Ulcerative colitis is a chronic disease of the colon (large intestine), in which the lining of the colon becomes inflamed and develops small sores or ulcers that produce pus or mucous. The inflammation and ulcers can cause significant abdominal discomfort and frequent emptying of the colon.
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Though researchers are making progress in understanding and effectively treating ulcerative colitis, it is still difficult to predict how the disease will affect each person. The type and severity of symptoms, the location of the inflammation in the colon and the response to treatment all vary from person to person. So, to better understand how ulcerative colitis specifically affects you and what you can do to effectively manage your unique symptoms, you need to learn as much as you can. This deeper knowledge will empower you in your management choices and enhance your ability to communicate with your healthcare team. Let’s start by distinguishing the different types of ulcerative colitis.
Types of ulcerative colitis
Though ulcerative colitis is typically discussed as if it is one disease, there are actually several types that are classified by the location of the inflammation within the colon. Your symptoms and possible complications may differ depending on which part of the colon is affected.
- Ulcerative proctitis. This type of ulcerative colitis is characterized by inflammation, redness, and ulcerations of the lining of the rectum (the last six inches of the large intestine). Ulcerative proctitis tends to be a milder form of ulcerative colitis with fewer complications and is typically more easily treated. Approximately 30% of those diagnosed with ulcerative colitis have this type. Symptoms include: diarrhea, bleeding, persistent urge to empty bowel, rectal pain and mucous discharge.
- Proctosigmoiditis. This type of colitis affects the rectum and sigmoid colon (the portion of the colon located right above the rectum). Symptoms include bloody diarrhea, cramps, and a persistent urge to empty bowel. When the disease is active, you may experience pain on the lower left side of the abdomen.
- Left-sided colitis. In this type of ulcerative colitis, there is continuous inflammation that begins at the rectum and extends up the entire left side of the colon to the first major bend (near the spleen and stomach). Symptoms include: loss of appetite, weight loss, diarrhea, pain on the left side of the abdomen and bleeding.
- Pan-ulcerative (total) colitis. This type of colitis affects the entire colon and is potentially serious because it can lead to massive bleeding and severe dilation of the colon (called toxic megacolon). Symptoms include diarrhea, severe abdominal pain, cramps and extensive weight loss. In some cases, serious complications may require surgery.
Differences in treatment approaches
Because ulcerative colitis manifests differently in each person, there is also no one treatment regimen that fits every person. The symptoms differ by the type of ulcerative colitis that you have and where the inflammation is located. Most people have symptoms that tend to come and go, often with long periods between flare-ups. During these periods of remission, which may last months or even years, there may be only short-lived mild symptoms or no symptoms at all. Others have frequent flare-ups. Because there is so much variance between people with ulcerative colitis, each approach to treatment must be individualized.
Many individuals with ulcerative colitis respond well to medical treatment that involve one or more medications and never need surgery. Others will go on to require surgery, which involves removal of the entire colon.
Ulcerative colitis needs to be approached as a disease that can manifest in any number of ways. The symptoms, progression of the disease and treatment approach that applies to one person may be very different for someone else. You may even find that what works for you now may need to be modified over time due to complications that develop. But, the more you know, the greater your confidence will be that you can still live well with ulcerative colitis.