Ulcerative Colitis

Ulcerative colitis is a form of inflammatory bowel disease that affects the lining of the large bowel (colon) and back passage (rectum). Approximately 100,000 people in Britain have ulcerative colitis.

What Are The Symptoms?

Most of the time, most sufferers feel well with no symptoms i.e. the disease is inactive (in remission). The disease may flare up from time to time and become active (relapse). The main symptoms are:

  • Frequent and urgent need to pass blood and mucus (slime from your back passage)
  • Diarrhoea
  • Abdominal pain
  • Lethargy

How Is Ulcerative Colitis Diagnosed?

It is essential to examine the lining of the back passage and colon usually with a flexible sigmoidoscope or colonoscope.

How Is Ulcerative Colitis Treated?

For most patients, the disease can be controlled by anti-inflammatory medications or other drugs such as steroids. If only the rectum is inflamed, treatment may just be with enemas, rectal foams or suppositories.

When Is Surgery Necessary?

With ulcerative colitis most people never need an operation. However, the colon may have to be removed if:

  • A very severe attack of ulcerative colitis fails to respond to intensive medical treatment
  • Repeated attacks cause ill-health
  • Pre-cancerous changes ('dysplasia') are found in the colon

What Operations Are Available For Ulcerative Colitis?

For some patients a restorative proctocolectomy with an ileal pouch is suitable. This involves removal of the entire large bowel and the formation of a pouch to replace the rectum. The pouch is made from a segment of the small bowel and joined to the anus. The operation is often done in stages. A part of the remaining small bowel (ileum) is brought through the abdominal wall onto the tummy as a spout (ileostomy). When the pouch has healed the bowel is then reconnected i.e. the spout is put back into the abdomen.

For patients who do not have a good working anal muscle, the most suitable operation is proctocolectomy. This is where the whole colon and rectum are removed and a permanent end ileostomy is formed. The ileostomy bag does not show even through bathing costumes and should not interfere with any activities, including sexual intercourse.

Other operations include ileorectal anastomosis or loop ileostomy. In each case, the choice of operation has to be made on an individual basis by the patient and surgeon.

Can Inflammatory Bowel Disease Lead To Cancer?

Yes, but the risks are greater in patients with ulcerative colitis if their disease affects most of the colon and has been present for many years. Patients at risk may be advised to have regular colonoscopy examinations to detect dysplasia. If dysplasia is found, the person is usually advised to have the colon removed.