Ulcerative colitis is a condition that affects your colon and rectum. Its symptoms vary based on how severe it is. They can range from mild cases with a few stomach cramps and constipation, to more severe symptoms such as anemia or weight loss. In all cases of ulcerative colitis, you may go through periods of remission, have less symptoms, or your symptoms may worsen.
To understand how doctors group ulcerative colitis, it’s helpful to know about a few terms first:
C-reactive protein (CRP). This test measures the level of a protein (C-reactive protein) that your liver makes. It does this in response to inflammation or infection.
Erythrocyte sedimentation rate (ESR). This measures the level of inflammation in your body. It looks at how fast your red blood cells settle in your blood.
Systemic toxicity. This means toxicity (something that is poisonous) at a cell level that can cause an organ to fail.
Levels of Severity
The definitions of moderate and severe ulcerative colitis may vary between different doctors. A diagnosis of mild ulcerative colitis is more clear, since symptoms aren’t as intense. Doctors grade your condition based on your symptoms and some lab tests.
Mild ulcerative colitis. This is the most common version. Over half of everyone with the condition has a mild form. Your doctor will diagnose you with mild ulcerative colitis if you have:
- Four or less bowel movements a day (with or without a small amount of blood)
- No signs of systemic toxicity (for example, no tachycardia, which is when you have a heart rate over 100 beats per minute)
- A normal CRP and/or ESR
With the mild form of this condition, you may notice symptoms like:
- Slight cramping pains in your abdomen
- A repeated and painful urge to move your bowels without being able to go
- Periods of constipation
Moderate ulcerative colitis. Doctors consider you to have moderate ulcerative colitis if:
- You have more frequent bowel movements (four to six a day)
- There are very little or no signs of systemic toxicity
- Your body keeps in nutrition and you don’t lose weight without trying
With moderate ulcerative colitis, your symptoms will be slightly more intense. You may have:
- Bloody stools
- Mild anemia
- Pain in your abdomen (but not severe pain)
Severe ulcerative colitis. Severe ulcerative colitis causes the most intense symptoms. Your doctor will group your condition as severe if you have:
- Loose and bloody stools more often (six or more a day)
- Clear signs of systemic toxicity (you’ll have a fever equal to or over 100 F or 37.8 C)
- Severe anemia
Other symptoms of severe ulcerative colitis include:
- An elevated CRP or ESR
- Severe cramps
- Weight loss
If your doctor diagnoses you with ulcerative colitis, you may be at any one of these stages. You could have a severe form of the condition right after you find out you have it. But in other cases, you may start off with a mild form. Over time, it’s common that your condition will progress into moderate or severe ulcerative colitis.
There are a few different indexes (or scores) that experts use to organize ulcerative colitis symptoms.
For example, there might be slight differences between the Truelove and Witts severity index, the Mayo Clinic score, and the Montreal classification.
What Are the Different Types of Ulcerative Colitis?
While ulcerative colitis severity describes the level of your symptoms, the type of your condition refers to how far it’s spread and which parts of your body it involves. The types of this condition tie to different levels of severity.
Your doctor will perform a colonoscopy with a biopsy to find out which you have. There are four main types of ulcerative colitis:
Ulcerative proctitis. If you have this form, it means the disease is only in your rectum. Your symptoms will most likely be more mild.
Ulcerative proctosigmoiditis. With this form, your ulcerative colitis affects your rectum and sigmoid colon (the end part of your large intestine). But it doesn’t involve your descending colon (the left part of your colon that moves downward). This type may happen with more severe symptoms.
Left-sided colitis. In this group, it goes beyond your sigmoid colon. It may go as far as your splenic flexure (the part of your large intestine that bends near your spleen) or 60 centimeters past your anal verge (where your anal canal connects to the outside skin of your anus). Left-sided colitis is usually more severe than the previous two types.
Extensive colitis or pancolitis. This form extends around your splenic flexure or 60 centimaters past your anal verge. If the condition affects your entire colon, experts call it “pancolitis.” This form has more intense symptoms.
Your doctor may also look at how intense your inflammation is. They’ll use the endoscopic evaluation for mucosal ulcerations and disease extent to do this. There are a few different scores to review this, but the Mayo endoscopic score of activity is common. This ranges from 0 to 3.
How Does the Severity of Your Ulcerative Colitis Affect Treatment?
There’s no cure for ulcerative colitis. But treatments can help ease your symptoms, inflammation, and treat underlying conditions. With any form of ulcerative colitis, the goal is to go into remission and stay there. Certain medications work well to ease mild-to-moderate symptoms. There are also treatment options for more severe ulcerative colitis.
To improve your quality of life, your doctor may suggest:
Aminosalicylates. If you have mild to moderate ulcerative colitis, sulfasalazine (Azulfidine) may help your symptoms. Make sure to let your doctor know if you’re allergic to sulfa. If you are, they can give you alternatives.
You’ll take these drugs in capsule form through your mouth. They also come in a rectal form (a suppository or enema formulation), which means you’ll put it in your bottom.
Corticosteroids. For severe cases of ulcerative colitis, your doctor might suggest prednisone (Deltasone) or budesonide (Entocort EC, Uceris). These drugs have serious side effects though. Your health care team will only suggest them for short-term use. They’ll give you other drugs to help keep you in remission.
You can take these medications through your mouth, bottom, or through an injection.
Biologics. These are good options for moderate to severe ulcerative colitis. They target parts of your immune system to ease symptoms. Some you might try are adalimumab (Humira), certolizumab pegol (Cimzia), golimumab (Simponi), or others.
Your doctor will give these to you through an IV. You may be able to give yourself these medications if your doctor allows you to do so.
JAK inhibitors. Janus kinase inhibitors can stop an enzyme (or chemical) in your body that triggers inflammation. You might try tofacitinib (Xeljanz).
You’ll take these drugs in a tablet form by mouth.
When you begin treatment for ulcerative colitis, ask your doctor about vitamins that may also help. Your body may lose nutrients due to your disease (this is especially common in children with the condition). Your doctor can recommend supplements that can keep you healthy alongside your treatment plan.