CAUSES, SYMPTOMS & TREATMENT OF CERATIVE COLITIS.

ULCERATIVE COLITIS

WHAT IS ULCERATIVE COLITIS?

Ulcerative colitis (UC) is an inflammatory disease affecting the large bowel (colon and rectum). The inflammation is usually confined to the internal lining of the intestinal wall (mucosa) and causes multiple ulcers which is small, shallow & red. It usually starts from rectum and extends upwards towards colon. Medical management is the first line option for treatment.  UC can go into remission and recur (come and go).  If surgery is needed for UC, it is usually curative

CAUSES, SYMPTOMS & TREATMENT OF CERATIVE COLITIS.

RISK FACTORS OF ULCERATIVE COLITIS

If someone’s first degree relatives have ulcerative colitis, he or she has slightly increased chance of getting affected by UC.

CAUSES OF ULCERATIVE COLITIS

Immune system abnormalities and bacterial infections are the main causes of UC. 

SYMPTOMS OF ULCERATIVE COLITIS

Most patients develop symptoms in their 30s. A smaller number experience symptoms for the first time later in life (ages 50 to 60). The most common symptoms of UC include: 

• Abdominal cramping. 
• Abdominal pain. 
• Blood dysentery (passage of blood and mucus with stool
• Diarrhoea 
• Bleeding with stool. 
• Fever. 
• Fatigue.
• Weight loss. 

DIAGNOSIS OF ULCERATIVE COLITIS

An expert Colorectal Surgeon or Gastroenterologist can diagnose UC by careful history and rectal examination. Colonoscopy and some blood and stool test may also be needed.  A colonoscopy looks at the inside of your colon and rectum to find ulcers and inflammation characteristic of UC.  This evaluation helps determine the extent and severity of UC, rules out other diseases such as Crohn’s disease, and guides management. Additional tests such as CT scans or X rays may be needed in rare exceptional cases.   

MEDICAL TREATMENT OF ULCERATIVE COLITIS.

Medical treatment is the first choice for most patients with ulcerative colitis. The goal of medical therapy is to treat the inflammation and improve a patient's quality of life by decreasing the diarrhea, bleeding, and pain. Long-term medications called immunosuppressants or anti-inflammatory medications are commonly used.   Initially, the most common therapy is 5-amino-salicylic acid & corticosteroids. Steroids should only be given briefly because of the side effects. Based on the extent of the disease, medications may be taken by mouth or as a rectal suppository. 

SURGICAL TREATMENT OF ULCERATIVE COLITIS

Surgery is considered for patients when medical management is no longer effective. Other reasons that a patient may require surgery include cancer or pre-cancer is found during colonoscopy.  Sometimes surgery needs to be performed when a complication of the disease occurs such as a perforated bowel (hole in the bowel), severe bleeding or serious infection (toxic colitis). 

UC involves only the colon and rectum and complete removal of both may be curative.  Initially, this would require an ileostomy, or stoma. Some patients may be candidates for an ileal pouch which reconnects the small intestines to the anus. This procedure involves the removal of the entire colon and all of the rectum with the exception of the last section where the sphincter muscles (the muscles that control bowel movements) are located.  The small bowel is then used to create a “new” rectum (the pouch). Because this pouch is often made in the shape of a “J”, it is often called a “J-pouch”. The patient will have a temporary ileostomy during the healing period however ultimately this will be removed and the patient will be able to pass stool through their anus again.    

Planned and emergency surgeries can be performed through traditional “open” procedures or minimally invasive (laparoscopic or robotic) approaches depending on the circumstances. The safest, most effective approach is determined on an individual basis. 

EMERGENCY SURGERY OF ULCERATIVE COLITIS

Because emergency surgery is done for potentially life threatening conditions, it is may need to done as an open procedure. During emergency surgery, the large bowel (colon) is removed. The rectum and anus are left in place temporarily. The end of the small bowel (ileum) is brought out through the abdominal wall to the skin as an where stool  is allowed to empty into a bag attached to the skin.  

 

After recovery, a second procedure can be performed. During this surgery, the diseased rectum is removed. A new rectum (ileal pouch) is created using the small bowel. The new rectum is connected to the anal opening. A loop ileostomy is created to protect the area until it has healed.  
 

When healing is complete, a third procedure is done to close the ileostomy. This three-stage UC procedure ultimately results in patients being able to live without an ileostomy. 

ELECTIVE SURGERY OF ULCERATIVE COLITIS

In elective surgery, the first and second stages described above are combined. This is the two-stage surgery for UC, done through a minimally invasive or open procedure. Both the colon and rectum are removed. A new rectum or J-pouch is made from the small intestine and connected to the anal opening. A diverting loop ileostomy is often made to protect the area until it heals. After the patient recovers, a second procedure is performed to close the ileostomy and reconnect the small bowel. In select cases, some surgeons choose not to create a diverting ileostomy, which results in a one-stage procedure. 

POSTSURGICAL PROGNOSIS OF ULCERATIVE COLITIS

After surgery, five to six bowel movements a day and one at night can be expected, maybe even more. Medications can be used to decrease this. Some patients may experience leakage or incontinence (inability to control bowel movements). Infection or inflammation may develop in the pouch. This can be treated effectively with antibiotics or steroids. Due to complications, about 10% of pouches must be removed and a permanent ileostomy created. 

LONG TERM FOLLOW-UP OF ULCERATIVE COLITIS

Regular follow-up medical appointments are scheduled. During these periodic visits, your physician will evaluate the function and health of the pouch. 

WHAT IS A COLORECTAL SURGEON?

A colorectal surgeon should have an MS degree in Colorectal Surgery &/or is the faculty of Bangabandhu Sheikh Mujib Medical University (BSMMU). He/she has huge knowledge, expertise, and experience in this field enough to do both medical and surgical treatment of ulcerative colitis. There are very few colorectal surgeons in Bangladesh. We can offer you the best treatment in this field. We treat piles (hemorrhoid), colon cancer, rectum cancer, Anal cancer, anal fistula, anal abscess, anal fissure, rectal prolapse, incontinence, constipation, chronic dysentery, abdominal pain, IBS, ulcerative colitis, Crohn's disease, tuberculosis, polyps, vomiting, abdominal gas, per rectal bleeding, anal pain, pilonidal sinus, obstructed defecation(ODS), rectocele, rectal intussusception, pelvic floor descend, rectovaginal fistula. We do colonoscopy, LASER Surgery, Laparoscopic surgery, rubber band/ring ligation, injection sclerotherapy, Longo, STARR, rectopexy, fistula surgery, Colon/rectal/anal cancer treatment, APR, Anterior resection, colectomy etc with excellence and hospitality.

APPOINTMENT

For high-quality patient care by and management of ulcerative colitis by Dr. Tariq Akhtar Khan; please call 10647 and take an appointment at BRB Hospitals Ltd, 77 West Panthapath, Dhaka.