What is Ulcerative Colitis? Risk Factors & Symptoms

Ulcerative Colitis is a chronic inflammatory bowel condition that leads to symptoms of diarrhoea, cramping and blood in the stool.

While the exact cause is unknown it leads to inflammation along the lining of the large intestine, also called the colon. There are various risk factors and symptoms for this bowel condition.

Ulcerative Colitis Explained

The symptoms of ulcerative colitis are for the most part in the digestive system, however, it is triggered by the immune system. This is described as an autoimmune process and is where the immune system is attacking healthy cells in the gut lining.

This immune attack then leads to inflammation and tissue damage. The amount of tissue damage and inflammation may then be reflected in the severity of symptoms.

The extent of the inflammation also varies between individuals, however, a common theme among all with this condition is the relapsing and remitting of symptoms. This refers to the periods where someone is symptom-free versus periods of flare-ups.

While the exact triggers are not fully understood, a leading theory is that changes in the gut microbiome, combined with environmental factors and genetics trigger the onset of symptoms.

Types of Ulcerative Colitis

The types of ulcerative colitis can be described based on the location of the inflammation.

While the disease process can be the same, the location may lead to different symptoms or different treatments.

Proctitis

This involves inflammation of the lining of the rectum. While diarrhoea can be present, some patients may only experience rectal bleeding.

Proctosigmoiditis

Inflammation of the rectum and the last section of the colon (the sigmoid colon). Diarrhoea and blood in the stool can be common. There can also be additional symptoms of pain, cramping as well as bloating.

Distal Colitis

Inflammation of the distal colon. This is similar to proctosigmoiditis but starts to extend further along the colon. This can lead to more severe symptoms.

Pancolitis

Inflammation of the entire colon. This will often lead to more severe digestive symptoms of pain, cramping and diarrhoea as well as well loss and low energy. [1]

What are the symptoms of Ulcerative Colitis?

The most common digestive symptoms in someone with Ulcerative Colitis include:

• Bloody diarrhoea (with or without mucus)
• Rectal urgency
• Abdominal pain (that is often relieved with bowel movements)
• Tenesmus (the urge to pass a stool even when bowels are empty)
• Weight loss
• Fatigue (low energy)

The diagnosis of this condition is made based on several factors. This is the presence of specific symptoms, findings from colonoscopies and the absence of an alternate diagnosis. However, Ileocolonoscopy with biopsy is the only way to make a definitive diagnosis. [2]

How food can impact Ulcerative Colitis

As already mentioned, changes in human dietary patterns have been closely linked with the onset of Ulcerative Colitis.

One study indicated that the consumption of soft drinks (sugar-sweetened/carbonated drinks) is associated with a 69% increase in Ulcerative Colitis development. [3]

In opposition to this, the consumption of omega-3 fats was associated with a reduction in the risk of disease development.

While the precise mechanisms regarding the role that foods play and how they contribute to the onset of the disease, is unknown several explanations have been explored.

These are:

• Its effects on the balance of the gut microbiome
• Productions of microbial byproducts that may damage the gut lining
• Alterations in the immune system along the gut lining
• Alterations to the gut lining itself

The imbalances in the gut microbes have been seen in many, but not all of these with Ulcerative Colitis. A key area that is often seen is a reduction in the diversity of the microbiome.

This reduction in diversity can be thought of a reduction in the richness and the resilience of the microbiome. This may make it more susceptible to further changes. Due to the central role that the food we eat plays in the consumption of the gut microbiome, diet is a key area of focus when addressing gastrointestinal conditions.

Part of the benefit that food provides is the production of short-chain fatty acids (SCFAs). These are essential energy sources for the cells along the lining of the gut.

SCFAs help to support the lining of the digestive tract as well as immune function in the gut. This has been reinforced via the use of SCFAs in the form of nutritional supplements in the treatment of inflammatory bowel conditions. [4]

Read more about inflammatory bowel disease and diet here.

Risk Factors

While a single cause for Ulcerative Colitis is not known, it’s understood to result from a combination of factors.

The risk factors can be thought of as creating a perfect storm which leads to the onset of the condition.

These risk factors are:

Age and gender

There are increased risk factors between 2 time points in someone’s life. These are between 20 and 30 years of and between 50 and 80 years of age. While not conclusive, some research has indicated an increased prevalence in males.

Race and ethnicity

Those of Jewish heritage have a 3 fold higher risk of developing Ulcerative Colitis when compared to non-Jews. Also, within the Jewish population, Ashkenazi Jews have a higher prevalence compared to the Sephardim, American and European Jewish populations .

Genetics

About 8-14% of those with a diagnosis of Ulcerative Colitis have a family history of IBD. Alterations in specific genes have been reported which are understood to be central to this increase.

Smoking

While the risk of Crohn’s disease increases in those who smoke, in Ulcerative Colitis the risk of developing the condition actually increases when individuals stop smoking.

Studies have shown that current smoking leads to a later onset of the disease, milder inflammation and a reduced need for immunosuppression medication and surgery.

Diet

Part of the understanding of the onset of Ulcerative Colitis is based on the immune response to specific foods. The Western Diet (which is high in refined carbohydrates, and processed meats) has been linked to an increased rate of inflammatory bowel conditions.

This type of diet, due to its low levels of gut-friendly fibres, can be thought of as weakening the gut, making it more susceptible. Sensitivity to cow’s milk protein during early life has also been associated with an increased risk of developing Ulcerative Colitis.

Gut microbiome

Dysbiosis (imbalances in the gut microbes) has been associated with on onset of IBD. Due to the role these organisms play in the health of the digestive system, alterations and imbalances in these can lead to dysregulation in the immune response.

This dysregulation can then leads to the onset of the inflammatory response.

Appendectomy

As seen with smoking, the removal of the appendix may reduce the risk of developing Ulcerative Colitis. One study saw a decreased risk of 55% in those who had their appendix removed before they were 20 years old.

The opposite however is true in regards to Crohn’s disease, where the removal of the appendix increases the risk of disease onset. [5]

When to seek medical advice for Ulcerative Colitis

Prior to the diagnosis of ulcerative colitis, symptoms can increase slowly or suddenly which may require medical advice or intervention.

This can be indicated by symptoms described as red flag symptoms which include:

• Blood in the stool
• A sudden change in bowel movements
• Weight loss

Since ulcerative colitis is relapsing and remitting, meaning symptoms can increase and decrease over time, flare-ups are also possible.

This can be where regular monitoring can be important. In some cases, flare-ups require meditations such as steroids to calm symptoms and help achieve remission.

Conclusion

Ulcerative colitis is a condition that involves a relationship between the immune system, the gut microbiome and other environmental factors. While it may not be possible to technically cure this condition, the aim is to achieve and then maintain a state of remission.

Working with a gut health nutritional therapist can help to guide this support process.