Ulcerative Colitis (cont.)
What are the Symptoms of Ulcerative Colitis?Common symptoms of ulcerative colitis include rectal
bleeding and diarrhea, but there is a wide range of symptoms among patients with
this disease. Variability of symptoms reflects differences in the extent of
disease (the amount of the colon and rectum that are inflamed) and
the intensity of inflammation. Generally, patients with inflammation confined to
the rectum and a short segment of the colon adjacent to the rectum have milder
symptoms and a better prognosis than patients with more widespread inflammation
of the colon. The different types of ulcerative colitis are classified according
to the location and the extent of inflammation:
- Ulcerative proctitis refers to inflammation
that is limited to the rectum. In many patients with ulcerative proctitis,
mild intermittent rectal bleeding may be the only symptom. Other patients
with more severe rectal inflammation may, in addition, experience rectal
pain, urgency (sudden feeling of having to defecate and a need to rush to
the bathroom for fear of soiling), and tenesmus (ineffective, painful urge to move one's bowels).
- Proctosigmoiditis involves inflammation of the rectum and the sigmoid
colon (a short segment of the colon contiguous to the rectum). Symptoms of
proctosigmoiditis, like that of proctitis, include rectal bleeding, urgency,
and tenesmus. Some patients with proctosigmoiditis also develop bloody
diarrhea and cramps.
- Left-sided colitis
involves inflammation that starts at the rectum and extends up the left colon
(sigmoid colon and the descending colon). Symptoms of left-sided colitis
include bloody diarrhea, abdominal cramps, weight loss, and left-sided
abdominal pain.
- Pancolitis or universal colitis
refers to inflammation affecting the entire colon (right colon, left colon,
transverse colon and the rectum). Symptoms of pancolitis include bloody
diarrhea, abdominal pain and cramps, weight loss, fatigue, fever, and night
sweats. Some patients with pancolitis
have low-grade inflammation and mild symptoms that respond readily to
medications. Generally, however, patients with pancolitis suffer more severe
disease and are more difficult to treat than those with more limited forms of
ulcerative colitis.
- Fulminant colitis
is a rare but severe form of pancolitis. Patients with fulminant colitis are
extremely ill with dehydration, severe abdominal pain, protracted diarrhea
with bleeding, and even shock. They are at risk of developing toxic megacolon
(marked dilatation of the colon due to severe inflammation) and colon rupture
(perforation). Patients with fulminant colitis and toxic megacolon are treated
in the hospital with potent intravenous
medications. Unless they respond to treatment promptly, surgical removal of
the diseased colon is necessary to prevent colon rupture.
While the intensity of
colon inflammation in ulcerative colitis waxes and wanes over time, the location
and the extent of disease in a patient generally stays constant. Therefore, when
a patient with ulcerative proctitis develops a relapse of his disease, the inflammation usually is confined to the rectum. Nevertheless, a small number
of patients (less than 10%) with ulcerative proctitis or proctosigmoiditis can
later develop more extensive colitis. Thus, patients who initially only have
ulcerative proctitis can later develop left-sided colitis or even pancolitis.
Next: How is the diagnosis of ulcerative colitis made? »
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