Ulcerative Colitis

Anyone who has Ankylosing Spondylitis is at an increased risk of developing inflammatory bowel disease. This condition, caused by chronic inflammation of the intestines, includes Ulcerative Colitis and Crohn's disease. Approximately three million people in the US have been diagnosed with inflammatory bowel disease.

Ulcerative Colitis is thought to be an auto-immune disease wherein the body's immune system attacks the linings of the intestines. This usually occurs toward the end of the digestive tract, in the large bowel, including the colon, rectum, and anal canal. This part of the body is lined with a very thin layer of epithelial cells called the mucosa. These delicate tissues can develop open sores or ulcers when exposed to chronic inflammation. In Ulcerative Colitis, these sores are typically small, but they can be numerous, covering whole sections of the colon or rectum. There is no cure for Ulcerative Colitis, but treatments are available to manage this illness.

The inflammation and sores cause abdominal pain, rectal pain, rectal bleeding, persistent diarrhea (often in the middle of the night), frequent/urgent bowel movements, blood in stools, anemia, fatigue, fever, loss of appetite, and unintentional weight loss. Flu-like symptoms or constantly feeling like one is coming down with something is also reported frequently. Some patients are unable to defecate even though they experience an urgent need to go. Ulcerative Colitis can cause skin rashes, eye issues and swelling, and painful joints, as chronic inflammation can affect the entire body. Left untreated, Ulcerative Colitis can result in perforations in the colon, severe bleeding in the large intestine, a swollen colon, osteoporosis (bone loss), liver disease, chronic inflammation, an increased risk of colorectal cancer, and emergency surgery. Not to mention the significant quality of life impairment for the individual suffering. Early treatment can result in long-term remission of Ulcerative Colitis.

To pursue treatment for Ulcerative Colitis, a person must first be diagnosed. This cannot be done by a general practitioner or family doctor. If an individual wants to be evaluated for Ulcerative Colitis, they should request a referral to a gastroenterologist or GI specialist. Ulcerative Colitis can be challenging to diagnose because its symptoms mirror several other digestive tract diseases. Several tests are required for diagnosis. These include blood tests, fecal testing, a biopsy of the colon, endoscopic procedures, and/or imaging procedures. Endoscopic procedures include colonoscopy and sigmoidoscopy, which involve inserting a small tube with lights and a camera into the rectum and through the colon. This gives the doctor a view of the inside of the colon and rectum. During this procedure, the doctor can also take a small tissue biopsy sample, which is necessary to diagnose Ulcerative Colitis. Doctors may also use X-rays, CT scans, or other imaging to check for colon inflammation and perforations.

Once an individual receives a diagnosis of Ulcerative Colitis, it is critical to follow up with a specialist appointment to discuss a treatment plan. Ulcerative Colitis cannot be effectively treated with supplements, lifestyle changes, or over-the-counter medications alone. Prescription medications are required to keep this disease from destroying the colon. Treatment for Ulcerative Colitis varies depending upon the severity of the disease and can consist of several drugs and, in the most severe cases, surgery. The medications taken for Ulcerative Colitis aim to reduce inflammation.

The most common medications to treat Ulcerative Colitis are anti-inflammatories, including Disease-Modifying Antirheumatic Drugs  (DMARDS) and corticosteroids. DMARDS work by making changes within the body to reduce overall inflammation. The category used to treat Ulcerative Colitis is called aminosalicylates. These are often the first line of treatment for Ulcerative Colitis and include medications such as sulfasalazine, mesalamine, and balsalazide. Although patients tend to respond well to these medications and report few side effects, these medications can cause loss of appetite, nausea, headache, stomach upset, and abdominal discomfort. On rare occasions, they can cause diarrhea. It is essential to stay in contact with the prescribing physician anytime a patient begins a new medication and reports any side effects. It can take up to a month for these medications to improve symptoms.

When anti-inflammatories aren't enough, doctors may prescribe corticosteroids, such as prednisone and budesonide. These medications tend to have much more significant side effects and can cause dangerous bodily changes when taken for long periods. While taking corticosteroids, patients experience mood changes, more intense moods, increased thirst and hunger, weight gain, and sleep disturbances. Most of these symptoms abate within a week of stopping the steroid. Long-term, frequent use of these medications leads to bone thinning, which causes osteoporosis and can cause diabetes, especially in those already at risk of developing diabetes. They can also increase the risk of developing glaucoma and cataracts.

The third category of medications used to treat Ulcerative Colitis is called 'biologics' because they were genetically engineered in human cells to affect a specific part of the immune system that causes inflammation. They are the cutting edge in treatment and, for this reason, can be expensive or require special authorization from health insurance plans. Biologics work by suppressing a specific part of the immune system; thus, they are called immunosuppressive medications. Most patients report very few side effects from biologics. Because they function by suppressing the immune system, they can make people more susceptible to opportunistic infections, including viral, fungal, and bacterial. They may increase the risk of certain cancers, but chronic systemic inflammation has been linked to cancers, strokes, and heart attacks. It is important to note that a doctor wouldn't prescribe medication unless he or she felt that the benefits outweighed any risks.

These medications can be costly, but manufacturers can offer co-pay programs to offset most of the patient's out-of-pocket costs. This is not a part of an insurance plan. The patient must contact the medication manufacturer to find out about co-pay assistance, which can be done through the manufacturer's website. Patients may have to consider co-pay programs and the expense of medications when choosing a biologic. Doctors are not always aware of the nuances of these programs, so patients must keep their doctor informed if they need to try a different biologic to access co-pay assistance programs. Once generics are available, a medication's price drops significantly.

Severe cases of Ulcerative Colitis do not always respond well enough to medications and dietary changes, making surgery a necessity. The type of surgery depends upon the large intestine area in which the patient's Ulcerative Colitis is active and generally involves removing part or all of the colon and/or large intestine. This can result in the patient being fitted with a colostomy bag, an external sack that essentially takes the place of the colon and its role in storing waste products from the body. Some doctors believe that surgically removing the entire colon "cures" Ulcerative Colitis. However, if Ulcerative Colitis is a systemic inflammatory disorder that can affect the whole body, removing the large intestine will not resolve 100% of Ulcerative Colitis issues but only those associated with the colon. There can still be lingering symptoms of chronic inflammation present in the rest of the patient's body post-surgery, which may require continued use of medications. Fortunately, surgery can significantly improve the quality of life for those with the most severe form of Ulcerative Colitis life.

Although Ulcerative Colitis cannot be controlled by diet alone, certain foods exacerbate symptoms. Some foods that are very healthy for most people can trigger an Ulcerative Colitis flare. High-fiber foods, such as breakfast cereals and whole grains, nuts, and seeds, are difficult for someone with Ulcerative Colitis to digest and should be avoided. The same is true for high-fiber vegetables, particularly in raw form (celery, onions, broccoli, brussels sprouts, cabbage). Saturated and trans fats, known as unhealthy fats, can worsen symptoms.

Some studies have also shown that palm oil, coconut oil, and dairy increase flares. Alcohol, caffeine, dairy, and spicy foods can exacerbate symptoms. Often foods that irritate Ulcerative Colitis vary from person to person. Because of this, it is crucial to keep a journal of all foods consumed and daily symptoms. This is a handy tool for establishing which foods to avoid.

Like many illnesses, Ulcerative Colitis can be worsened by stress. Mindfulness practices can help control stress levels and improve quality of life. Daily meditation and deep breathing exercises are great places to incorporate mindfulness into everyday life. Many patients also benefit from CBT or cognitive behavioral therapy. This therapy targets how a person thinks and behaves and provides new skills to better manage stressors. CBT is not only proven helpful to those with stress, anxiety, and depression but also offers many benefits for those living with chronic illnesses. Exercise can also assist in stress relief, but it is important to start gently, especially if the patient has any joint inflammation.

Watch the YouTube video below to follow David's journey and learn how comprehensive and compassionate care helped him recover from Ulcerative Colitis.

I'm Ed Smith, a Personal Injury Attorney in California. If you have been in a motor vehicle accident and have experienced a worsening of your Ulcerative Colitis or Ankylosing Spondylitis condition, please call our law office at (916) 921-6400 or (800) 404-5400 for free, friendly advice.

See our case history of Verdicts and Settlements.

Photo by CDC on Unsplash.com

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