Anal Pain

Ulcerative colitis is inflammation of the lining (mucosa) of the large intestine or colon.

What is the cause of ulcerative colitis?

The cause is unknown.  It does not appear to be contagious or hereditary.  It is rare for more than one family member to have the condition.  Diet is not a contributing factor.  It may follow acute diarrhoea.

How common is ulcerative colitis?

Ulcerative colitis is a rare disease, affecting approximately 5 in 100,000 people.  Males and females are equally affected.

Ulcerative colitis and the bowel?

Only the large bowel is involved.  Inflammation may start at the rectum and extend to the beginning of the large bowel (caecum).  If the caecum is involved it is called pancolitis.  If only the rectum is involved, it is proctitis.  Ulcerative colitis is comparable to a “burn” of the inner lining of the bowel resulting in inflammation and shallow ulceration.  This causes diarrhoea, bleeding and mucous.  Given time, a patient may become anaemic.

Other problems

Occasionally liver disease, eye inflammation, arthritis, and skin lesions may occur.  Ulcerative colitis is a pre-malignant disease, and the incidence of colon cancer progressively increases with the duration of the disease.

Symptoms

Symptoms are many and varied.  They can include episodic or continuous diarrhoea with blood and mucus, urgency to defaecate, with cramping lower abdominal pains.  Symptoms can be mild or severe, with multiple bowel actions each day.  Patients can feel completely normal or become very ill.  Episodes can be life-threatening.  The illness may be continuous or relapse.

Diagnosis

Diagnosis is based on the clinical picture and the appearance of the large bowel mucosa at colonoscopy.  Biopsies are taken.  In the earliest stages of the disease it is sometimes confused with other conditions.  There are no diagnostic blood tests.

Treatments

Medications can be very effective.  Anti-inflammatories are necessary either in the form of local rectal preparations or tablets.  Sometimes immune-suppressants are needed.  Iron tablets, anti-diarrhoeals and good nutrition are all helpful.  There is no known cure for ulcerative colitis other than surgical removal of the large bowel.  Biopsies looking for potential malignant change are usually undertaken at appropriate intervals in patients who have longstanding disease.

Surgery

Surgery may be needed when medical treatment can no longer control the symptoms, and may be used in to prevent complications such as haemorrhage, acute toxic colitis and cancer.  If surgery is indicated, the aim will be to remove all the large bowel, and this will be done in one or more procedures.

Following a total colectomy you may have a permanent ileostomy (bag at the end of the small bowel).  However, many patients are suitable to be considered for a restorative operation involving the construction of an internal “pouch” (made from the patient’s small intestine to act as a new storage pouch and eliminate the need for a stoma (abdominal bag).  In this way, the anal sphincter muscles are preserved to maintain continence.  This operation is not suitable for all patients and is more complex than a permanent ileostomy.  It does result in a variable number of bowel motions in a 24 hour period.  If cancer is involved, other surgical intervention may be recommended.

Prognosis

Removal of the diseased bowel removes the risk of cancer.  Life expectancy should be normal.

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