Ulcerative colitis is a type of inflammatory bowel disease. It causes swelling, irritation, and sores in the lining of the colon, or large intestine. It’s more common in adults, but children and teens can get it, too.
Ulcerative Colitis Symptoms in Children
Your child’s symptoms can range from mild to serious. Bloody diarrhea is the most common sign.
Other symptoms include:
- Stomach tenderness, pain, and cramps
- An urgent need for bowel movements
- A feeling of incomplete bowel movements
- Poor appetite
- Weight loss
Your child may also have:
- Red, irritated eyes
- Swollen or painful joints
- Rashes or other skin problems
- Mouth sores
- Liver problems
- Kidney stones
How Common Is UC in Children?
Ulcerative colitis is relatively rare in younger kids, though it’s a little more common in teens. Symptoms in children are often worse than in adults. The younger your child is when their doctor diagnoses the condition, the more likely they are to have serious symptoms.
Diagnosing UC in Children
Your child’s doctor can’t diagnose ulcerative colitis with a single test, and some other diseases have similar symptoms. This means your child’s doctor may need to use several methods to rule out other conditions and make a diagnosis.
Your child’s doctor will start with a physical exam and ask you and your child about past and present symptoms and conditions. Ulcerative colitis can run in families, so your child’s doctor will ask if you or another relative has ever had similar symptoms.
Your child’s doctor may also recommend one or more tests. These can include:
Blood tests. These look for signs of inflammation and anemia.
Stool tests. These check for blood and signs of infection.
Colonoscopy or sigmoidoscopy. For a colonoscopy, your child’s doctor will insert a long, flexible, lighted tube with a camera at one end through your child’s rectum to look inside their colon. The doctor may also remove and test a small amount of your child’s colon tissue. A sigmoidoscopy works almost the same way but checks only your child’s lower colon and rectum.
Upper endoscopy. Your child’s doctor will insert a flexible tube through your child’s mouth to check their upper digestive system.
Imaging tests . Your child’s doctor may use one of several methods to take detailed pictures of your child’s digestive system.
Ulcerative Colitis Treatments in Children
First, your child’s doctor will work to ease or stop your child’s symptoms and to help their colon heal. Once your child’s disease is under control, their doctor will work to head off future flares. Your child will need regular visits with their doctor, who will watch for new symptoms and for those that get worse.
The treatments your child’s doctor recommends depend on your child’s age, symptoms, and how serious their ulcerative colitis is. Your child may need a combination of treatments. Options include medications, changes in diet, and surgery.
Medications. One or more of these drugs can ease your child’s symptoms, lower inflammation, and help their colon heal:
Aminosalicylates. These drugs lower inflammation.
Corticosteroids. Steroids also reduce inflammation, but they can cause unwanted side effects, so your child’s doctor won’t use them for long periods.
Immunomodulators. These drugs act on the immune system to lower inflammation.
Biologics. These IV medications calm the immune system and lower inflammation.
How to Help Your Child With Ulcerative Colitis
Dealing with ulcerative colitis, like any long-term condition, can be stressful for your child and your family. It helps to do these things, in addition to keeping up with your child’s medical care:
Learn about ulcerative colitis. The more you and your child know about the condition, the better you can manage it.
Get support. Support groups and health care professionals such as social workers and psychologists can help you and your child manage emotional and social issues. Ask your child’s doctor how to connect with these resources.
Make stress management a habit. Stress doesn’t cause UC, but it can trigger a flare-up. There are many positive ways to handle stress, including exercise, taking time to relax, hobbies that your child enjoys, and enjoying healthy relationships.
Inform others. Tell your child’s teachers and other caregivers about your child’s ulcerative colitis and how they can help your child manage it when you’re not there.
Pouchitis. If the UC is severe enough that surgery is needed to remove the entire large intestine (total proctocolectomy), then the surgeon will create a “pouch.” After the removal of the colon, the surgeon uses the end of the small intestine to create the pouch that connects to your anus which helps store and pass your stools. Inflammation of this pouch is called pouchitis.
Toxic megacolon. It happens when irritation and inflammation from UC expands (“dilates”) all or part of your colon to wider than normal and starts to push toxic substances throughout your body. It requires immediate care because it could lead to tears in the digestive tract, blood loss, and a serious condition called sepsis, in which your body overreacts to toxins and inflames your entire body.
Cancer. UC raises your risk of colorectal cancer 10 years after diagnosis. About 5% of kids who get UC before age 14 will have colorectal-cancer at age 20. About 40% will have it at age 35.
Arthritis. The most common complication that happens outside of the digestive tract is arthritis. It occurs in up to a quarter of adolescents with ulcerative colitis. The arthritis usually passes and doesn’t deform any joints. In some cases, your child may get arthritis several years before GI symptoms of UC start.
Diet Changes for Kids With UC
Foods that are harder to digest may be a bad idea for kids with UC. This is especially true for those with a narrowing intestinal area or “stricture.” Foods to avoid might include:
- Any foods that cause stomach upset
- Anything with lots of fiber
- Uncooked vegetables
- Nuts and seeds
Anyone with a possible blockage (obstruction) in their digestive tract or toxic megacolon should get medical help before eating anything at all as it may not be safe.
When to Check in With the Doctor
It’s important to have regular checkups with your gastroenterologist (or pediatric gastroenterologist, for kids) if you or your child has ulcerative colitis. Call your doctor right away with any new UC symptoms or if you feel very sick or can’t go to the bathroom.
Children with a pouch after colon surgery should get an endoscopy every 2 years. This should shorten to every year if there is regular inflammation of the pouch (pouchitis).