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Ulcerative Colitis

Ulcerative colitis (UC) is a disease in which the lining of your large intestine (colon) becomes inflamed. This inflammation leads to the formation of raw sores or ulcers causing pain and bloody diarrhea. UC can begin at any age but most people who get it are in their early twenties. For most UC comes and goes for the rest of their lives. Most people can control attacks by taking medicine and adjusting their diet. But in about one-quarter of people with UC surgery becomes necessary.

Signs and Symptoms

UC usually begins gradually with bloody diarrhea rectal bleeding cramping or pain in the belly and growing urgency to move your bowels. Depending on which area of the colon is affected the stool may be normal or hard and dry. Other symptoms might be fever fatigue weight loss loss of appetite anemia from loss of blood pus in stools malnutrition and slow growth in children. UC can also affect parts of the body outside the colon causing skin sores mouth sores joint pain and inflammation of the eyes liver kidneys or gallbladder.

What Causes It?

Nobody knows what causes UC. It might start with an infection. Ten to 20 percent of people with UC have at least one family member with an intestinal disorder called inflammatory bowel disease (IBD).

What to Expect at Your Provider's Office

Your health care provider will take stool and blood samples and will look inside your rectum through a flexible tube called an endoscope. You may also have an X ray with or without barium (a chalky liquid that makes organs and structures easier to see on an X-ray image).

Treatment Options

Treatment Plan

Your health care provider will prescribe drugs to control inflammation and prevent complications. You will probably take more than one drug at a time. Some drugs can stop an episode but none can prevent a relapse. For severe cases that are unresponsive to medications surgery is recommended.

Drug Therapies

Prescription

bullet5-aminosalicylic acid (5-ASA)—helps control active disease; various side effects
bulletCorticosteroids—for severe flare-ups; continuous low dose is used for chronic activity; new topical corticosteroids are now available; various side effects
bulletCyclosporine—may help stop an episode; various side effects
bulletNicotine patches—may help stop an episode but cannot prevent relapse; various side effects

Over the Counter

N/A

Complementary and Alternative Therapies

Nutrition

bulletDecrease refined foods sugars and saturated fats.
bulletEliminate all food allergens from the diet. Common allergenic foods are dairy soy citrus peanuts wheat fish eggs corn tomatoes.
bulletA rotation diet in which the same food is not eaten more than once every four days may help reduce symptoms.
bulletDairy products Brassica vegetables (cabbage Brussels sprouts broccoli cauliflower and kale) and gluten-containing grains (wheat oats barley triticale rye) may make UC worse.
bulletFiber supplementation can help reduce abdominal pain cramping and gas: psyllium flax meal slippery elm (Ulmus fulva) powder and marshmallow root (Althea officinalis) powder.
bulletProflora supplements taken two to three times a day.
bulletEssential fatty acids may protect intestinal lining. Max-EPA or fish oil (3 to 4 g up to 18 g per day).
bulletBromelain (250 to 500 mg between meals) for inflammation.

Inflammatory bowel disease which may be associated with UC is associated with low levels of many vitamins and nutrients. Ask you provider about taking supplements.

Herbs

Herbs may be used as dried extracts (capsules powders teas) glycerites (glycerine extracts) or tinctures (alcohol extracts). Teas should be made with 1 tsp. herb per cup of hot water. Steep covered 5 to 10 minutes for leaf or flowers and 10 to 20 minutes for roots.

bulletEnteric-coated peppermint oil: one to two capsules (0.2 ml peppermint oil per capsule) three times per day after meals. Peppermint oil (Mentha piperita) is a potent relaxant that reduces bowel irritability.
bulletA tincture of equal parts of the following herbs may be taken before meals (20 to 30 drops three times per day): cramp bark (Viburnum opulus) passionflower (Passiflora incarnata) meadowsweet (Filependula ulmaria) wild yam (Dioscorea villosa) valerian (Valeriana officinalis) and lemon balm (Melissa officinalis).
bulletUse equal parts of the following in a tincture (30 drops four times per day): coneflower (Echinacea purpurea) goldenseal (Hydrastis canadensis) and geranium (Geranium maculatum)
bulletLicorice root (Glycyrrhiza glabra) and marshmallow root (Althea officinalis) promote healing of the gastrointestinal lining. Make a tea of licorice root by steeping one tsp. in one cup of hot water for 20 minutes. Drink three cups per day. (Contraindicated in hypertension.) For marshmallow root tea soak one heaping tbsp. of root in one quart of cold water overnight. Strain and drink throughout the day. Do not take licorice if you have high blood pressure.
bulletQuercetin (250 to 500 mg before meals) for food sensitivities.

Homeopathy

Some of the most common remedies for this condition are listed below.

bulletArsenicum album for intense cramping and burning with scanty dark blood in stool. Patient is restless chilly and anxious.
bulletChina for extreme bloating and gurgling in abdomen
bulletPhosphorus for painless diarrhea with prostration and thirst
bulletSulfur for morning diarrhea that drives patient out of bed
bulletMercurius vivus for IBD with canker sores and metallic taste

Physical Medicine

Castor oil pack. Apply oil directly to skin cover with a clean soft cloth and plastic wrap. Cover with a heat source and let sit for 30 to 60 minutes.

Acupuncture

Acupuncture can help relieve spasm and normalize digestive function.

Following Up

People who have UC for a long time are more likely to get colon cancer than other people and must be checked for it regularly.

Supporting Research

Berkow R ed. The Merck Manual of Diagnosis and Therapy. 16th ed. Rahway NJ: Merck Research Laboratories; 1992.

Blumenthal M ed. The Complete German Commission E Monographs. Boston Mass: Integrative Medicine Communications; 1998:427–428 432.

Greenfield S.M. et al. A randomized controlled study of evening primrose oil and fish oil in ulcerative colitis. Aliment Pharmacol Ther. 1993;7:159–166.

Roediger WE Moore J Babidge W. Colonic sulfide in pathogenesis and treatment of ulcerative colitis. Dig Dis Sci. 1997;42:1571–1579.

Weatherall DJ Ledingham JGG Warrell DA eds. Oxford Textbook of Medicine. 3rd ed. New York NY: Oxford University Press; 1996.

Werbach M. Nutritional Influences on Illness. New Canaan Conn: Keats Publishing; 1988:424–427.

Wyngaarden JB Smith LH Bennett JC eds. Cecil Textbook of Medicine. Philadelphia Pa: WB Saunders; 1992.