Venessa Rouzeau, PharmD

The symptoms of ulcerative colitis can cause embarrassment and pain, but pharmacists' expert advice can help ease the discomfort.

	Ulcerative colitis is also known as inflammatory bowel disease because it mainly affects the large intestine, colon, and sometimes the rectum. In this chronic condition, the colon and rectum become inflamed and develop ulcers or sores. As a result, you may experience bleeding and diarrhea, which are characteristic of ulcerative colitis.

	No one knows what causes ulcerative colitis. The immune system is involved, but it is not clear exactly how. Ulcerative colitis affects men and women equally. You can have ulcerative colitis at any age, but it often occurs between the ages of 15 and 30 years, or later in life, from the ages of 50 to 70 years.

	It is more common in Whites and those of Jewish descent. It is important to receive treatment for ulcerative colitis. If left untreated, it can increase the risk of more serious complications in the long run.

	Some complications of ulcerative colitis are:

	• Inflammation in other parts of the body, such as the skin, eyes, and joints

How Do I Know If I Have Ulcerative Colitis? 

	Your doctor will first check for the usual symptoms of ulcerative colitis, mainly bloody diarrhea, abdominal pain, and fever. Following this, several tests can be performed to confirm that it is ulcerative colitis. These include:

	• Colonoscopy or sigmoidoscopy (cameras are used to view inside the intestine, and biopsies can be performed)

	• X-rays (barium enema, computerized tomography scan) • Stool samples to check for bacteria (sign of infection) and white blood cells (sign of inflammation)

	• Sedimentation rate, an indicator of inflammation

	The symptoms of ulcerative colitis can be embarrassing and uncomfortable, and they can have a negative impact on your social life. Certain foods and spices can trigger the symptoms, causing bouts of diarrhea in public places.

	The symptoms will vary depending on how serious your condition is, but they are manageable. Symptoms will occur as flare-ups (worsening of inflammation) that can range from mild, with symptoms coming on gradually, to severe, in which a person can become very ill. Some people may have periods of remission in which symptoms go away for months and even years, but in most, the symptoms will eventually return.

	You may also experience joint pain, mouth sores, nausea and vomiting, skin lumps or ulcers, or anemia.

	The recurrence of symptoms can be reduced by making some dietary and lifestyle changes. Avoiding certain foods that can worsen diarrhea and gas symptoms is a good start. Try the process of elimination to find out which specific foods aggravate your symptoms. The key is to eat a well-balanced diet to prevent the malnourishment that can result from your intestines not being able to absorb nutrients as well. Eliminating dairy products will only help people who are lactose intolerant.

	•Try eating small meals more frequently

	• Experiment with fiber—getting more fiber can sometimes help eliminate diarrhea, but may also aggravate your symptoms

	• Do not choose “gassy” foods, such as beans, cabbage, and broccoli

	• Avoid greasy or fried foods—these can cause more gas and diarrhea because your body might not be able to completely absorb the fat

	• Drink plenty of fluids to prevent dehydration

	• Avoid or limit alcohol and caffeine consumption

	• Consider taking multivitamins to replace lost vitamins and minerals

	When flare-ups occur, medical treatment is necessary to control the inflammation that is triggering your symptoms. In more severe cases, when there is massive bleeding, rupture of the colon, risk of cancer, or your condition is not responding to medical therapy, you might need surgery. About 30% of people with ulcerative colitis will require surgery. This involves removing the colon and rectum, which cures the ulcerative colitis and eliminates the threat of cancer.

	There are 4 types of drugs that are used to treat the inflammation from ulcerative colitis: aminosalicylates, corticosteroids (often referred to as “steroids”), immunomodulators, and biologics.

	Aminosalicylates are aspirin-like medications that are usually tried first in cases of mild to moderate ulcerative colitis. They are moderately effective at treating active inflammation, and better at maintaining remission. They can reduce the long-term risk of colorectal cancer.

	Sulfasalazine is a less expensive aminosalicylate, but not as well tolerated. Nausea, headache, and rash are some of the side effects seen with this medication. Sulfasalazine should be avoided when there is an allergy to sulfur. Enemas and suppositories may be used in combination with oral tablets to better treat the symptoms.

	Corticosteroids are highly effective medications that work quickly to relieve moderate to severe symptoms of inflammation during acute flare-ups. They have predictable side effects when used long term, such as osteoporosis, high blood pressure, and diabetes, so they should only be used for a short amount of time. They are used when aminosalicylates don’t work, or in combination with other treatments. The latest corticosteroid, Entocort HC, offers a safer alternative by causing fewer side effects.

	Immunomodulators and biologic drugs are used as a last resort when other therapies do not work. They work by suppressing the body’s immune system, so there is a potential for serious complications, including an increased risk for infection. Regular monitoring for side effects is required with these medications. They act slowly, and can take from 3 to 6 months to be effective, so they are usually combined with corticosteroids to speed up the response.

	Over-the-counter alternatives can help treat some of the milder symptoms. For diarrhea, Immodium or Metamucil can help, and acetaminophen can alleviate pain. Ibuprofen and naproxen can actually worsen the symptoms of ulcerative colitis, so these should not be taken for pain.

	You might receive antibiotics if you have a fever and your doctor suspects an infection. Iron supplements can be used to prevent anemia. Some herbal supplements that might help include fish oils, probiotics, and Boswellia. Aloe vera has not been proved to be effective for ulcerative colitis. PT 

Dr. Pelegrin is a pharmacist for Publix Pharmacy and Dr. Rouzeau is a pharmacist who has worked in retail and health systems pharmacy.

Venessa Rouzeau, PharmD

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