Are you also experiencing stomach pain and bleeding? This could be due to Ulcerative Colitis (UC).

Do you often need to go to the bathroom? Does your stomach hurt like a knife? Have you ever noticed a little blood in your stool? Don't dismiss these things as normal. Because they could be symptoms of a condition called Ulcerative Colitis (UC), which requires some attention. Don't be afraid, it's not as dangerous as you think. Let's talk about this in a simple, friendly way and make everything clear.

Simply put, what is Ulcerative Colitis (UC)?

Ulcerative Colitis (UC) is a lifelong condition that is incurable but can be managed well. It causes inflammation and small sores (ulcers) in the lining of our large intestine (colon) and rectum. Simply put, the inside of the intestine becomes inflamed and sore.

UC is one of two major diseases in the group of diseases called Inflammatory Bowel Disease (IBD) . The other is Crohn's disease. A person with UC may experience symptoms such as frequent diarrhea, stomach pain, and blood in the stool.

The nature of this disease is that it doesn't always have the same symptoms.

• Flare-ups: During this time, symptoms are more severe.
• Remission (period of remission): During this time, you can live normally without symptoms.

The main goal of treatment is to reduce flare-ups and prolong remission as much as possible.

What are the main types of UC?

Doctors classify UC based on where in your large intestine the inflammation occurs. It usually starts near the anus, or rectum. It can then spread throughout the large intestine. Let's look at this chart to help you understand this better.

In addition to these types, UC is classified as mild, moderate, or severe depending on the severity of symptoms. The most severe form, which is very rare and can be life-threatening, is called fulminant ulcerative colitis . In such cases, immediate medical attention is required.

What are the symptoms of this disease?

UC symptoms can gradually increase over time. In the early stages, you may experience some mild symptoms. Later, as the disease progresses, more symptoms may appear. Let's look at these separately.

Are there any other effects besides the intestines?

Yes. In about 25% of UC patients, this inflammation can affect other parts of the body in addition to the intestines. Then, related symptoms may also appear.

• Joint pain and swelling: Joints like knees and elbows can become painful and swollen.
• Eye problems: Redness, inflammation, and itching of the eyes may occur.
• Skin problems: Painful bumps, spots, or sores may appear on the skin.

Why does this disease occur? What are the risk factors?

In fact, the exact cause of UC has not yet been discovered. However, researchers believe that it is caused by a combination of several factors.

The main idea is that this is caused by an overactive immune system . Think of it like our national army. Its job is to protect the body from foreign invaders like germs and viruses. But sometimes this system goes wrong and starts attacking our own healthy cells. In UC, the immune system attacks the cells in the colon. That's what causes this inflammation and scarring.

There are several risk factors that can contribute to this condition:

• Age: This disease is most often diagnosed in young people between the ages of 15-30, or in older people after the age of 60.
• Genetics: If someone in your family, such as your mother, father, or sibling, has UC or Crohn's disease, you are at higher risk of developing it too.
• Gut microbiome: Our gut is home to millions of beneficial bacteria, as well as harmful bacteria, viruses, and fungi. It has been found that changes in the balance of this ecosystem may contribute to UC.

What other complications can occur due to UC?

Having ulcerative colitis slightly increases the risk of developing other health problems, so it is important to stay under medical supervision.

• Anemia: Continuous bleeding from the intestines can cause a decrease in the number of red blood cells in the body, leading to anemia.
• Colon cancer: People with UC have a higher risk of developing colon cancer than the general population. This risk depends on how long you have had UC and what part of your colon is affected. It's important to talk to your doctor about this and get regular colonoscopy screenings.
• Osteoporosis: Long-term inflammation in the body and some treatments can cause bones to become weak and break easily.
• Liver problems: Rarely, this inflammation can also affect the liver, causing a condition called primary sclerosing cholangitis .
• Effects on children's growth: If a child develops UC, their growth may be stunted because they cannot properly absorb nutrients from the intestines.

Emergency situations requiring immediate medical attention

If these symptoms occur, it is an emergency. Go to the nearest hospital Emergency Department (ETU) immediately.

• Dehydration: Excessive diarrhea can cause dehydration, which can lead to dehydration. In severe cases , IV fluids (saline) may be given in the hospital.
• Perforation of the large intestine: If the inflammation becomes severe, the wall of the large intestine can become perforated. This is a very dangerous condition.
• Excessive bleeding: If you are bleeding too much to control, you may need a blood transfusion.
• Toxic megacolon: This is a very serious, rare complication. In this case, the large intestine swells, stops functioning, and begins to absorb toxins from within into the body.
• Blood clots: UC increases the risk of blood clots forming in the body's blood vessels.

How do you diagnose this disease?

After listening to your symptoms, the doctor will order several tests to confirm this disease.

• Blood tests: Check for anemia (low blood count) or signs of inflammation.
• Stool tests: Check for blood, germs, or parasites in the stool.
• Imaging tests: Tests such as X-ray, CT scan, or MRI can give an idea of ​​the condition of the intestine.
• Endoscopic examination: This is the most accurate way to diagnose UC. A thin, flexible tube with a camera (endoscope) is inserted through the anus and the inside of the large intestine is viewed on a screen. This test is called a colonoscopy or sigmoidoscopy . At this time, a small piece of tissue is removed from the colon for examination. This is called a biopsy .

How is it treated?

There are two main goals of treatment. One is to control symptoms during flare-ups and bring the disease into remission. The second is to maintain remission for as long as possible. This is mainly done using medications and surgery.

Medications

There are several types of medications that can reduce inflammation in the intestines.

• Aminosalicylates: A type of medication commonly used for mild to moderate UC. Examples: sulfasalazine, mesalamine .
• Corticosteroids: These are powerful anti-inflammatory drugs. They are only given for a short period of time during a severe flare-up. They have more side effects when used long-term. Examples: prednisone, budesonide .
• Immunosuppressants: Drugs that control overactivity of the immune system. Examples: azathioprine, methotrexate .
• Biologics: These are newer, targeted therapies that target specific parts of the immune system that cause inflammation. Examples: infliximab (Remicade®), adalimumab (Humira®) .
• JAK inhibitors: These are also a new class of drugs that block the process that causes inflammation. Examples: tofacitinib (Xeljanz®) .

Surgery

If the disease cannot be controlled with medication, or if severe complications occur, surgery may be necessary. About 30% of people with UC will need surgery during their lifetime.

There are two main types of surgery. Both involve a procedure called a proctocolectomy , which involves removing the large intestine and the last part of the rectum.

1. Proctocolectomy and ileal pouch: This is the most common surgery. In this procedure, the large intestine is removed, a pouch is made from a portion of the small intestine, and it is connected to the anus. After healing, you will be able to have normal bowel movements.

2. Proctocolectomy and ileostomy: This is done when the above surgery is not possible. In this procedure, the entire large intestine is removed, an opening (stoma) is created in the abdomen, and a bag is attached to collect feces from the outside.

What can be done to prevent the disease from worsening?

Identifying your triggers and avoiding them can greatly reduce the risk of flare-ups.

• Manage stress: Get enough sleep, exercise, and do something calming like meditation.
• Avoid certain painkillers: NSAIDs (e.g., ibuprofen, diclofenac) can worsen UC symptoms. It's best to take a medicine like paracetamol for fever or pain. Always consult your doctor before taking any medication.
• Avoid foods that trigger UC: Not everyone has the same triggers. Some people have a sensitivity to dairy, while others may have a sensitivity to high-fiber foods. The best way to figure out what triggers you is to keep a food diary and write down the foods you eat and the symptoms you experience. Then, talk to your doctor and come up with a diet plan that works for you.

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