Why is your stomach hurting?
You wake up one morning because your stomach is hurting and all of sudden you have an urgent need to go to the bathroom. Once you’re in the bathroom, despite feeling like you need to go, you’re unable to. While you’re in there, you realize that for the past several weeks you’ve been having a significant amount of stomach pain, diarrhea and weight loss. What’s going on? Why is this happening? What can you do about it?
Colitis is an inflammatory bowel disease and is also known as ulcerative colitis. It causes ulcers and long-term inflammation of your digestive tract. Both of these are usually found at the innermost lining of your large intestines and rectum. The cause of colitis isn’t known, but thought to be related to either an immune system malfunction, genetics or a combination of both. When your immune system is activated to get rid of an invader, like bacteria or viruses, it can overreact and attack your digestive system. Colitis is more common in people who have family members with the disease. While diet and stress don’t cause colitis, they can exacerbate it.
Symptoms depend on the type of colitis. Typically, colitis is classified based off of its location. When it’s confined to your rectum, it’s called ulcerative proctitis. This type is usually the mildest and often the only symptom is rectal bleeding. If your rectum and lower end of your colon (sigmoid area) are affected, it’s called proctosigmoiditis. Symptoms usually are bloody diarrhea and abdominal cramps/pain. Sometimes, you might not be able to have a bowel movement even though you feel like you need to. If the inflammation and/or ulcers go from your rectum pass the sigmoid portion of your colon into the descending portion, it’s known as left-sided colitis. In addition to bloody diarrhea, you’ll have pain/cramping in your abdomen, but it’ll be more focused on the left side. Also, you might have unintended weight loss. If your entire colon is affected, you’ll have bloody diarrhea, severe abdominal pain/cramping, fatigue and substantial weight loss. This type is known as pancolitis. A rare form that involves your entire colon is acute severe ulcerative colitis. Besides severe pain, it causes profuse diarrhea/bleeding, fever and inability to eat.
Colitis is usually treated through medications or surgery. While it depends on the severity of your symptoms, your doctor will probably recommend you try anti-inflammatory medications first. These usually come from either one of two groups, 5-aminosalicylates or corticosteroids. Another class of medications that can be used are immunosuppressants. This reduce the inflammation by suppressing your immune system response that initiates it. For many people, they need to take a combination of several medications from this type in order to get the desired effect. The only down side is that it they can increase your risk of developing other infections because they depress your immune system as a whole, not just the part of it acting up in your digestive tract. The goal of any of these medications is to cause your colitis to lessen in severity and hopefully go into remission. In order for you to be more comfortable, your doctor might want you to take other medications that can manage your symptoms, but doesn’t make them go away. These can include antibiotics to get rid of an infection, anti-diarrhea medications, pain relievers (ex. acetaminophen, but not ibuprofen or naproxen—these will make your symptoms worse) and iron supplements, if you become anemic.
Surgery can make your colitis go away, but it involves removing your colon and rectum. If possible, the preferred method is for your doctor to make a pouch at the end of your small intestines and attach it directly to your anus. This allows you to get rid of waste as normally as possible and you don’t need to wear a bag to collect stool in. If this isn’t possible, your doctor will create a permanent opening in your abdomen called an ileal stoma. Stool passes through this into a bag that you must empty and change periodically.
There isn’t a way to prevent colitis from occurring, but there are things that you can do to help minimize the severity of your symptoms. The most important thing you can control is your diet. Keeping a food diary to track when your symptoms are worse allows you to see if there is any correlation to foods that you’ve eaten. Limiting dairy products is an important element since they can contribute to diarrhea, abdominal pain and gas. For some individuals with colitis, fiber can make symptoms worse. So, since fresh fruits and vegetables often have fiber, cooking them can help to decrease the level of the fiber’s impact on your body. It can be helpful to avoid spicy foods, alcohol and caffeine because they can also make your symptoms worse. It’s essential to drink plenty of water because this will help prevent you from becoming dehydrated (especially when you have diarrhea). Eating five or six small meals each day can lessen the severity of your symptoms while getting the nutrients your body needs. If you’re unsure of what to eat or are looking for more options, it’s a good idea to talk to a dietitian.
Besides diet, there are several things you can do to help. A big consideration is stress and how to reduce it. Exercise is a great way, but talk to your doctor before starting a routine to make sure that it’s right for you. Practicing relaxation techniques, like deep breathing or meditation, is extremely useful in reducing stress. Some people use a biofeedback machine to help with this. All of this can seem overwhelming, so it’s valuable to learn as much as you can, join a support group and talk to a therapist, if needed.
Colitis can be an uncomfortable thing to live with, but by doing what you can to prevent it from flaring up, you’ll be able to have a healthy life. If you have any questions or concerns about colitis, please speak with your doctor. If you would like more information, please visit the National Institute of Diabetes and Digestive and Kidney Diseases’ Ulcerative Colitis page at https://www.niddk.nih.gov/health-information/digestive-diseases/ulcerative-colitis