Ulcerative Colitis (UC) is a type of inflammatory bowel disease characterized by chronic inflammation of the large intestines, or colon. This inflammation is limited to the inner most lining of the colon wall. Inflammation can affect different parts of the colon, and different terms are commonly used to differentiate these types of UC based on the extent involved of the colon. About half of UC patients have disease that affects the left side of the colon, or anywhere from the splenic flexure and beyond that towards the rectum. See some of the different types of UC below.
Types of UC
Ulcerative proctitis refers to inflammation limited only to the rectum. About 30 percent of all patients with UC start with this type, and it typically results in milder symptoms than any of the other types of UC.
Disease limited to the rectum and part of the colon above the rectum, or sigmoid colon, is referred to as proctosigmoiditis. Symptoms during flares can include cramping in the left lower part of the abdomen, bloody diarrhea, and persistent sensation of needing to have a bowel movement, or tenesmus.
Inflammation that extends continuously from the rectum, to the sigmoid colon, then descending colon, and up to the turn by the spleen called the splenic flexure is referred to as left-sided colitis. Symptoms with this extent of disease include abdominal pain in the upper and lower left abdomen, bloody diarrhea, weight loss, and decreased appetite.
Extensive colitis involves the colon extending from the rectum to any point beyond the splenic flexure, but not including the far right area of the colon that meets the small intestines called the cecum. Symptoms are usually similar to those of left-sided colitis, but as more colon is involved, symptoms can often be worse, resembling those of pancolitis.
Pancolitis refers to inflammation affecting the entire colon, including the cecum. Symptoms include severe abdominal pain, bloody diarrhea, and significant weight loss. Severe complications, such as massive bleeding or toxic dilation of the colon, can occur in the setting of pancolitis.
Ulcerative proctitis and proctosigmoiditis
For mild to moderate active proctitis or proctosigmoiditis, topical 5-aminosalycylic acid (5-ASA) are recommended. These include mesalamine enemas (Rowasa) and suppositories (Canasa). Steroid foam or suppositories can be used in patients who do not tolerate or respond to 5-ASA’s. To maintain remission and free from flares, daily 5-ASA enemas are recommended.
Left-sided colitis, extensive colitis, and pancolitis
For patients with mild to moderately active left-sided colitis, extensive colitis, and pancolitis, combination therapy with oral 5-ASA’s , 5-ASA enemas, and 5-ASA suppositories is recommended. Again, steroid enemas and suppositories can be used in place of 5-ASA enemas and suppositories if 5-ASA’s are not tolerated, or response is limited. If this combination does not improve symptoms, resulting in remission, then oral steroids (prednisone) is then used. To maintain stable disease and avoid flares, the oral 5-ASA should be continued, and the enemas and suppositories can be tapered to once daily dosing.
Patients with severe inflammation require a complicated treatment approach. This may include hospitalization, intravenous medications, and even colon surgery. It is important that you follow closely with your gastroenterologist, and be open and honest regarding any symptoms you experience to maintain stability of your colitis and avoid disease flares.
Constance Pietrzak, M.S., M.D., is a gastroenterologist with Advocate Medical Group in Chicago. Through her work with HealthCentral, she strives to expand knowledge on gastroesophageal reflux disease (GERD) and inflammatory bowel disease (IBD). Follow Constance on Facebook and Twitter for timely updates on IBD, and more.