Causes of ulcerative colitis
The causes of ulcerative colitis are currently unknown. Symptoms of ulcerative colitis may be the result of problems with the immune system, though it is not known whether or not these immune system problems actually cause the disease.

There are two periods in life when ulcerative colitis is more likely to develop. The first of these is between fifteen and thirty years of age, the second is between fifty and seventy years. There is some evidence of a genetic component in the disease as some populations or ethnicities are at greater risk of developing it than others.

What to expect
Symptoms affect sufferers differently. Fifty percent of sufferers experience a milder form of the disease, with the remaining fifty percent suffering more aggressive symptoms.  These include:

• Cramps and abdominal pains.
• Inflammation of the skin, eyes and joints.
• Stools (poo) with pus, mucus and blood.
• Diarrhoea.
• Weight loss.
• Fever.
• Tenesmus (the feeling of constantly needing to pass stools, often with pain).
• In children: Inhibited growth and development.
• Urgency and incontinence.

Typically the disease begins at the rectum, the area of lower bowel near to the anus, and can spread, involving progressively more of the colon. In some patients the disease is limited to the rectum whilst in others it can develop to involve the whole left hand side of the large bowel, known as left-sided disease. In some sufferers the disease can cover the whole of the colon (large bowel) when it is called pan-colitis (or extensive colitis).

After many years of inflammation, the colon is at higher risk of changes that can lead to colon cancer. Patients therefore undergo examination of the colon to check on the disease and to look for any changes that might indicate cancer risk.

Testing for ulcerative colitis
Colonoscopy with biopsy is used to diagnose ulcerative colitis, and subsequently to test sufferers for risk of colon cancer. During a colonoscopy a small tube with a camera at the doctors’ end is inserted in to the anus so that a doctor can examine the colon visually and take photographs or video of the colon. 

Treatment
Treatment of ulcerative colitis can be both reactive, to treat flare-ups and bring patients in to remission, and proactive, to maintain remission. There are steps that sufferers can take to assist medical treatments.

Lifestyle suggestions
Flare-ups of the disease can be triggered or made worse by outside factors such as diet or stress, though they don’t cause of the disease itself.

Certain foods can provoke flare ups and this varies from sufferer to sufferer. Patients tend to avoid these after some trial and error.

Some sufferers find the disruptive symptoms of ulcerative colitis distressing and embarrassing. Many hospitals have specialist nurses to advise sufferers. There are also charities to assist and support ulcerative colitis sufferers:

UK: Crohn’s and Colitis UK (NACC) www.nacc.org.uk

EU: European Federation of Crohn's and Ulcerative Colitis Associations (EFCCA) www.efcca.org

USA: the Crohn's and Colitis Foundation of America (CCFA) www.ccfa.org  

Medical solutions
Certain medicines are used to treat and reduce the severity of flare-ups. Others are used to try to reduce the number of attacks suffered by a patient. These include:

• 5-aminosalicylic acid (also known as mesalazine or mesalamine) administered either as oral tablets or suppositories or liquid enema inserted directly into the back passage (rectum).
• Corticosteroids like prednisolone administered as tablets or as an enema.
• Immunomodulators such as azathioprine and 6-mercaptopurine.
• Biologicals such as infliximab as a treatment for patients whose disease is not controlled by other medicines.

Surgery is currently the only cure for ulcerative colitis. Many patients undergo a ‘colectomy’, which means surgical removal of part orall of the colon. Colectomised patients may receive a stoma, where the end of the intestine is brought to the wall of the belly or abdomen where the contents of the intestine are collected in a disposable plastic bag. This operation is called a colostomy or ileostomy depending on what part of the bowel is connected to the wall of the belly. Alternatively an artificial rectum is created, called a pouch, where a loop of small bowel (intestine) is used to make an artificial internal bag to hold the contents of the intestine which is then connected to the anus.

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