What is Ulcerative Colitis

Ulcerative Colitis is one of the most prevalent Irritable Bowel Syndromes (or IBSs) diagnosed today amongst adults in the United States.  The disorder occurs when the lining of the colon becomes compromised due to persistent inflammation, thus breaking down the cells in the colon wall and thereby forming lesions or sores in the anus, also known as ulcers.

Who Does Ulcerative Colitis effect

Ulcerative Colitis affects individuals differently, depending on a variety of considerations, including the status of one’s health, in addition to their family history and hereditary factors.  Because cases are not identical regarding exact causes and symptoms, no two treatments are identical.  However, because causal similarities are consistent amongst sufferers, in addition to the presence of fairly predictable symptoms, remedy options tend to follow certain trends.  Typically drug treatment options are the first measures advised.  Three drugs that are frequently prescribed to help alleviate symptoms are a) Aminosalicylates, b) Corticosteroids, and c) Immunomodulators.  Compounds that include what are called 5-aminosalicylates help to reduce symptoms of inflammation.  An example of a 5-aminosalicylate is a drug composed of two agents, respectively Sulfasalazine and sulfapyridine.  Because one or more of these chemicals is known to induce unpleasant side-effects such as nausea, diarrhea, heartburn, vomiting, indigestion and migraines, 5-ASA compounds will often be augmented with other agents such as olsalazine or balsalazide, which carry fewer side-effects.  5-ASAs can be administered rectally, through an enema or suppositories, or taken orally.  In mild or moderate cases the condition is often first combated with one or more combinations of these of substances.

Ulcerative Colitis and Steroids

Ulcerative Colitis treatment also responds favorably to the use of Corticosteroids (or steroids), of which hydrocortisone and prednisone are two examples.  These agents also possess anti-inflammatory properties, and are frequently turned to for relief when individuals with moderate to severe colitis do not respond favorable to 5-ASAs.  Like 5-ASAs, corticosteroids can be taken orally or employed rectally, but can also be administered intravenously.  Side-effects from using steroids can be severe, and may include changes in skin composition resulting in acne, weight gain, in women the development of facial hair, reduction of bone mass, and a heightened vulnerability to infection.  In rarer cases diabetes can develop, which is why the use corticosteroids must be closely supervised by a doctor.  Immunomodulators, of which azathioprine is an example, lessen inflammation by acting on the immune system.  Immunomodulators such as azathioprine and 6-mercapto-purine (or, 6-MP) can be administered in cases where individuals have not responded to either 5-ASAs or to corticosteroids.  Drawbacks of taking Immunomodulators include complications regarding hepatitis, a heightened risk for developing infections, a heightened risk of succumbing to pancreatitis, and also the fact that benefits derived from the drug can take six to nine months to develop.  In addition to these treatment options, one’s physician can also prescribe medications to address issues of infection or nausea, in addition to medications that combat symptoms of diarrhea or pain.

Ulcerative Colitis in very severe and rare cases may require hospitalization.  In the event an individual experiences copious bleeding or diarrhea that is intense enough to generate dehydration, it might become necessary to rehydrate the body of its fluids or undergo transfusion treatment to address the loss of blood.  In these cases dietary needs may necessitate intravenous feeding for a period of time during recovery, administering specific medications or even surgery.  It has been estimated that approximately one quarter to forty percent of individuals suffering from severe and prolonged Ulcerative Colitis will eventually have to undergo surgery to have their colons removed.  If this becomes a necessity it is the result of massive hemorrhaging, rupturing of the colon itself, or in cases where the risk of cancer is either high or malignant polyps have already developed.  There are two procedures that are performed in such cases: an Ileostomy and an Ileoanal Anastomosis.  Respectively, an ileostomy involves making a small incision in the abdomen, through which a small section of the intestine, or ileum, is drawn.  In this way solid waste bypasses the rectum and is eliminated instead into a small pouch to which the section of intestine is fastened, where the stool then collects and can be emptied as necessary.  In contrast to the ileostomy, ileoanal anastomosis provides for the individual to maintain normalized bowel movements.  This procedure involves removal of the colon, while leaving intact the rectal muscles.  The surgeon creates a small pouch with material from the ileum in rectum in which waste is stored, and in this way allows for normal elimination of stool from the body.  Not every surgical procedure or medication regiment is appropriate for every person.  The procedure or drug therapy regiment one opts for should take into account what stage the disease is in, the severity of its symptoms, the individual’s genetic make-up, hereditary factors, and the general state of their health.  If faced with this decision one should acquire as much information as possible by consulting their physicians to best ensure they have explored and decided upon the appropriate treatment course to effectively resolve their specific case of Ulcerative Colitis.

David Gilbert received his BA from U.C.L.A. He is currently doing graduate work in psychology at California Graduate Institute, in Los Angeles, CA. Throughout his career in the mental health field he has worked clinically with several populations, and also contributed to academic works whose topics address both health and mental health issues.

Irritable Bowel Syndrome – H.I.C ©

What Is Your Stool Telling You about your health? Nobody likes to talk about bowel movements. As a Clinical Nutritionist in practice for over 15 years I was taught many years ago that your stool can be an invaluable source of information about what may be going on in the body. It’s a standard question in my Initial Consultation with every client and I usually have to come right out and ask as most people leave that section of the health history form blank. It’s not the easiest subject to bring up and I wasn’t crazy about asking my clients in the early years but I quickly learned how important it is diagnostically. Many poor health conditions stem from poor elimination in some way.

Since checking out your stool is a free and easy way for a person to figure out what may be going on with their digestive health – and most people do take a peek and probably are wondering what it means when for example they have greasy yellowish stools, I decided to write an article about stools and your health.

First of all, for healthy digestion and elimination a person should have a bowel movement 1-3 times a day. Yes, a day. I’ve had clients come to me and say that they have “normal” digestion and that they go 2 times a week regularly. That is not normal under any circumstances. It’s constipation. Some people say they go every hour and that isn’t normal either, it’s diarrhea. Ideally a person should have a bowel movement shortly after each meal. Normal transit time is about 12 hours. Most Americans don’t eliminate as often as they should.

A healthy bowel movement should be light to medium brown, shaped like a small banana but without the curve, light enough to float and not drop to the bottom of the toilet bowl, it should be formed (not liquid or runny) and easy to pass with no pain or straining. If this sounds like your stools, you are doing well. If not, maybe you recognize some of the issues below.

• Stools that are too large can be a sign of lactose or casein intolerance. Both casein and lactose are found in dairy products like cheese and milk and can cause digestive pain and symptoms in many people.
• Stools that are hard and pebble like can be a sign of poor liver and gallbladder function and or a lack of digestive enzymes. Both large and hard stools as well as diarrhea can lead to straining and possibly hemorrhoids.
• Thin stringy or flattened looking stools can be a sign of a polyp or other obstruction that causes a narrowing of the elimination pathway. This is also present with Irritable Bowel Syndrome (I.B.S.) and spastic colon.
• Stools that are greasy, fatty and messy and leave a film or grease in the toilet can be a sign of pancreas dysfunction, pancreatitis or an inability to absorb the nutrients in your foods.
• Pale, grayish or light yellow colored stools can indicate liver and gallbladder problems.
• Dark black stools could mean bleeding in the digestive track. Stools with blood or mucous can be sign of ulcerative colitis, Crohn’s disease, hemorrhoids or even colon cancer.

See your physician right away it there’s blood in your stool. While some of these issues are diet related and can be discussed with an experienced Nutritionist, many of these are serious health concerns and you should see a doctor as soon as possible.

A healthy stool should not be extremely strong and foul smelling. The worse it smells the higher degree of bowel toxicity is present. Poor diet alone can cause odor problems but other health issues can contribute. The odor may signal a lack of the healthy bacteria like acidophilus and bifidobacterium (also called probiotics) your gut needs to stay balanced and to assist in the digestion and assimilation of the foods you eat, or you may have an overgrowth of unhealthy yeast or bacteria such as Candida Albicans. If you are having an issue with serious odor or chronic diarrhea or constipation a stool test from a specialty lab like Genova Diagnostics can give you a credible report of what is going on in your gut. Your Physician or Nutritionist should be able to get the testing done and interpret the results for you. Either way – take a look at what’s going on, and if you have one of the on the list go see a health specialist and get it checked out.

If you would like me to perform your stool test follow the directions below. Until next time…best of health to all, Juli !!!

E-mail me at jknutrition@earthlink.net or juli@julikeene.com letting me know you are interested in testing. I will e-mail you a health history and symptom assessment to help determine which test would be most helpful for you.

I will have you pay by check or credit card using Paypal. See each test for prices.

I will have the test kit and instructions sent directly to you.

When you receive the test kit, you will follow instructions to collect the stool sample/s.  You will FedEx it to the lab via the pre paid envelope. Be sure to keep your testing box as it will be sent back to the lab with the samples inside of it. Write your name and Juli Keene on the test kit box somewhere on the top of the outside.

The lab will analyze your stool specimens and send the results to the office. The results are sent to me and we will schedule your 30- minute phone or e-mail consult with Juli Keene, CN to review the results and your options. You will receive a copy of test results and a printed summary of your consultation.

The testing takes about 14-21 business days from the day the lab receives your sample kit for us to receive the results and contact you for a consultation.

The complete costs are listed next to each test. Cost includes the test kit, lab services, a printed copy of lab results and interpretation, and a 30- minute review of findings with Juli Keene, Licensed Clinical Nutritionist and a printed summary of our consult and your plan.

Juli Keene B.Sc, CN is not a physician.  She does not diagnose or treat disease. This information is not intended to replace a one-on-one relationship with a qualified healthcare professional and is not intended to provide medical advice.  For medical advice, always seek a physician. This information is intended solely as a sharing of knowledge and information based upon the experience and research of Juli Keene, CN and Nutrition Solutions

by Juli Keene, B.S.c, CN,
Licensed Clinical Nutritionist

julikeene@earthlink.net

Juli Keene, B.S.c, CN

© Hemorrhoid Information Center  2009

Inflammatory Bowel Disease refers to a group of diseases characterized by swollen or inflamed intestines or colon. This is due to an immune reaction of the body against its own tissues. Some symptoms of the disease include abdominal cramps, fever and bloody diarrhea. The main goal for treatment is to reduce inflammation caused by abnormal autoimmune reactions of the body.

Types:

Inflammatory Bowel disease affects around one million Americans yearly; it is one of a hundred or more autoimmune diseases. The two most common manifestations are Crohn’s Disease and Ulcerative Collitis.

Lesser forms include:

• Collagenous colitis
• Lymphocytic colitis
• Ischaemic colitis
• Diversion colitis
• Behcet’s syndrome
• Infective colitis
• Indeterminate colitis

Inflammatory Bowel Disease Causes:

The disease is idiopathic or the real cause is unknown. The inflammation is due to an auto-immune response of the body to its own tissues. It is believed that an abnormality in the immune system causes its inability to recognize normal cells and attack it. The disease progresses when bacteria and gastric contents pass through damaged tissues and enters the body’s bloodstream. The digestive system especially the small intestines are highly vascularized meaning it is very well connected to the bloodstream. Absorption of nutrients is usually done through the small intestine and received through the blood stream. Tissue damage can easily spread infections to the body through the bloodstream.

Cases of Inflammatory Disease are high in patients whose family has a history of the disease. It’s still not considered a major factor since the percentage of developing the disease is minimal. It is believed that genes may play a factor but this is in conjunction with other factors.

Persons of Northern European and Jewish descent have higher incidents of the disease. Cases of IBD in people of Jewish descent grow with Ashkenazi Jews (European descent).

Recent studies identified that certain genes present may enhance an individuals chances of getting the disease. In researches the first gene associated with Crohn’s disease was identified. The NOD2 gene is suspected as one of the factors responsible for the development of the disease.

Inflammatory Bowel Disease Symptoms:

Patients suffering from Chronic (persist for a long periods) IBD may experience periods of remissions and attacks. Symptoms range from mild to severe. Severity depends on the area affected by the disease. Inflammatory Bowel Diseases interferes with normal function of the intestines.

• Chronic diarrhea
• Abdominal cramps and pain
• Fever
• Blood and mucus in the stool
• Abnormal weight loss
• Loss of appetite
• Nausea and Vomiting
• Inflammation (results due to infections released to the bloodstream)

Inflammatory Bowel Disease Diagnostic Tests:

Differential diagnosis

Signs and symptoms for Inflammatory Bowel Disease are similar to other medical conditions. Elimination of other possible diseases is done to increase the possibility of the person suffering from IBD.

Laboratory Studies

Clinical studies of blood and stool testing determine if there is an infection and to identify the causative agent of infection

• CBC (Complete Blood Count)
• ESR (Erythrocyte Sedimentation Rate)
• Serum Chemistry
• Stool Exam
• Blood Culture

Imaging Studies

Doctors perform a series of procedures to view your intestines for inflammation or bleeding.

• X-ray
• Sigmoidoscopy or Colonoscopy

Management and Treatment of Inflammatory Bowel Disease :

Diet

Management of patients suffering form IBD includes eating a healthy diet. Inadequate absorption of nutrients is common because the disease affects the small intestines. Eating a low residue diet and restricting or minimizing foods rich in fiber is also advised. Fats are also avoided to control instances of diarrhea.

Pharmacologic

Drugs are prescribed to control or suppress the body’s immune system. Because IBD is an autoimmune disease these drugs are used to reduce the body’s natural defense system from attacking normal tissue. Antibiotics are also used to treat infections brought about by IBD. Medications which reduce peristalsis or movements in the digestive tract are also used to control diarrhea.

Surgery

Advanced stages of IBD may require surgery as drug interventions alone can not treat the disease.

Crohn’s Disease

Surgery does not cure Crohn’s Disease. Inflammation may transfer to another part of the intestines or may develop near the affected area. If a blockage or fistula (abnormal connection between organs) develops surgery is indicated.

Ulcerative Colitis

Removing the entire colon area, rectum and anus eliminates the possibility of developing colon cancer. Surgery is indicated when drugs or medications have failed to arrest the progress of the disease. People suffering from chronic symptoms of  Ulcerative Colitis are also candidates for surgery.

Prevention:

Inflammatory Bowel Diseases are idiopathic diseases. There are no known causes for IBD, diet or lifestyle changes may not affect the possibility of a person acquiring the disease. Diet and lifestyle changes are done to manage or treat symptoms of persons suffering from IBD.

Inflammatory Bowel Disease affects millions of Americans today. Visiting your doctor for a daily checkup helps in detecting diseases at their early stages. Preventing and detecting diseases at their early stages is the best way of treating an illness. Signs and symptoms of IBD like diarrhea, loss of appetite and weight loss are often neglected as everyday occurrences. Crohn’s disease and Ulcerative Colitis are only noted when a patient has been suffering from chronic symptoms of IBD. Education and yearly visits helps in early detection and gives you the best chance of coping with Inflammatory Bowel Diseases.

Written by,

Ronald Uy, RN

© 2009  Hemorrhoid Information Center

Sources:

Inflammatory Bowel Disease. Retrieved Aug 28, 2009 from emedicine: http://medgenmed.medscape.com

Digestive Diseases: Causes of Inflammatory Bowel Disease: Retrieved Aug 28, 2009 from MedicineNet.com: http://www.medicinenet.com/script/main/art.asp?articlekey=41964

Inflammatory bowel disease. Retrieved Aug 28, 2009 from Wikepedia: http://en.wikipedia.org

Inflammatory Bowel Disease. Retrieved Aug 28, 2009 from UCSF Children’s Hospital: http://www.ucsfhealth.org

Surgical Procedures for Inflammatory Bowel Disease. Retrieved Aug 29, 2009 from Beth Israel Deaconess Medical Center:  http://www.bidmc.org

Irritable Bowel Syndrome, or IBS, is today one of the most commonly diagnosed gastrointestinal disorders amongst adults in the United States.  It is typically associated with symptoms such as bloating, diarrhea, abdominal cramping, and constipation.  Although it is unclear exactly how and why the condition of Irritable Bowl Syndrome develops, it is nonetheless defined by specific symptoms and characteristics that in turn are amenable to a variety of treatment remedies.  One of the most frequent prescriptions for dealing with the disorder is to learn stress management.

Irritable Bowel Syndrome’s symptoms, unlike the symptoms that attend Ulcerative Colitis, can be alleviated in part by learning to better cope with the daily exigencies and rigors which commonly precipitate anxiety and stress.  It is not entirely clear what mechanism stress management affects, or even if there is a causal link between poor stress management and the development of the condition; however, because evidence seems to support the theory that undo stress impacts the overall severity of the condition, physicians routinely advise their patients to conduct a multi-pronged approach for treatment that should include strategies aimed at improving stress management.

Irritable Bowel Syndrome sufferers show a marked predisposition to suffering from emotional or psychiatric disorders such as Generalized Anxiety Disorder or Depression.  As stated previously, whether or not this link is causal, or merely a symptomatic response to the body’s inability to cope with emotional stress, remains obscure.  However, the theories propounded explaining this association include:

a) Sufferers of Irritable Bowl Syndrome  show greater sensitivity to emotional crises and appear to be more susceptible to anxiety or depression.

b) A secondary symptom of high-stress is a heightened awareness of physical discomfort, which includes greater sensitivity to symptoms such as colon spasms .

c) Because stress affects the immune system, Irritable Bowel Syndrome may be activated by a compromised immune system.

Irritable Bowel Syndrome responds well to a variety of exercises, including relaxation techniques, which can be learned from, and practiced with, a professional, performed alone or with a partner, and involve using techniques such as deep breathing and guided or non-guided visualization, in which a tranquil situation or scene is conjured in the mind and then explored.  Since stress is frequently an outgrowth of lifestyle, it is often advised to integrate into one’s life style activities that are set apart from one’s daily schedule and that will generate calm and contentment.  For example, doctors will advise sufferers to explore activities such as hiking or meditating or yoga, or suggest finding a hobby that promotes a sense of well being.

Irritable Bowel Syndrome also appears to respond favorably to medications, some of which are psychiatric in nature, and include anti-anxiety medications and anti-depressants, others which directly treat symptoms such as bloating or cramping.  Traditional therapy too can assist one to better cope with stress, which in turn can help to alleviate symptoms.  Clinical therapeutic modalities associated with reduction of IBS symptoms include Behavioral therapy, which seeks to curb certain destructive tendencies or behavior patterns, and Cognitive Behavioral Therapy, which seeks to make the individual conscientious of thought patterns or behaviors that reinforce negative aspects or self-images one has developed over time.  Other alternative modes include biofeedback and hypnosis, although the evidence supporting efficacy for these remedies is still largely circumstantial.  There is, of course, no one treatment plan that will work for all people, and since the disorder affects and manifests differently for each individual, care should be taken to create a regiment that fully addresses one’s specific situation.  In the event one is suffering from the disorder, it is imperative to remain open to all of the treatment possibilities at one’s disposal and thus ensure a comprehensive plan is implemented to address their case of Irritable Bowel Syndrome.

written by David Gilbert

© Hemorrhoid Information Center 2009