Signs And Symptoms Of Ulcerative Colitis
Recognizing the symptoms of ulcerative colitis is your first step toward knowing when your disease is in a flare and when to seek medical attention.
The symptoms of ulcerative colitis vary from person to person and about half of all ulcerative colitis patients experience mild symptoms. If you experience any of these symptoms, consult your healthcare provider.
Loose and urgent bowel movements
Persistent diarrhea accompanied by abdominal pain and blood in the stool
What Are The Symptoms Of Ulcerative Colitis
Symptoms of ulcerative colitis vary from person to person. Common symptoms of ulcerative colitis include
- passing blood with your stool or rectal bleeding
- cramping and pain in the abdomen
- passing mucus or pus with your stool
- tenesmus, which means feeling a constant urge to have a bowel movement even though your bowel may be empty
- an urgent need to have a bowel movement
Symptoms of ulcerative colitis may vary in severity. For example, mild symptoms may include having fewer than four bowel movements a day and sometimes passing blood with stool. Severe symptoms may include having more than six bowel movements a day and passing blood with stool most of the time. In extremely severeor fulminantulcerative colitis, you may have more than 10 bloody bowel movements in a day.3,4
Some symptoms are more likely to occur if ulcerative colitis is more severe or affects more of the large intestine. These symptoms include
You may have periods of remissiontimes when symptoms disappearthat can last for weeks or years. After a period of remission, you may have a relapse, or a return of symptoms.
What Are The Signs & Symptoms Of Ulcerative Colitis
The most common symptoms of ulcerative colitis are cramping belly pain and diarrhea. Other symptoms include:
- blood in the toilet, on toilet paper, or in the stool
- urgent need to poop
Ulcerative coliits can cause other problems, such as rashes, eye problems, joint pain and arthritis, and liver disease. Kids with ulcerative colitis may not grow well as well as other kids their age and puberty may happen later than normal.
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When To See A Doctor
See your doctor if you experience a persistent change in your bowel habits or if you have signs and symptoms such as:
- Ongoing diarrhea that doesnt respond to over-the-counter medications
- Diarrhea that awakens you from sleep
- An unexplained fever lasting more than a day or two
Although ulcerative colitis usually isnt fatal, its a serious disease that, in some cases, may cause life-threatening complications.
Does Ulcerative Colitis Make You Immunocompromised
Ulcerative colitis doesnt make you immunocompromised. Some of the medicines that treat it may change the way your immune system responds. This change is different for each medication. Some of these changes may increase the risk of certain infections or other issues. A discussion with your health care team before starting a medication is the best way to understand these risks and ways to prevent them.
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How To Talk To Your Child About Ulcerative Colitis
Its important to help your child feel comfortable to share changes in symptoms, or when theyve missed a medication dose. Here are some ways to help them cope with symptoms and to feel confident about opening up to you:
- Ask them for updates on how they feel both mentally and physically.
- Use language they can understand. Medical terminology can be scary and confusing, so be sure to explain things at their level.
- Dont diminish the severity of their symptoms. Make sure they feel like they can keep you informed of any changes in how theyre feeling. This can be especially true for psychological symptoms like anxiety and depression.
- Make sure children know that their condition isnt their fault and that they arent alone. Online support groups, forums, and even specialized summer camps can be a good way to share other childrens stories.
- Be an advocate for your child with all medical professionals to let them know that you have their back.
- Remember to take care of yourself as a caregiver. Its easy to let your own needs slide when caring for others.
How Do Nsaids Cause A Peptic Ulcer
To understand how NSAIDs cause peptic ulcer disease, it is important to understand how NSAIDs work. Nonsteroidal anti-inflammatory drugs reduce pain, fever, and inflammation, or swelling.
Everyone has two enzymes that produce chemicals in your bodys cells that promote pain, inflammation, and fever. NSAIDs work by blocking or reducing the amount of these enzymes that your body makes. However, one of the enzymes also produces another type of chemical that protects the stomach lining from stomach acid and helps control bleeding. When NSAIDs block or reduce the amount of this enzyme in your body, they also increase your chance of developing a peptic ulcer.
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Nsaids And Stomach Ulcers
The risk of ulcers increases if the drugs are taken in high doses or regularly for a long time.
Stronger NSAIDs, such as those available on prescription, carry a greater risk of stomach ulcers than those that people can buy over the counter.
A person should always check labels and consult a pharmacist or a doctor about any concerns regarding using pain relief medication. They may recommend an alternative, such as acetaminophen.
Treatment For A Stomach Ulcer
Special diets are now known to have very little impact on the prevention or treatment of stomach ulcers. Treatment options can include:
- medication including antibiotics, to destroy the H. pylori colony, and drugs to help speed the healing process. Different drugs need to be used in combination some of the side effects can include diarrhoea and rashes. Resistance to some of these antibiotics is becoming more common
- subsequent breath tests used to make sure the H. pylori infection has been treated successfully
- changes to existing medication the doses of arthritis medication, aspirin or other anti-inflammatory medication can be altered slightly to reduce their contributing effects on the stomach ulcer.
- reducing acid tablets are available to reduce the acid content in the gastric juices
- lifestyle modifications including quitting cigarettes, since smoking reduces the natural defences in the stomach and impairs the healing process.
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Search Strategy And Selection Criteria
We searched for relevant manuscripts in PubMed/MEDLINE, Embase, and Cochrane Central from their inception until March 1, 2016. The search combined the MeSH terms ulcerative colitis and inflammatory bowel disease with the subheadings epidemiology, etiology, physiopathology, innate and adaptive immunity, diagnosis, genetics, diagnosis, endoscopy, therapy, surveillance, and complications. Bibliographies of included articles were searched and experts in inflammatory bowel disease were consulted to identify additional studies. Relevant articles and abstracts published in English were critically reviewed. Priority was given to manuscripts published in the past 5 years, randomised placebo-controlled trials, and meta-analyses.
Abdominal And Rectal Pain
People with ulcerative colitis often experience rectal or abdominal pain. Having a large amount of abdominal pain may be a sign that youre having a flare-up or that your condition is getting worse. Pain can range from mild to severe and may also affect your rectum.
Pain may be accompanied by persistent muscle spasms and cramping.
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What Should I Ask My Doctor On Behalf Of My Child Or Teenager
Ask your healthcare provider the following questions in addition to the ones listed above:
- What vitamins should my child take?
- Will my other children have pediatric ulcerative colitis?
- Is my child at risk for other conditions?
- Can you recommend a psychiatrist or therapist to help my child with emotional issues related to pediatric ulcerative colitis?
- Is my child growing at a normal rate?
- What can I do to help my child cope at school?
A note from Cleveland Clinic
When you have ulcerative colitis, its essential to work closely with your healthcare team.
Take your medications as prescribed, even when you dont have symptoms. Skipping medications youre supposed to take can lead to flareups and make the disease harder to control. Your best shot at managing ulcerative colitis is to follow your treatment plan and talk to your healthcare provider regularly.
Youre More Bloated Than Usual
If you notice your stomach feeling particularly bloated, it may be more serious than a little bit of gasit could be one of the signs of an ulcer. According to RM Healthy, bloating is often one of the earliest ulcer symptoms, with patients especially complaining of pain in their midsection. Of course, bloating can also be caused simply by eating something your body doesnt agree with or not drinking enough water, but when combined with these other symptoms, its worth checking out.
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How Are Stomach Ulcers Treated
Ulcers can heal if they are given a rest from the factors that created them. Healthcare providers treat uncomplicated ulcers with a combination of medicines to reduce stomach acid, coat and protect the ulcer during healing and kill any bacterial infection that may be involved. Medicines may include:
- Antibiotics. If H. pylori was found in your digestive tract, your healthcare provider will prescribe some combination of antibiotics to kill the bacteria, based on your medical history and condition. Commonly prescribed antibiotics include tetracycline, metronidazole, clarithromycin and amoxicillin.
- Proton pump inhibitors . These drugs help reduce stomach acid and protect your stomach lining. PPIs include esomeprazole,dexlansoprazole,lansoprazole, omeprazole,pantoprazole and rabeprazole.
- Histamine receptor blockers . These reduce stomach acid by blocking the chemical that tells your body to produce it . H2 blockers include famotidine, cimetidine and nizatidine.
- Antacids. These common over-the-counter medicines help to neutralize stomach acid. They may bring some symptom relief, but they arent enough to heal your ulcer. They also might interfere with some antibiotics.
- Cytoprotective agents. These medicines help to coat and protect your stomach lining. They include sucralfate and misoprostol.
- Bismuth Subsalicylate. This over-the-counter medicine, commonly found as Pepto-Bismol, can help coat and protect your ulcer from stomach acid.
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Crohns Disease And Ulcerative Colitis
A serious but rare complication of these forms of inflammatory bowel disease is fulminant or toxic colitis, formerly called toxic megacolon.
The signs and symptoms of this condition can include bloody diarrhea along with fever, racing heartbeat , low blood pressure , metabolic acidosis , low urine output , and acute kidney failure.
Toxic colitis is more common with ulcerative colitis than it is with Crohns disease.
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Gastric Vs Duodenal Ulcer Symptoms
When the lining of the stomach or duodenum breaks down, it can lead to the formation of an ulcer. The stomach and duodenum have a mucosal lining that protects them, but it can get worn down.
When that happens, the acids and enzymes used in digestion can eat away at the wall of the stomach or intestine and cause an ulcer. This erosion of the lining and then the wall can result in an open sore.
There may be some differences in the symptoms of duodenal and gastric ulcers. Duodenal ulcers are likely to present with abdominal pain a few hours after meals, when the stomach is empty . The pain usually gets better after eating.
Gastric ulcers may cause pain soon after eating, nausea, vomiting, and weight loss.
What Else Should I Know
It can be a challenge to deal with the symptoms of ulcerative colitis. But many people with the condition can stay well and have few symptoms for long periods of time. Talk to your doctor about ways you can feel better during flares. Because stress can make symptoms worse, its important to get enough sleep and manage stress in positive ways. Yoga, meditation, breathing and relaxation techniques, music, art, dance, writing, or talking to a friend can help.
If you feel sad or anxious about your symptoms, it may also help to talk to a therapist or other mental health professional.
As you get older, you can take on more responsibility for managing your health care. Getting treatment for ulcerative colitis, managing your symptoms, and keeping a positive attitude can help get you back on track.
You also can find more information and support online at:
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What Causes Ulcerative Colitis
Researchers think the cause of ulcerative colitis is complex and involves many factors. They think its probably the result of an overactive immune response. The immune systems job is to protect the body from germs and other dangerous substances. But, sometimes your immune system mistakenly attacks your body, which causes inflammation and tissue damage.
Mild To Moderate Disease
First-line therapy in mild to moderate disease is the 5-ASA drugs, which can be administered as suppositories, enemas, or oral formulations . There does not appear to be any difference in efficacy or safety between different 5-ASA formulations.119 Sulfasalazine, which is metabolised to 5-ASA, appears to have similar efficacy to 5-ASA drugs, but tends to be less well tolerated.114 Patients with proctitis should be treated initially with 5-ASA suppositories since they directly target the site of inflammation and appear to be more effective than oral 5-ASA.114,118,120 In left-sided colitis, 5-ASA should be administered as an enema instead of a suppository in order to reach the splenic flexure. For patients with left-sided or extensive disease, it is recommended that oral 5-ASA be used in combination with topical 5-ASA to induce remission.114,118 Oral 5-ASA doses of 2 g or higher per day are more effective than lower doses at inducing and maintaining remission.121123 5-ASA can be started at a dose of 2.02.4 g per day and increased up to 4.8 g, if needed.114,123 Dosing of 5-ASA once a day has similar efficacy to divided doses and could increase adherence.114,123 Patients typically see a response within 14 days, but this response might take up to 8 weeks for symptomatic remission.114 5-ASA drugs have also been shown to be effective at maintaining remission, and patients who achieve remission with 5-ASA should continue on the same medication.114
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What Is The Best Diet For Ulcerative Colitis
Theres no single diet that works best for ulcerative colitis. If the disease damages the lining of the colon, your body might not absorb enough nutrients from food. Your healthcare provider may recommend supplemental nutrition or vitamins. Its best to work with your provider and nutritionist to come up with a personalized diet plan.
Deterrence And Patient Education
American College of Gastroenterology has made guidelines on preventive care in patients with ulcerative colitis. These recommendations include:
- Screening for skin malignancies irrespective of the use of biological agents
- Assessing bone mineral density
- Be vaccinated against herpes zoster
- Vaccinated against pneumococcus, H. influenzae, and the flu virus
- Should not travel to areas of yellow fever without first consulting with an infectious disease expert
- Be screened for depression and anxiety
- Women with ulcerative colitis should get annual cervical cancer screening
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Surgery For Ulcerative Colitis In Kids
Talking about having surgery to treat ulcerative colitis can be difficult for kids and parents. However, surgery can be a good treatment option for some patients, especially when there is severe disease thats causing complications or a low quality of life.
Having surgery thats planned, rather than emergency surgery, gives a better chance at a good outcome. It may help to talk early on with a gastroenterologist and a colorectal surgeon about having surgery. They can answer your questions and help you make decisions as a family about when surgery should be considered.
For kids who have severe disease or complications, being treated in the hospital is a possibility. There, medications might be given intravenously, along with fluids. Extra-intestinal or intestinal complications might also be managed with other treatments or procedures.
Can I Get Surgery For My Ulcerative Colitis
Surgery is an option if medications arent working or you have complications, such as bleeding or abnormal growths. You might develop precancerous lesions, or growths that can turn into colorectal cancer. A doctor can remove these lesions with surgery or during a colonoscopy.
Research shows that about 30% of people with ulcerative colitis need surgery sometime during their life. About 20% of children with ulcerative colitis will need surgery during their childhood years.
There are two kinds of surgery for ulcerative colitis:
Proctocolectomy and ileoanal pouch
The proctocolectomy and ileoanal pouch is the most common procedure for ulcerative colitis. This procedure typically requires more than one surgery, and there are several ways to do it. First, your surgeon does a proctocolectomy a procedure that removes your colon and rectum. Then the surgeon forms an ileoanal pouch to create a new rectum. While your body and newly made pouch is healing, your surgeon may perform a temporary ileostomy at the same time. This creates an opening in your lower belly. Your small intestines attach to the stoma, which looks like a small piece of pink skin on your belly.
After you heal, waste from your small intestines comes out through the stoma and into an attached bag called an ostomy bag. The small bag lies flat on the outside of your body, below your beltline. Youll need to wear the bag at all times to collect waste. Youll have to change the bag frequently throughout the day.
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