Ulcerative colitis is another subtype of inflammatory bowel disease (IBD) in which inflammation is found only in the large intestine.
The term "ulcerative" is used because when the disease is active, the patient usually has hundreds of small breaks - called ulcers - from the inflammation in the lining of the colon. Ulcers are areas where the lining of the intestine has been so damaged that it has been worn away, leaving a small hole or sore.
Unlike CD, in UC these are shallow ulcers and involvement is only on the surface of the colon wall rather than all the way through the bowel wall. Abscesses or a hole on the bottom (fistulas) do not develop. In children, UC usually involves the whole colon (pancolitis). In some children, however, the colitis affects only the left side of the large intestine (left-sided colitis) - or rarely, only the rectum (ulcerative proctitis).
Since one of the functions of the colon is water resorption - and the inflammation of UC starts at the rectum - the symptoms of UC are mucousy diarrhea, rectal bleedin, and lower abdominal cramping. In fact, it is not unusual for patients to say they have to wake up at night to go to the bathroom and often feel like they have to go again and again. These symptoms are the result of the inflammation of the lining of the colon. When all these symptoms disappear, the lab tests return to normal and the lining of the colon looks normal again rather than very red with inflammation. The doctor will consider this to be UC in remission.
In addition to gut symptoms, patients with UC may also develop inflammation outside their gastrointestinal (GI) tract, including joint swelling (arthritis), eye redness (uveitis), and skin rashes. Complications of IBD that occur in organs - like the liver - other than in the intestine are called extraintestinal symptoms.
While UC is a lifelong illness, it can usually be well controlled with medications. During flare-ups (periods of disease activity), stronger medications may be needed. During periods of remission (inactive disease), milder medications (maintenance therapies) are often used. The course of the illness is also variable Some patients have more frequent flare-ups than others. In a small number of people, the disease does not respond well to medications and surgical options may need to be considered.
In summary, UC is a disease characterized by a pattern of inflammation in the large intestine. The most common symptoms during a flare are abdominal cramping, diarrhea, and rectal bleeding. The physician and the parent share the same goal - to control the child's illness in order to keep flares as short as possible and remissions as long as possible.