Ulcerative colitis is a chronic inflammatory condition whereby, tiny abscesses and ulcers are formed on the inner lining of the large intestine, or on the colon or rectum. These ulcers may burst frequently resulting in diarrhea and bloody stools. This disease may also be responsible for causing anemia as well as harsh abdominal pain.

Ulcerative colitis normally alternate periodically from flaring up to receding quickly. These periods of remission can either last for weeks or maybe, even for years at a stretch. They are, however, not permanent and although the disease may seem to have disappeared completely, it can soon show up again in no time. Usually beginning in the rectum, it can, by and by, spread rapidly to other parts of the colon. If it is, however, limited only to the rectum, then it is more commonly referred to as ulcerative proctitis.

Surgery is generally obligatory and mandatory when it comes to treating ulcerative colitis. If surgery is not performed, you may suffer from long-lasting side effects, including cancer and colon rupture. Here are the different types of surgery that you may undergo:

1. Colectomy: This is done when the entire colon needs to be removed and is usually performed to eliminate the perils of acquiring colon cancer.

2. Proctocolectomy: This concerns the total removal of both colon and rectum and is usually the standard procedure when dealing with ulcerative colitis.

3. Ileal Pouch Anal Anastomosis: If the treatment does not require a permanent stoma, and if you can still manage to let out stool from your anus, then this surgery, also called restorative proctocolectomy would be most appropriate.

Here, both colon and rectum are removed, but at the same time, the small intestine is utilized to form an internal reservoir, called a J-pouch, which is linked to the anus and can hereafter serve as your new rectum.

Types Of Ulcerative Colitis Surgery

Ulcerative Colitis is a chronic inflammatory disease that affects the lining of the intestine and the rectum. It is located just above the anus. Patients suffering from ulcerative colitis tend to have small ulcers in their rectum and the colon. These eventually flare up leading to diarrhea, bloody stools, anemia and abdominal pain. The inflammation starts from the rectum and eventually, spreads to the colon. Ulcerative Colitis tends to flare up and remit in an alternate phase. The remission can last from few weeks to few years.

Methods adopted to diagnose Ulcerative Colitis-
Ulcerative Colitis is very similar to an inflammatory bowel disease known as Crohn s disease. The only differentiating factor is the fact that, ulcerative colitis affects the colon whereas, Crohn s disease affects the digestive system and the small intestine. A doctor might prescribe certain tests such as the colonoscopy, blood tests, CT scan, pill camera, stool sample tests etc.

Why is surgery necessary to treat Ulcerative Colitis?
An estimated 40 percent of all Ulcerative Colitis patients need to undergo surgery to recover completely. The reason surgery becomes necessary to treat ulcerative colitis are the following:

Drug therapy and medication become ineffective.
Without undergoing surgery, the condition might increase the risk of developing cancer.
The colon has the risk of getting ruptured if surgery is not performed on time.
There could be excessive bleeding.
Toxic megacolon might set in.
Types of surgery available to treat Ulcerative Colitis
A procedure where the entire colon is removed is known as the colectomy. In case both the colons are removed, the procedure is termed as proctocolectomy. In this procedure, an external pouch needed to be attached to the stoma that collects the stools. There is another method known as pouch surgery. 

Pelvic pouch or ileal pouch is also termed as IPAA. This procedure doesn t involve permanent stoma. In this procedure, both the colon and the rectum are eradicated from the body. The small intestine is then used to form a J-shaped pouch, that serves as the new rectum. The pouch is then connected to the anus. The whole procedure is done via two surgeries.

What are the surgical complications of this procedure?

There could be an excessive bowel movement.
There are instances where an inflammation of the pouch is observed. This condition is known as pouchitis.
There could be a situation of intestinal blockage from adhesion due to surgery.
There could be pouch failure that can happen inside within 5 few years. This is observed in 4 out of 100 patients who are treated. In this case, the patient should go for a permanent ileectomy.

Ulcerative Colitis - What You Need To Know?

What is Colitis?
Colitis is a chronic bowel disease that causes inflammation in the lining of your colon i.e. the large intestine.

Prevalence in India -
Once prevalent in Western countries, colitis is on the rise in India among other Asian countries. The causes for this rise are mainly the degrading environment and the consequent changes in your genes. Colitis brings many changes to your lifestyle. Therefore, it is important to arm yourself with all the information about the disease to better manage it and lead the life you want.

What are the causes?
The common causes of colitis are -

Infection due to virus, bacteria and parasites
Decreased blood supply
Allergic reactions
What are the signs and symptoms of Colitis?
The signs and symptoms of colitis include the following-

Extreme pain before, during or after diarrhoea in the lower abdomen
Aches in joints and muscles
Tender abdomen
Swelling of colon
Redness on the colon surface
Bleeding from stool
Diarrhoea or constipation
Loss of appetite
Weight loss
Fever, fatigue
Dehydration
Eye and skin inflammation
What can you do to prevent it?
In order to prevent the occurrence of colitis, you can adopt a few steps. Precautionary measures mostly include dietary changes. You should avoid intake of certain foods to eliminate the symptoms of the disease.

Avoid the consumption of dairy products
Avoid eating spicy foods
Avoid including vegetables like cabbage, dried beans, peas in your diet
Refrain from drinking alcohol, caffeine and carbonated drinks
Instead, include white bread, white rice, pureed vegetable soup, canned fruits, etc
Depending on the diagnosis and the treatment, people do get better. Many people can build successive careers after getting treatments. However, initially, the symptoms will cause a problem in your daily life. It is important to know how you can identify the early signs and what you can do to manage or prevent them.

Know More About Colitis!

Ulcerative Colitis is one of the severe and chronic forms of Inflammatory Bowel Disease (IBD) that can throw life in a jeopardy. The condition that mainly affects the rectum and the large intestine can cause severe inflammation, ulceration, and abscess formation. The ulceration or the inflammation of the colon and the rectum left unattended for too long can give rise to deleterious consequences including damage and perforation of the colon, osteoporosis. Various studies also suggest that ulcerative colitis can increase the risk of a person suffering colon cancer.

Like most of the IBD, there is no definite cure for ulcerative colitis. The illness is a chronic condition and can flare up or recur at any point in time. Though medications may help to control the damage and the complications triggered by ulcerative colitis, a surgery may be essential in case of

Severe damage to the colon.
The nonsurgical treatments could do little to improve the conditions.
There is an increased risk of colon cancer.
Ulcerative colitis has resulted in Toxic megacolon (a life-threatening condition where the large intestinal muscles have dilated with some swelling).
There are extreme discomfort and bleeding.
Surgeries to deal with Ulcerative Colitis

In the case of Ulcerative Colitis, the nature of the surgery depends on the extent to which the colon or the rectum or both have been affected and damaged.
In the case of extensive damage with a high risk of colon cancer, the surgeon may perform Proctocolectomy or colectomy
Colectomy may involve
Removal of all of the colon- Total Colectomy
Removal of the diseased part of the colon- Partial Colectomy.
Following the excision, the surgeon may carry out necessary rearrangements to reconnect the remaining portion of the colon to the abdomen through an opening known as stroma (the procedure is known as colostomy).
In case of Total Colectomy, the small intestine will be connected to the abdomen by a process known as Ileostomy.
Proctocolectomy involves the removal of both the rectum and colon to avoid further aggravation.
Following the proctocolectomy, the surgeon may carry out Ileoanal Anastomosis (Ileal Pouch-Anal Anastomosis). In this procedure, a pouch is created using a small part of the small intestine. This pouch is then connected to the anus to help in the elimination of the wastes.
General precautionary measures to control Ulcerative Colitis
Making healthy lifestyle and dietary modifications can go a long way to control ulcerative colitis and the associated symptoms.

Spicy foods can worsen the incidence of ulcerative colitis. Enrich your diet with lots of fruits, vegetables (squash, avocados, fish (especially salmon and tuna), meat, dairy products, olive oil, walnuts, flaxseed oil, almonds.
Make sure the diet is a low-fiber diet.
Avoid alcoholic and caffeinated drinks and beverages, foods high in sulfur content, refined sugar.
Research suggests stress and lack of physical activities can aggravate the ulcerative colitis. Mediation and daily exercise can produce fruitful results.
Make sure your sleep is not compromised (6-8 hours daily).

Ulcerative Colitis - How Surgery Can Help Manage It?

It is gastrointestinal bleeding in the upper gastrointestinal tract, commonly defined as bleeding arising from the oesophagus, stomach, or duodenum. Blood is often observed in vomit (hematemesis) or in the stool (melena). Upper gastrointestinal bleeding denotes a medical emergency and typically requires hospital care for primary diagnosis and treatment. The incidence of upper gastrointestinal bleeding is 50-150 individuals per 100,000 annually. Depending on its severity, it carries an estimated mortality risk of 11%.

The causes of upper gastrointestinal bleeding are as follows:

Oesophagal causes (gastrorrhagia):

Oesophagal varices
Esophagitis
Oesophagal cancer
Oesophagal ulcers
Mallory-Weiss tear
Gastric causes: 

Gastric ulcer
Gastric cancer
Gastritis
Gastric varices
Gastric antral vascular ectasia
Dieulafoy's lesions

Duodenal causes
Duodenal ulcer
Vascular malformation, including aorto-enteric fistulae
Hematobilia or bleeding from the biliary tree
Hemosuccus pancreaticus or bleeding from the pancreatic duct
Severe superior mesenteric artery syndrome
The signs and symptoms of upper gastrointestinal bleeding are as follows:

Hematemesis - Vomiting of blood
Melena - Blood in the stool
Hematochezia - Passage of fresh blood through the anus, usually in or with stools
Syncope - Loss of consciousness (fainting)
Presyncope - State of lightheadedness, muscular weakness, blurred vision, and feeling faint
Dyspepsia   IndigestionEpigastric painHeartburnDiffuse abdominal pain
Dysphagia - Difficulty in swallowing. Weight lossJaundice - Yellow discolouration of the skin, mucous membranes, and sclera
The diagnosis of upper gastrointestinal bleeding is made when hematemesis is present. In the absence of hematemesis, an upper source of GI bleeding is likely in the presence of at least two factors among - Black stool, age < 50 years or blood urea nitrogen/creatinine ratio 30 or more

If these findings are absent, consider a nasogastric aspirate to determine the source of bleeding. If the aspirate is positive, an upper GI bleed is greater than 50%, but not high enough to be certain. If the aspirate is negative, the source of a GI bleed is likely lower. The accuracy of the aspirate is improved by using the Gastroccult test. Also, the following diagnostic tests are done:

Orthostatic blood pressure
Complete blood count with differential counts
Hemoglobin level
Type and crossmatch blood
Basic metabolic profile, BUN,
Coagulation profile
Serum calcium
Serum gastrin
Endoscopy
Chest radiography
Nasogastric lavageAngiography (if bleeding persists and endoscopy fails to identify a bleeding site)
Upper gastrointestinal bleeding can be managed in the following ways:

Airway management and fluid resuscitation using either intravenous fluids and or blood
Medications to stop the bleeding (Proton-pump inhibitors are often given in the emergency)
Surgical intervention
Treating the consequences (like anaemia) that the bleeding may have caused
Precautions are taken to prevent re-bleeding

What Are The Reasons Behind Ulcer?

This is a disease that affects the large intestine and the rectum. The Ulcerative Colitis refers to the inflammation in the innermost lining of the large intestine. The main function of the large intestine is to absorb water from indigestible food matter in the body before throwing away any waste. Hence, the large intestine is a vital part of our body. If left untreated, the disease increases risk of colon cancer.

Symptoms:

    Diarrhea with blood or pus: A person suffering from Ulcerative Colitis is likely to suffer from loose stools accompanied with blood or pus.
    Stomach pain and Cramping: In many cases, patients complain of severe stomach pain and cramping.
    Rectal pain: At times, many patients feel pain while sitting or even after a bowel movement.
    Bleeding from the rectum: Bleeding can be observed while passing stools.

The other complications leading to this disease are kidney stones, swelling of the colon, thickening of intestinal walls and blood infection.

Diagnosis:
This disease can be diagnosed by several methods. A simple stool test may be done to check out for bacteria and parasites. A blood test to check the level of C-reactive protein helps determine the inflation rate of the body. Endoscopy, colonoscopy, biopsy are some other methods of diagnosis.

Treatment

    Oral medication: Treatment involves drug therapy or surgery. The first step in treating Ulcerative Colitis will be an intake of anti-inflammatory drugs, but these may have a side effect. Another option is immune system suppressors, which help to bring down the inflammation by suppressing the immune system response. Antibiotics, anti-diarrheal medications, pain relievers are some of the additional drug supplements recommended by doctors.
    Surgery: Surgery plays an important role because this disease is pre-malignant in nature. Depending on the severity of the condition, the medical practitioner may advice surgery. The common methods of surgery are:
        Proctocolectomy and Ileostomy: Proctocolectomy involves removal of the colon in part or whole. Ileostomy is carried out by placing a special bag in the small intestine to collect waste from the body.
        Proctocolectomy and Ileo-anal: Ileo-anal pouch is a bag directly created the small intestine and connected to the anus, for diffusing the stools. As colon is removed Ulcerative Colitis cannot re-occur.

Precautions after surgery
It is very important that the patient takes healthy, sufficient and nutritious food so that bowel movement can be carried out with ease and zero strain. The patient has to restrict lifting of heavy grocery, mowing the lawn, any physical activity that can strain the abdomen and related areas.

Surgery and Post Surgery Care for Ulcerative Colitis

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