Ulcerative Colitis (UC) is a chronic inflammatory bowel disease (IBD) that affects the gastrointestinal tract, specifically the colon. However, there are a few subtypes of UC, largely differentiated by the area of the intestinal colonic wall impacted by inflammation.
Although symptoms can overlap, these subtypes have distinct features and signs to watch out for. Recognizing the different types of UC and tailoring treatment accordingly is crucial for managing symptoms effectively.
Ulcerative Proctitis
Ulcerative proctitis is a subtype of UC in which inflammation is confined to the rectal area.
Various factors, including sexually transmitted infections, severe constipation with a solitary rectal ulcer, and radiation therapy, can similarly cause inflammation in the rectum and mimic this condition.
Complications of ulcerative proctitis may include anemia from loss of blood, ulcers, anal fissures, and rarely fistulas. Still, unlike other UC subtypes, ulcerative proctitis rarely leads to systemic symptoms.
Symptoms of Ulcerative Proctitis
Rectal bleeding is the primary symptom of ulcerative proctitis. However, patients may experience any of the following:
Symptoms of Ulcerative Proctitis include:
- Tenesmus (persistent urge to defecate with a feeling of incomplete evacuation)
- Rectal pain
- Lower abdominal pain (typically on the left side)
- Fecal urgency, which in more severe cases may even lead to incontinence ‘accidents’
- Presence of blood or mucous in stool
- Diarrhea, which is usually less pronounced in proctitis compared to more extensive colitis forms
- Pain during bowel movements
If you experience any of these signs or symptoms, it’s essential to consult a healthcare professional.
Diagnosis & Treatment for Ulcerative Proctitis
Ulcerative proctitis is usually determined through clinical presentation, endoscopic findings and biopsy results, and a family history of IBD.
Treatment typically involves rectal 5-ASA (mesalamine) in the form of suppositories or enemas, and less commonly rectal steroids like enemas or foams. In more severe forms, or when rectal preparations are not enough to control symptoms, oral medications may be needed, or even biologic drugs. Patients may also benefit from some evidence-based herbal compounds
Left-sided Colitis
Left-sided colitis affects the rectum, sigmoid, and descending areas of the colon. This condition is also known as distal colitis. Complications can include anemia, fulminant colitis, perforation, and toxic megacolon.
Symptoms of Left-sided Colitis
Symptoms of left-sided colitis are similar to other UC types and may include:
- Diarrhea, commonly with bloody stool with or without mucus
- Abdominal or rectal pain
- Weight loss and lack of appetite
- Rectal spasms
- Fecal urgency, which in more severe cases may even lead to incontinence ‘accidents’
- Fever, which is not common and signifies a more severe disease
Consult a doctor if you notice blood in your stool, which can indicate significant colon damage.
Diagnosis & Treatment for Left-sided Colitis
Diagnosis of left-sided colitis involves endoscopy with biopsies to identify signs of inflammation, such as redness and irregularities in the intestines. In this subtype, signs of inflammation do not extend beyond the splenic flexure of the colon, i.e. involving the left-side third part of the colon.
Treatment options include medications, which may be reinforced by complementary alternative medicine, lifestyle and diet adjustments, exercise, improved sleep quality, and stress reduction.
Proctosigmoiditis
Proctosigmoiditis causes inflammation that extends further inwards than proctitis but less than left-sided colitis and affects both the sigmoid colon and rectum.
As such, patients may not experience as many systemic symptoms as those with more extensive UC.
Symptoms of Proctosigmoiditis
Symptoms of Proctosigmoiditis can vary in severity, with most symptoms concentrated in the left side of the abdomen. Common symptoms include:
- Diarrhea, commonly with bloody stool with or without mucus
- Abdominal or rectal pain
- Weight loss and lack of appetite
- Rectal spasms
- Fecal urgency, which in more severe cases may even lead to incontinence ‘accidents’
- Constipation (unusual, as stool moves slowly through the inflamed colon)
Diagnosis & Treatment of Proctosigmoiditis
Diagnosis of protosigmoiditis will involve a colonoscopy to observe signs of swelling and inflammation. Treatment typically starts with 5-ASA medications, with mesalamine enemas and suppositories often in combination with oral 5 ASA, as the combination was shown in several trials to be better than giving either one of these alone.
Pancolitis
Pancolitis, also known as extensive colitis, is the term describing a disease that starts in the rectum and extends beyond the left side of the colon to the transverse colon (affecting two-thirds of the colon) or further to the right colon (affecting the entire large intestine). This condition often results from UC but occasionally can arise from infections that need to be ruled out.
Symptoms of Pancolitis
Symptoms of Pancolitis can differ depending on the severity of inflammation, but in general are similar to left-sided colitis, with greater potential to become severe.
- Diarrhea, commonly with bloody stool with or without mucus
- Abdominal or rectal pain
- Weight loss and lack of appetite
- Fatigue and exhaustion
- Fecal urgency, which in more severe cases may even lead to incontinence ‘accidents’
- Fever, which is not common and signifies a more severe disease
Seek immediate medical attention if you experience severe symptoms.
Diagnosis & Treatment for Pancolitis
Diagnosis of pancolitis involves physical examination, stool sample, blood tests, colonoscopy, and biopsy. Treatment options include anti-inflammatory drugs (5-ASA, corticosteroids), immune suppressors, and, in extreme cases, surgical removal of the colon (colectomy), which rarely also needs to be performed in severe refractory forms of more limited colitis (left-sided or even proctosigmoiditis).
Microscopic Colitis
Microscopic colitis is a distinct disease that is different from the various sub-types of ulcerative colitis described above. Microscopic colitis is characterized by inflammation in the colon or large intestine that is too small to see with the naked eye, i.e it cannot be seen during an endoscopy even by a skillful GI doctor, and only by biopsies and microscopic examination can the inflammation be detected.
It includes two subtypes: collagenous and lymphocytic colitis, although both have similar symptoms and treatments. Although microscopic colitis can impact people of any age, it is more commonly diagnosed in females, and in those 60 or older.
Symptoms of Microscopic Colitis
Symptoms of microscopic colitis may include:
- Watery, non-bloody diarrhea lasting for weeks to months
- Cramps
- Pain, although this is an uncommon symptom
- Bloating
- Dehydration
Diagnosis & Treatment for Microscopic Colitis
As mentioned above, the only way to diagnose Microscopic Colitis is by examining under a microscope tissue samples obtained by biopsies during lower endoscopy.
Treatment options include avoiding trigger foods, fiber supplementation, discontinuing medications that worsen symptoms, and, if necessary, prescription medications including bismuth subsalicylate or certain types of corticosteroids.
Navigating the Subtypes of UC
Understanding the different types of Ulcerative Colitis and microscopic colitis is essential for proper management and treatment. If you experience symptoms of colitis, consult a healthcare professional for a thorough evaluation and personalized care plan.
Shomron Ben-Horin
