Expert Answers to Questions About Ulcerative Colitis

When you find out that you have ulcerative colitis (UC), that explains why you have symptoms like diarrhea and abdominal cramps. But you probably still have questions about things like food, stress, and how likely your kids are to get UC.

Sushila Dalal, MD, an assistant professor of medicine at the University of Chicago, sets the record straight about the condition.

What's the difference between ulcerative colitis and Crohn’s disease?

Both diseases involve inflammation in the digestive tract, but they affect different parts.

Ulcerative colitis is found only in the colon, or large intestine. It only affects the inner lining of the colon.

Crohn's disease can affect any part of the gastrointestinal tract, from the mouth to the anus. And it can involve all layers of the bowel wall.

How similar are UC and irritable bowel syndrome (IBS)?

Ulcerative colitis is one type of inflammatory bowel disease (IBD). Something in the environment triggers the immune system to react and damage the digestive tract. Certain people are more likely to have this immune system response because of genes they've inherited.

Irritable bowel syndrome (IBS) involves bowel symptoms like cramps, abdominal pain, bloating, gas, and diarrhea. But it's not caused by changes to the GI tract from an immune system response.

Each condition is treated in a different way. With IBS, the goal is to manage symptoms. IBD is treated with medicines that dampen the immune system response, and sometimes surgery to remove the damaged bowel section.

Is ulcerative colitis hard to diagnose?

No, it's usually not. Symptoms like bloody diarrhea will often prompt the doctor to do a colonoscopy. Once people have this test, the diagnosis is pretty clear-cut.

But sometimes it can take a little longer to diagnose ulcerative colitis in teenagers. Doctors might think something else is to blame for the symptoms in a young, healthy person and not send them for a colonoscopy.

Can ulcerative colitis shorten someone's life?

No. Doctors can manage it with medicine and other treatments.

If someone has ulcerative colitis, how likely is it that their children will get it?

Genes are involved in ulcerative colitis, but they play a pretty small part in the disease. About 200 genes have been discovered that are related to IBD (ulcerative colitis and Crohn’s disease). No single gene causes the condition.

Children of a parent with ulcerative colitis have only about a 2% increased chance of getting IBD. Some environmental trigger has to happen on top of the genes, and we don't know exactly what those triggers are at this point.

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Does the disease tend to get worse over time, or does it come and go?

Symptoms do come and go, but ulcerative colitis is a chronic condition, which means it never goes away completely. People have to stay on medicine to go into remission and stay well long-term.

How does stress affect ulcerative colitis?

When people with UC have a disease flare, there's a good chance something stressful has happened in their life. Stress doesn't alter the immune system and change the disease course. But it can trigger symptoms.

What are the most common mistakes people make in managing their ulcerative colitis?

The worst mistake is not taking medicines regularly. When you feel well, you might not think you need them. But the medicine is keeping you well, so it's important to stay on it.

Can certain foods make ulcerative colitis worse?

Diet will affect your symptoms, but it’s not going to affect the underlying disease. It’s like putting lemon juice on a cut. You'll hurt more, but the lemon juice won't make the cut worse.

Certain foods, like fiber, grease, and coffee, can cause more bowel movements. When patients are in a flare, we tell them not to eat these foods to help manage their symptoms.

Does having ulcerative colitis increase the risk for colon cancer?

Having uncontrolled inflammation can lead to cancerous changes in the colon. Even if you are doing well with ulcerative colitis symptoms, you still need to see a gastroenterologist regularly to monitor you for precancerous changes in the colon.

Is there any cure for ulcerative colitis?

There is no [medication that cures] ulcerative colitis at this time. However, surgery to remove the entire colon and rectum (called a proctocolectomy) provides a surgical cure.

WebMD Feature Reviewed by Minesh Khatri, MD on October 14, 2018

Sources

SOURCES:

Sushila Dalal, MD, assistant professor of medicine, University of Chicago.

Cedars-Sinai: “M.I.R.I.A.D. Biobank.”

Crohn’s and Colitis Foundation of America: “Bringing to Light the Risk of Colorectal Cancer among Crohn’s & Ulcerative Colitis Patients,” “Fact Sheet -- About Surgery for IBD,” “Living with Ulcerative Colitis.”

Molodecky, Natalie A. Gastroenterology & Hepatology, May 2010.

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