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Colitis

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Introduction
Ulcerative Colitis is a type of IBD- inflammatory bowel disease causing bowel inflammation, pain, diarrhoea, or rectal bleeding. Colitis generally starts with the rectum and lower intestine sigmoid tissue inflammation that quickly spreads to the colon and causes severe diarrhoea with blood clots, pus and mucus. Hence it is called infectious colitis.

Ulcerative Colitis Causes (In Adults/ Babies/ Pregnant Women)
In Adults
The exact causes are unidentified at present. It generally is triggered by bacterial and virus infections affecting all males/females/children, especially those in the 15 to 30 age group. The inflammation may go unnoticed until severe and leads to immunity deficiency, colon cancer, pernicious and chronic anaemia, etc.

In Babies
It is rare in infants and can be found in young children since it has a genetic disposition to run among family members. Symptoms can be managed with long-term care and medications but ultimately may need surgery, as they generally reoccur. About 1 in 50 of the 2-4 aged children need surgery due to risk of colon cancer, side effects, heavy bleeding, severe illnesses, colon perforation etc.

In Pregnant Women
Women, who have Crohn’s disease or IBD and get pregnant, have a tough time managing the symptoms and avoiding the flaring up of Colitis during pregnancy. Chronic digestive disorders, loss of blood supply and infections of the bowels can cause it. Pregnant women stand a definite risk of preterm deliveries, cleft palate in the baby, delivery/ labour complications, anaemia etc., even when the disease is well-managed.

Ulcerative Colitis Symptoms:
Symptoms can differ in adults, kids and pregnant women. They include
●Bloody diarrhoea.
●Stomach pain.
●Fatigue.
●Loss of appetite.
●Weight loss.
●Rectal bleeding.
●Anaemia caused by severe bleeding.
●Dehydration and loss of body fluids and nutrients.
Some children may complain of
●Inflammation of the eyes
●Rashes and skin lesions.
●Liver problems
●Joint pain
●Osteoporosis
●Kidney stones
The ulcerative colitis symptoms look like several other symptoms. It can lead to severe complications and is an emergency. Midas Hospitals suggests calling and consulting with your doctor for diagnosis, evaluation and treatment as early as possible to treat for IBD and a flare-up in ulcerative colitis.
How Is Colitis Diagnosed?
A proper diagnosis of colitis starts with a
Physical examination: The doctor will ask and answer all your questions. He will also check for medical health history, symptoms and examine the belly area. He may order:
●Blood tests such as the blood picture, total count, RBC, WMC counts, haemoglobin levels etc., to detect infections and check for anaemia.
∙€Stool and urine tests.
Imaging tests:
∙Upper GI endoscopy where an endoscope with a camera is non-invasively used/ swallowed and used to look inside the digestive tract and collect tissue samples.
∙Colonoscopy, like endoscopy, uses a colonoscope used through the rectum to study the colon.
A biopsy involves a small tissue sample collected during endoscopy/ colonoscopy using scrapings and needle biopsy techniques.
Barium meal enema (lower GI series) involves using a Barium meal as an enema followed by an x-ray to study the lower GI tract and large intestine.

Colitis Treatment:
Treatment depends on the severity of the disease, age, symptoms, and general health conditions. Ulcerative Colitis will need surgery though the symptoms are often managed by
A healthy diet:
Your diet may not help but can avoid triggers. Diet changes are advised by the gastroenterologist and may include supplements, vitamins etc., to be strictly taken as per the doctor’s prescriptions and not on a self-help basis.
Infectious Colitis Treatment Medicines:
Doctor’s may use the following medications to control bowel inflammations.
●(5-ASA) or 5-aminosalicylic acid-containing mesalamine, balsalazide, sulfasalazine, olsalazine used as suppositories, pills etc. If allergic to sulpha drugs, let your doctor know it.
●Corticosteroids are anti-inflammatory drugs used to suppress severe symptoms and may have long-term effects/ complications.
●Immuno-suppressants may be used where 5-ASA/ corticosteroid drugs are contraindicated and include medications like 6-mercaptopurine, cyclosporine, Envarsus XR, tacrolimus, azathioprine, Prograf etc.
●Biologics are drug groups that include Humira, Cyltezo, Amjevita, pegol, Simponi Aria, Renflexis, Remicade, Inflectra, Stelara, Avsola, Entyvio etc.
●JAK or Janus kinase inhibitors are effective oral pills like Xelijanz.
●New modulator groups like oral pills of receptor modulators (sphingosine 1-phosphate) to be taken to create antibodies.
The doctor may recommend a hospital stay for pregnant women and children especially, to ensure they get the required nutrition, stop diarrhoea, dehydration or emergency surgeries.
Surgery may involve
●Ileostomy and Proctocolectomy, where the entire rectum and colon are removed through a small incision in the abdomen. The Ileum/small intestine is connected to an external bag to allow the draining of waste.
●Ileoanal anastomosis involves the removal of the affected colon part and the insertion of a rectal pouch to hold the waste. The rectum muscles aren’t removed, so the anus can be used for defecation and may involve 2/3 surgery stages.

Warning Signs:
Call for an emergency doctor’s help if you have any new symptoms or when you have:
●Blood in the stools or rectal bleeding.
●Persistent diarrhoea and dehydration.
●Constant abdominal pain and high fever.
In rare cases, death may occur. If colitis is widespread, you could be at risk for colon cancer. Pregnant women will need to avoid flare-ups of IBDs and require immediate hospitalisation.
Note: If you notice persistent IBD symptoms, Midas Hospitals recommends that you consult a doctor immediately.

Conclusion:
If you are experiencing the symptoms mentioned, get in touch with Midas Hospitals for evaluation. Since it’s problematic to assess the severity of these symptoms, a diagnosis/surgery becomes essential, and you are advised against any self-help decisions.

FAQs:
What can I do to help my child with Colitis?
Here are some tips.
●Discuss your doubts, questions etc., with the doctors to understand the outcome, side-effects, financial limitations etc.
●Note down newer approaches, medicines, tests or treatments and ask if any alternative methods are available.
●Understand what happens when medications are not taken, how the tests help and get the contact number of an emergency line to your doctor.
●Contact reliable teams of doctor’s and not just one doctor.
What are safe medicines to use during nursing and pregnancy?
Generally, doctors may prescribe 5-ASA Aminosalicylates/ compounds or corticosteroids, which are safe for developing babies and breastfeeding during pregnancy and nursing.
Can UC cause miscarriage?
Controlling UC when pregnant and nursing is crucial for women with IBD. They often risk preterm deliveries, miscarriages and babies having a low birth weight.
What foods should I avoid with ulcerative colitis?
Foods rich in sulfides and sulfates, alcohol, smoking, teas, sodas, coffee, red meat, beer, dairy milk, grape and apple juice, eggs, vegetables like cauliflowers, cheese, well-water and dried fruits are best avoided.
How can you calm a flare-up of colitis at home?
Try a saltwater bath and take pain killers like acetaminophen if advised by the doctor. Do not take OTC NSAIDs such as naproxen/ ibuprofen as they cause other complications and trigger the flares.

Reference:
https://docs.google.com/spreadsheets/d/1kblLjTTnmPbcJFuZQ0piYRbs3sBKCxWw/edit#gid=1586350786
https://www.webmd.com/ibd-crohns-disease/ulcerative-colitis/digestive-diseases-ulcerative-colitis-treatment
https://www.stanfordchildrens.org/en/topic/default?id=ulcerative-colitis-in-children-90-P02020
https://www.urmc.rochester.edu/encyclopedia/content.aspx?contenttypeid=90&contentid=P02020#:~:text=Ulcerative%20colitis%20is%20an%20inflammatory,have%20stomach%20pain%20and%20diarrhea.