Ulcerative Colitis

By Dr Harold Gunatillake Health Writer

This is a disease of the large bowel where inflammation occurs on the inner lining (mucosa) of the large bowel, more common in the distal large bowel and rectum. In addition to inflammation tiny ulcers are seen on endoscopic examination. The inflammation causes lot of mucosal discharge from the lining, sometimes containing pus due to infection. The inflammation reduces the chance of absorbing fluids, and diarrhoea is quite common in this condition. The tummy can get bloated and urgency for bowel action is common due to the inflammation of the lining of the rectum.

Most people with ulcerative colitis (80-90%) respond well to treatment and never develop any complications. In more severe cases where inflammation has penetrated deeper into the walls of the colon, serious complications may arise.

These include:
• Profuse bleeding from deep ulcers
• Perforation (rupture) of the colon
• Fulminant colitis/toxic mega colon (partial or full shutdown of normal intestinal contractions)
These complications can occur over a short period of time and usually require immediate medical attention.
People having ulcerative colitis may lose weight, are malnourished and anaemic, tired and easily fatigued. Hence a good nutritious diet is mandatory.
• Drink fluids adequately. Smoothness can be a good drink to the nutrition when you can't handle solids. Iron containing vegetables like spinach, egg yolk and artichokes are generally accepted by the bowels without discomfort.
• Dairy products may worsen symptoms due to lactose intolerance. First, try dairy that is lower in lactose – such as hard cheeses and yogurt. If you need to avoid dairy completely, look for substitutes like soy.
Your goal: make sure you are getting plenty of bone-strengthening calcium and vitamin D. Inflammatory bowel disease can put you at risk for bone loss.
• Good bacteria in your bowels may be wiped out. Probiotics like yogurt and supplements may help to replace them.
• You may have to avoid high fibre diets, so skip the nuts and seeds and raw fruits.
• You may have to avoid gassy foods like broccoli, cauliflower and beans. If you cook these vegetables well, you may be tolerant.

Cramping is common after meals. Try eating small meals more frequently. There is no magic diet that is right for everyone with ulcerative colitis. Talk to your doctor or a registered dietician. Getting personalized information can help you find food that is easy on your digestion and good for you. These experts can also help you figure out if you are missing out on any key nutrients. If so, they may suggest types of food or supplements to help you get the nutrition you need.

Ultimately, surgery would be the answer. The large bowel is removed and the end of the small bowel is brought end to end with the anus, or the small intestine can be redirected to empty into a bag attached to an opening on the outside of the abdomen.

Remember this would be the last resort, but don't rush into anything, try to manage through diet (trial and error), unless complications arise and removal is necessary.

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