You are here: Home / Services and Specialities / Inflammatory Bowel Disease / Ulcerative Colitis
Share:

Ulcerative Colitis

While Crohn’s disease can appear anywhere in the gastrointestinal system, ulcerative colitis is limited to the large intestine, also known as the colon.

Key Facts

  • Ulcerative colitis affects the inner lining of the bowel (the mucosa), causing it to ulcerate and bleed.
  • Ulcerative colitis always starts in the rectum and can continue to extend further along the colon in a continuous fashion.
  • Unlike Crohn’s, ulcerative colitis does not "skip" portions of the colon in its progression.
  • Ulcerative colitis usually appears early in life, but some individuals will only begin to experience symptoms in their 50s or 60s.
  • In rare cases, symptoms will only begin after the age of 70.
  • There is a slightly higher incidence of ulcerative colitis in females than in males.

Some of the more common symptoms people with ulcerative colitis may experience include:

  • Diarrhea, which can be associated with the loss of blood
  • Frequent, urgent, bowel movements that may involve spasm or cramping
  • Abdominal pain
  • Fever
  • Weight loss

Medicine is used to suppress the chronic intestinal inflammation that causes the symptoms of ulcerative colitis. The success of the medication is determined by its ability to suppress the inflammation and eliminate symptoms (known as remission) without causing significant side effects.

There are four main categories of medication used to treat ulcerative colitis.

  • Aminosalicylates: These anti-inflammatory compounds decrease inflammation at the intestinal wall to both reduce symptoms and maintain remission.
  • Corticosteroids: These medications help keep the immune system in check and are effective for short-term control of flare-ups. They are not recommended for long-term or maintenance use due to side effects.
  • Immunomodulators: These medications modify the activity of the immune system to prevent ongoing inflammation. They are generally used to maintain remission in some individuals.
  • Biologic therapies: These are the newest treatments for IBD. These are options for people with moderate to severe disease who have not responded well to conventional therapies.

Surgical options for ulcerative colitis include:

  • Proctocolectomy: The standard procedure for individuals with ulcerative colitis who require surgery is a total proctocolectomy and ileostomy. In this procedure, the surgeon removes the colon and rectum and then makes a small cut in the abdomen for stool to pass directly from the last part of the small intestine into a bag. This is advantageous as the surgery is performed in one stage and it has a low complication rate compared to other procedures. The most common complication is related to the ileostomy and perineal wound.
  • Pelvic pouch or Iieoanal reservoir procedure: This involves different surgical scenarios depending on the individual's state of health at the time of surgery. Pelvic pouches are done laparoscopically (with a small tube and camera) at Mount Sinai as well as other centres. Many patients can be considered candidates for laparoscopic surgery. Our colorectal surgeons work as a team, offering a laparoscopic approach whenever appropriate.

View this video for helpful information on surgical treatment for ulcerative colitis by TVASurg - The Toronto Video Atlas of Surgery.