appearance of blood or mucus in stools. The colon and rectum can be examined with a lighted viewing instrument called an endoscope (flexible sigmoidoscopy or colonoscopy). These imaging tests also can be used to take a sample (biopsy) of the intestinal lining to confirm ulcerative colitis and rule out other conditions.

Although endoscopy may be all that is needed, other imaging tests that may be used include barium enema X-ray or abdominal X-ray. Blood tests may be done to look for infection or inflammation.

A stool sample is usually tested for blood and signs of bacterial infection and parasites. The presence of white blood cells in stool indicates inflammation or infection and may be a sign of ulcerative colitis or another condition. However, white blood cells in stool mean that you do not have irritable bowel syndrome, a less serious condition that sometimes has similar symptoms.

How is it treated?

Ulcerative colitis often can be controlled with home treatment and medicines to stop inflammation.

Mild ulcerative colitis symptoms may respond to antidiarrheal medicines and changes in your diet. Moderate to severe symptoms may require one or more prescription medicines. For disease that is limited to the rectum, you can try topical medicines (suppository, enema, or foam). For severe inflammation of the rectal lining (proctitis) or inflammation throughout the colon, you may need medicines that act on the whole body, such as medicines to control inflammation (aminosalicylates and corticosteroids) and medicines to suppress the immune system (azathioprine, 6-mercaptopurine, and cyclosporine).

If you have symptoms that are severe and do not respond to medicine, you may need surgery to remove part or all of your colon. Removal of the entire colon cures ulcerative colitis.

How will ulcerative colitis affect my life?

Ulcerative colitis is an ongoing (chronic) condition that may flare up throughout your life. You may have only mild symptoms or long periods without symptoms. A few people have symptoms that are persistent and severe.

People who have only mild symptoms that respond to home treatment cope well with the disease. But for some others, ulcerative colitis can be a frustrating and depressing condition. The persistent diarrhea that often occurs may make you feel as if your life revolves around the bathroom, and you may be embarrassed by the symptoms and have a poor body image. However, most people with the condition live normal, productive lives using medicines to control inflammation and treat symptoms. In some cases, surgery may be needed. Most people who have surgery say it improved their quality of life.^{2, 3}

Ulcerative colitis can cause psychological stress, which in turn may affect the course of the disease. If you are struggling with the condition, seek support from family, friends, clergy, or a professional counselor. A strong social network may reduce stress and make the disease less active.⁴

Frequently Asked Questions

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	Decision Points focus on key medical care decisions that are important to many health problems.
	Should I have surgery to cure ulcerative colitis?
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	Caring for your ostomy
	Eating plan for inflammatory bowel disease

The cause of ulcerative colitis is unknown. Studies suggest that this and other inflammatory bowel diseases may result from an abnormal response by the body's immune system to normal intestinal bacteria.⁵ Disease-causing bacteria and viruses also may play a role in causing the condition.

Ulcerative colitis can run in families—some people may have a genetic tendency to develop the condition.

The symptoms of ulcerative colitis may include:

• Diarrhea or rectal urgency. Some people may have diarrhea 10 to 20 times per day. The urge to go to the bathroom may wake you up at night.
• Rectal bleeding. Ulcerative colitis usually causes bloody diarrhea and mucus. You also may have rectal pain and an urgent need to empty your bowels.
• Abdominal pain, often described as cramping. Your abdomen may be sore when touched.
• Constipation. This symptom may develop depending on what part of the colon is affected. Constipation is much less common than diarrhea.
• Loss of appetite.
• Fever. In severe cases, fever or other symptoms that affect the entire body may develop.
• Weight loss. Ongoing (chronic) symptoms, such as diarrhea, can lead to weight loss.
• Too few red blood cells (anemia). Some people develop anemia because of low iron levels caused by bloody stools or intestinal inflammation.

You also may develop symptoms and complications outside the digestive tract, such as joint pain, eye problems, skin rash, or liver disease. However, some of these problems are generally more common in Crohn's disease, the other major inflammatory bowel disease.

Other conditions with symptoms similar to ulcerative colitis include Crohn's disease, diverticulitis, irritable bowel syndrome (IBS), and colon cancer.

The course of ulcerative colitis varies greatly from one person to another. Some people may have only mild symptoms, and others may have severe symptoms or complications that, in unusual cases, may be life-threatening.

Ulcerative colitis may be mild, moderate, or severe. It may be described as dependent on corticosteroids, unresponsive to steroids, or not active (in remission).

Ulcerative colitis also may be defined by the part of the large intestine affected: the rectum (proctitis), the left side of the colon (left-sided colitis), or the entire colon (pancolitis). One out of every two adults with ulcerative colitis has proctitis. Pancolitis is the most common form of ulcerative colitis in children, affecting about half.⁶

Most people with ulcerative colitis have periods of remission that may last up to several years. These periods are interrupted by occasional flare-ups of moderate symptoms. Between 5% and 10% of people have symptoms all the time.⁵

Children may have the same symptoms as adults. In addition, children with ulcerative colitis may grow more slowly than normal and go through puberty later than expected.

Complications and long-term effects

• Inflammation and scarring of the bile ducts (primary sclerosing cholangitis) may occur. A bile duct is a passage that carries fluid produced in the liver to the small intestine.
• Severe inflammation and ulceration sometimes irritate muscles in the colon, causing colon walls to stretch. The colon may swell to many times its normal size, a condition known as toxic megacolon. This is an emergency that requires immediate treatment, but is rare.
• Narrowed areas of the intestine (strictures) may occur in ulcerative colitis, causing difficulty in passing stools. Abnormal connections or openings (fistulas) between parts of the intestine or between the intestine and other organs are rare because ulcerative colitis does not affect the deeper intestinal tissues.
• Your risk of cancer of the colon and rectum is higher than average if you have had ulcerative colitis for 8 years or longer. With regular screening, some cancers can be detected early and treated successfully.
• Ulcerative colitis can cause rare complications such as scarring of the pancreas and inflammation of the membrane surrounding the heart (pericarditis).

Some people who have ulcerative colitis also have irritable bowel syndrome (IBS), which is not as serious as ulcerative colitis. IBS causes abdominal pain along with diarrhea or constipation.

Most women who have ulcerative colitis are able to become pregnant and usually have healthy babies. Symptoms may become worse during the first 3 months of pregnancy. Some medicines to treat the disease can be used during pregnancy.

You have an increased risk of developing ulcerative colitis if you:

• Have a family history of ulcerative colitis. Your risk increases if an immediate family member such as a parent, brother, or sister has the disease.
• Are of Ashkenazi Jewish ancestry. For more information on genetic diseases in this group, see the topic Ashkenazi Jewish Genetic Panel (AJGP).

Call a doctor immediately if you have been diagnosed with ulcerative colitis and you have any of the following:

• Fever over 101° (38.3°) or shaking chills
• Lightheadedness, passing out, or rapid heart rate
• Stools that are almost always bloody
• Severe dehydration
• Severe abdominal pain with or without bloating
• Pus draining from the area around the anus or pain and swelling in the anal area
• Repeated vomiting
• Not passing any stools or gas

If you have any of these symptoms and you have been diagnosed with ulcerative colitis, your disease may have gotten significantly worse. Some of these symptoms also may be signs of toxic megacolon, a condition in which the colon swells to many times its normal size. Toxic megacolon requires emergency treatment. Untreated toxic megacolon can cause the colon to leak or rupture, which can be fatal.

People who have ulcerative colitis usually know their normal pattern of symptoms. Call your doctor if there is a change in your usual symptoms or if:

• Your symptoms become significantly worse than usual.
• You have persistent diarrhea for more than 2 weeks.
• You have lost weight.

Watchful Waiting

Watchful waiting is not appropriate when you have any of the above symptoms. If your symptoms are caused by ulcerative colitis, delaying the diagnosis and treatment may make the disease worse and increase your risk of complications.

Even when the disease is in remission, your doctor will want to see you regularly to check for complications, some of which can be hard to detect. It is always appropriate to call your doctor's office for advice.

Who To See

Health professionals who can diagnose ulcerative colitis include:

• Family medicine doctor.
• Internist.
• Gastroenterologist.

For the treatment and management of ulcerative colitis, you are likely to be referred to a gastroenterologist.

To be evaluated for surgery, you may be referred to a:

• General surgeon.
• Colon and rectal surgeon.

To prepare for your appointment, see the topic Making the Most of Your Appointment

Ulcerative colitis can be relatively easy to diagnose because it normally affects only the colon and rectum and usually causes an obvious change in daily bowel habits, such as frequent stools containing blood or mucus. Your health professional will conduct a medical history and physical exam before doing other tests.

The colon and rectum can be examined with flexible sigmoidoscopy or colonoscopy, tests in which a doctor examines the inside of the large intestine using a small, lighted scope. In general, colonoscopy is the preferred test because it can be used to examine the entire colon. However, flexible sigmoidoscopy may be all that is needed to diagnose ulcerative colitis. Both procedures can be used to take a sample (biopsy) of intestinal tissue. The diagnosis of ulcerative colitis is made by ruling out other causes of diarrhea and assessing the results of these tests.

Other exams and tests that may be used to evaluate ulcerative colitis include:

• Abdominal X-ray, which provides a picture of structures and organs in the abdomen.
• Barium enema, a test that allows the doctor to examine the large intestine (colon). For a barium enema, a whitish liquid (barium) is inserted through the rectum into the colon and large intestine. The barium outlines the inside of the colon so that it can be more clearly seen on an X-ray.
• Computed tomography (CT) scan, which uses X-rays to produce detailed pictures of structures inside the body.
• Magnetic resonance imaging (MRI), which uses a magnetic field and pulses of radio wave energy to provide pictures of organs and structures inside the body.

A stool analysis (including a test for blood in the stool) is often done, depending on symptoms, to look for blood, signs of bacterial infection, parasites, or the presence of white blood cells. This test can be used to distinguish ulcerative colitis from irritable bowel syndrome (IBS), a less serious condition that sometimes has similar symptoms.

The presence of white blood cells in stool indicates inflammation and infection but is not necessarily a sign of ulcerative colitis. However, white blood cells in stool mean that you do not have IBS. Stool analysis may be done during a flare-up of ulcerative colitis if there is concern that new symptoms are caused by another problem. You can collect a stool sample, or the doctor may obtain it during sigmoidoscopy or colonoscopy.

• Standard blood and urine tests may be done to check for anemia, inflammation, or malnutrition. Depending on the symptoms, an erythrocyte sedimentation rate (ESR, or sed rate) or C-reactive protein (CRP) blood test may be done to look for infection or inflammation. C-reactive protein is a substance produced by the liver as a result of inflammation in the body.
• Biopsy of a sample of tissue from the lining of the intestine may be done. Biopsies are collected during sigmoidoscopy or colonoscopy to confirm the diagnosis of ulcerative colitis. A biopsy also may be done to find out whether a tumor is present. Multiple biopsies for cancer screening are often done in people who have had ulcerative colitis for 8 years or more. Bowel biopsies are painless (other than the potential discomfort of the scope procedure) and remove only a tiny piece of tissue.

In about 10% of people who have symptoms, neither Crohn's disease nor ulcerative colitis can be diagnosed. These people have a form of inflammatory bowel disease called indeterminate colitis, which doctors believe is a combination of Crohn's disease and ulcerative colitis.⁷

Treatment for ulcerative colitis depends mainly on the severity of the disease and usually includes medicines to control symptoms, such as diarrhea, and changes in diet. A few people have symptoms that are persistent and severe, in some cases requiring treatment with additional medicines or surgery.

The goals of treatment include:

• Relieving symptoms and ending sudden (acute) attacks as quickly as possible.
• Treating complications, such as anemia or infection. Treatment may include taking nutritional supplements to restore normal growth and sexual development in children and teens.
• Preventing or delaying new attacks.

Initial treatment

If you don't have any symptoms of ulcerative colitis or if your disease is not active (in remission), you may not need treatment. If you do have symptoms, they usually can be managed with medicines to put the disease in remission. It often is easier to keep the disease in remission than to treat a flare-up.

Mild symptoms may respond to antidiarrheal medicines and changes in your diet. Sometimes you may need to use enemas or suppositories. Talk with your health professional before taking antidiarrheals. Prescription medicines may be used to treat mild symptoms and keep the disease in remission. Usually, corticosteroids (such as hydrocortisone or prednisone) are given for a few weeks to control active disease.

When your symptoms are under control, you may take aminosalicylates (such as sulfasalazine or mesalamine) to keep the disease in remission. Aminosalicylates relieve inflammation in the intestines.

Moderate to severe symptoms usually require corticosteroids to control inflammation. The required dose of steroids may be higher than that needed to treat mild colitis. When inflammation goes away, you will take aminosalicylates to keep the condition in remission. For more information about making good food choices, see:

Eating plan for inflammatory bowel disease.

Immunomodulator medicines, such as azathioprine (AZA) or 6-mercaptopurine (6-MP), also may be needed for severe cases that cannot be controlled with aminosalicylates alone. These medicines suppress the body's immune system to prevent inflammation. Immunomodulators also may be needed to avoid long-term use of steroids, which can cause side effects such as increased risk of infection and osteoporosis.

For severe ulcerative colitis, when corticosteroids don't work, your doctor may have you try infliximab. Infliximab (Remicade) may work to put you in remission when other medicines don't. Infliximab has also been shown to help heal the lining of the intestine.

Ongoing treatment

The goal of ongoing treatment is to keep ulcerative colitis from causing symptoms (keep it in remission). Most people take aminosalicylates (such as sulfasalazine or mesalamine) to prevent symptoms from recurring. Aminosalicylates relieve inflammation in the intestines. If you do have flare-ups, you will be given corticosteroids (such as hydrocortisone or prednisone) to control the inflammation.

Usually, steroids are given only long enough to control inflammation. If your condition is so severe that aminosalicylates alone cannot keep you in remission and you would need long-term use of steroids, you may take immunomodulator medicines (such as azathioprine [AZA], 6-mercaptopurine [6-MP], or cyclosporine). These strong medicines suppress the immune system to prevent inflammation.

If these medicines don't work, your doctor may have you try infliximab (Remicade). Infliximab also blocks the inflammatory response in your body and helps reduce the inflammation in your colon.

Your health professional will want to see you for a follow-up visit about every 6 months while your condition is stable and more frequently if you are having problems. If you are taking medicines, you may have laboratory tests every 2 to 3 months. Many people who have ulcerative colitis are so familiar with the course of their condition that they can handle minor flare-ups on their own. In some cases, you may be able to consult with your health professional on the phone for minor problems.

Treatment if the condition gets worse

You may have to receive treatment in the hospital if you have severe, persistent ulcerative colitis with symptoms outside the digestive tract, such as fever or anemia. Treatment includes replacing fluids and electrolytes lost because of severe diarrhea.

Your health professional may increase your dose of corticosteroids (such as hydrocortisone or prednisone) to control active disease or may increase your immunomodulator medicines (such as azathioprine [AZA], 6-mercaptopurine [6-MP], or cyclosporine) or infliximab to suppress your immune system. However, steroids are usually not used as long-term therapy because they do not keep ulcerative colitis in remission.

Surgery may be necessary if your symptoms do not improve with medicines or you have complications such as bleeding or perforation of the intestine. Removal of the large intestine (colon) cures ulcerative colitis. Some people with severe ulcerative colitis need urgent surgery to remove their colon.⁵ Several types of surgery can be done. For more information, see the Surgery section of this topic.

Some people who have precancerous changes in their colon may decide to have surgery to prevent cancer even if they have no symptoms. In some cases, people decide to have their colon removed to improve their quality of life and to eliminate the risk of colon cancer.

Should I have surgery to cure ulcerative colitis?

You cannot prevent ulcerative colitis because the cause is unknown. However, you can take steps to reduce the severity of the disease.

• Medications taken regularly may reduce acute attacks and keep the disease in remission.
• Most experts recommend acetaminophen (Tylenol) for pain relief rather than nonsteroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen and naproxen. NSAIDs have been linked to flare-ups of inflammatory bowel disease (IBD).⁸

Antibiotics may make ulcerative colitis symptoms worse and should only be used when necessary.

If ulcerative colitis does not cause symptoms, no treatment is needed. If you have only mild symptoms, antidiarrheal medicines and changes in diet and nutrition may help. For disease in the rectum alone, you can try topical medicines (suppository, enema, or foam). Ask your health professional about these products. For more information about making good food choices, see:

Eating plan for inflammatory bowel disease.

Generally, doctors recommend that you do not use nonsteroidal anti-inflammatory drugs (NSAIDs, such as ibuprofen or naproxen). Studies have linked these pain relievers with flare-ups of ulcerative colitis.⁸ However, some people may be more likely to have flare-ups from NSAIDs than others. Talk to your health professional about whether to avoid these medicines.

If you have had or are planning to have surgery that will create an opening from the intestines to the outside of the body through which stool passes (ostomy), you may feel self-conscious or embarrassed. After a period of adjustment, most people are able to resume all of their usual activities. In fact, you may feel better than before surgery because you may no longer suffer painful symptoms. Support groups are available for people with ostomies.

Caring for your ostomy

Children with ulcerative colitis may feel self-conscious if they do not grow as fast as other children their age. Encourage your child to take medicine as prescribed. Offer your help with the treatment so that your child can feel better, start growing again, and lead a more normal life. Children tend to have a harder time managing ulcerative colitis than adults, so your support is especially important.

Medications usually are the treatment of choice for ulcerative colitis. They control or prevent inflammation in the intestines and help:

• Relieve symptoms.
• Promote healing of damaged tissues.
• Put the disease into remission and keep it from flaring up again.
• Postpone or prevent the need for surgery.

Medication Choices

The choice of medicine usually depends on the severity of the disease, the part of the colon affected, and whether complications are present.

• Treatment of mild to moderate ulcerative colitis often begins with aminosalicylates (such as sulfasalazine or mesalamine). Aminosalicylates relieve inflammation in the intestines and help the disease go into remission. They may also keep the disease from becoming active again.
• Corticosteroids may be added if symptoms continue. Corticosteroids relieve inflammation in the intestines.
• For severe cases, stronger treatment with medicines that suppress the immune system (such as azathioprine [AZA], 6-mercaptopurine [6-MP], or cyclosporine), infliximab (Remicade), and intravenous (IV) corticosteroids may be needed.

If you are pregnant, talk to your health professional about which medicines are safe for you to take. Usually, aminosalicylates and corticosteroids are safe, especially when your doctor thinks that ulcerative colitis is more dangerous to the fetus than these medicines. Ask your doctor whether you can take medicines that suppress the immune system. These are used only when the benefit outweighs the potential harm to the fetus. A health professional can recommend medicines based on the stage of the pregnancy and the severity of your symptoms.

Several studies have shown that the nicotine patch may help treat active ulcerative colitis. It is not yet known how long the benefits of the nicotine patch last or if the patch can help prevent flare-ups of ulcerative colitis. If the patch works, it most likely benefits people whose symptoms began or became worse after quitting smoking. However, due to the addictive power and other harmful effects of nicotine, most doctors still prefer to use traditional medicines to treat ulcerative colitis before trying the nicotine patch.

What To Think About

Aminosalicylates are the most common medicines used to treat ulcerative colitis. Most of the time, these medicines are all a person needs to keep the disease in remission (a period of time with no symptoms). When aminosalicylates do not work, corticosteroids are most often the next medicine tried. Corticosteroids will only be used long enough to stop the inflammation in your colon. After the inflammation goes down, aminosalicylates will most likely be used to maintain remission.

If aminosalicylates are not strong enough to keep you in remission, or if corticosteroids don't work, your doctor may have you try different medicines. These medicines include immunomodulators, cyclosporine, and infliximab. All of these medicines control the immune response in your body and will decrease the amount of inflammation in your intestine. The inflammation is what causes the symptoms of ulcerative colitis.

Ulcerative colitis affects only the large intestine, so surgery that removes the entire large intestine can cure the disease. Some people who have ulcerative colitis in the entire colon (pancolitis) eventually need surgery to remove the colon.

People may need surgery for ulcerative colitis in several situations, such as when other therapy fails to manage symptoms, when holes develop in the large intestine, or if dysplasia is found during colonoscopy or biopsy.

Should I have surgery to cure ulcerative colitis?

Surgery

Removal of the colon to cure ulcerative colitis involves one of these surgeries:

• In ileoanal anastomosis, the surgeon removes some or all of the large intestine (colon) and the diseased lining of the rectum. Then the end of the small intestine (the ileum) is connected to the anal canal. The anal sphincters are saved and this allows you to have bowel movements without an ostomy.
• In proctocolectomy and ileostomy, the large intestine and rectum are removed, leaving the lower end of the small intestine (the ileum). The surgeon sews the anus closed and makes a small opening called a stoma in the skin of the lower abdomen. The ileum is connected to the stoma, creating an opening to the outside of the body. Stool empties into a small plastic pouch called an ostomy bag that is applied to the skin around the stoma.
• In continent ileostomy, the surgeon removes the large intestine (colon) and creates a pouch and a valve from the lower end of the small intestine (the ileum). The surgeon then connects the valve to an opening (stoma) in the skin of the lower abdomen. After this surgery, you can insert a tube into the valve to release stool from the intestines.

What To Think About

Ileoanal anastomosis is performed most often. Proctocolectomy with ileostomy is preferred for people who cannot tolerate anesthesia for a long period of time because of illness or age.

Both children and adults may have ileoanal anastomosis, which may be done in stages to reduce the risk of complications. A temporary ileostomy is created first, with the ileum pouch completed 3 to 6 months later. Surgery can improve a child's well-being and quality of life and restore normal growth and sexual development.

In the past, many people who had surgery for IBD had an ileostomy and wore an ostomy bag outside the abdomen. Newer surgeries like ileoanal anastomosis or continent ileostomy can eliminate the need for an ostomy bag with fairly good results when they are done by a trained surgeon. Traditional ostomy surgery is easier and may have fewer risks and complications than the newer procedures, but some people may be less satisfied with the results.

People with ulcerative colitis may choose to have their colon removed because their symptoms cause a poor quality of life. They also may want the surgery to prevent the possibility of colon cancer.

In most cases, surgery can be scheduled at your convenience. Emergency surgery usually is not needed unless an acute attack causes toxic megacolon, severe uncontrolled bleeding, or a spontaneous rupture in the intestine. The risk of complications after surgery can be high if surgery is done during a severe or rapidly worsening attack or if emergency surgery is needed. If toxic megacolon has developed, surgery may be the only option to save a person's life.

Even though there is little scientific proof that it works, many people with ulcerative colitis consider nontraditional or complementary medicine in addition to prescription medicines. They may turn to these alternatives because there is no complete cure other than removal of the colon. Other reasons for seeking complementary medicine include:

• Coping with the difficult side effects from standard medicines.
• Dealing with the emotional strain caused by chronic disease.
• Dealing with the negative impact that severe disease has on daily life.

Other Treatment Choices

Complementary medicine

The various complementary therapies include:

• Special diets or nutritional supplements, such as probiotics.
• Fatty acids found in oily fish, such as salmon and tuna.
• Vitamin supplements, such as vitamins D and B₁₂.
• Herbs, such as aloe and ginseng.
• Massage.
• Stimulation of the feet, hands, and ears to try to affect parts of the body (reflexology).
• Chiropractic therapy.

Probiotics and fatty acids are the most promising complementary therapies being studied for ulcerative colitis. But there is still not much known about their value. As with any treatment, talk with your doctor before using complementary medicines or therapies.

What To Think About

You may want to seek professional counseling or social support from family, friends, or clergy. Ulcerative colitis can affect every aspect of your life. Research has shown that strong social support can reduce psychological stress and disease activity.⁴

Organizations

• Crohn's Disease

Citations

1. Kornbluth A, Sachar DB (2004). Ulcerative colitis practice guidelines in adults (update): American College of Gastroenterology, Practice Parameters Committee. American Journal of Gastroenterology, 99(7): 1371–1385.

2. Camilleri-Brennan J, Steele RJ (2001). Objective assessment of quality of life following panproctocolectomy and ileostomy for ulcerative colitis. Annals of the Royal College of Surgeons of England, 83(5): 321–324.

3. Thirlby RC, et al. (2001). The long-term benefit of surgery on health-related quality of life in patients with inflammatory bowel disease. Archives of Surgery, 136(5): 521–527.

4. Sewitch MJ, et al. (2001). Psychological distress, social support, and disease activity in patients with inflammatory bowel disease. American Journal of Gastroenterology, 96(5): 1470–1479.

5. Su C, Lichtenstein GR (2006). Ulcerative colitis. In M Feldman et al., eds., Sleisenger and Fordtran's Gastrointestinal and Liver Disease, 8th ed., vol. 2, pp. 2499–2548. Philadelphia: Saunders Elsevier.

6. Ghosh S, et al. (2000). Ulcerative colitis. BMJ, 320(7242): 1119–1123.

7. Podolsky DK (2002). Inflammatory bowel disease. New England Journal of Medicine, 347(6): 417–429.

8. Hanauer SB (2005). Inflammatory bowel diseases. In DC Dale, DD Federman, eds., ACP Medicine, section 4, chap. 4. New York: WebMD.

Author:	Monica Rhodes	Last Updated November 14, 2006
Medical Review:	Kathleen Romito, MD - Family Medicine Jerome B. Simon, MD, FRCPC, FACP - Gastroenterology
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