The Different Types of Ulcerative Colitis

Knowing Which Form of Ulcerative Colitis You Have Is Important

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Ulcerative colitis is one form of inflammatory bowel disease (IBD). Ulcerative colitis is a chronic, incurable disease that affects the large intestine (colon). Within this broad category of IBD there are different forms, depending on how much of the colon is involved. Ulcerative colitis can affect any part of the colon, but it does not skip areas as the other main form of IBD, Crohn's disease, does.

In ulcerative colitis, the inflammation is continuous throughout the parts of the colon that are affected.

Why You Need To Know Your Ulcerative Colitis Type

It's important for anyone who has this form of IBD to understand ulcerative colitis and how it affects the body. The treatment needed will depend greatly on the part of the colon that is inflamed (has colitis). If the entire colon is inflamed, a gastroenterologist may want to do different tests than if only part of the colon is affected. A physician may also refer to ulcerative colitis based on the primary area of the large intestine involved, and patients and caregivers will want to be knowledgeable enough to discuss it.

It's possible that not all cases of ulcerative colitis fall into one of these broad categories. Questions about a diagnosis of ulcerative colitis should be directed to a gastroenterologist, who will be able to clarify where the inflammation is located in the colon.

See "What is the Digestive System?" for more information on the parts of the large intestine.

The most common forms of ulcerative colitis are:

  • Ulcerative proctitis
  • Proctosigmoiditis
  • Left-sided colitis
  • Pancolitis

Ulcerative Proctitis

Ulcerative proctitis is defined by inflammation that is located in the rectum, most commonly the last 6 inches or less.

For about 30% of patients, their ulcerative colitis starts in this form. Symptoms include diarrhea, bloody stool, rectal pain, and an urgent need to move the bowels (tenesmus). With the inflammation limited to a smaller area than in the other forms of ulcerative colitis, ulcerative proctitis is considered a less severe type of ulcerative colitis, and usually has fewer complications.

Because the inflammation is at the end of the colon, treatment can be topical: meaning that medication can be put right on the inflamed areas. The medicine could be in suppository, enema, or foam form. These forms can be administered through the bottom (the anus) and may include anti-inflammatory drugs or steroids.

Proctosigmoiditis

When inflammation is located in the rectum and sigmoid colon (the last section of the colon), it is known as proctosigmoiditis. Symptoms include diarrhea, bloody diarrhea, crampy pain, urgency, and pain on the left side of the abdomen.

This type of ulcerative colitis may also be treated with topical medications in the form of suppositories, enemas, and foam. Enemas can reach further up into the colon, making them more effective in treating inflammation that is higher up, in the sigmoid.

This form of ulcerative colitis may also be treated with a 5-ASA (5-aminosalicylic acid) drug or sulfasalazine, which are given orally and used for long-term maintenance and in continuing remission. An oral corticosteroid (such as prednisone) may also be used as a short-term therapy during a flare-up to get symptoms under control.

Left-sided colitis

Also known as limited, or distal colitis, left-sided colitis is when inflammation is in the left side of the colon (the rectum, sigmoid colon, and descending colon). Symptoms include diarrhea, bloody stools, weight loss, loss of appetite, and occasionally severe left-sided pain.

This type of ulcerative colitis may be treated with a combination of topical medications (suppositories, enemas, or foam) as well as a 5-ASA drug, sulfasalazine, or a corticosteroid.

Pancolitis

Pancolitis is when there is inflammation throughout the whole colon. Symptoms include diarrhea, cramps, significant weight loss, and severe abdominal pain. This form of colitis must be treated with oral medications (5-ASA drugs, sulfasalazine, or a corticosteroid) in order for the medication to reach all the areas of the colon. Other types of drugs that might be used include the Tumor necrosis factor-alpha (TNF-alpha) drugs, which are often given either by infusion (in a vein at an infusion center) or by injection. Moderate to severe cases of this type of ulcerative colitis may require treatment in the hospital at times.

The Bottom Line

IBD is a very complicated disease that takes many forms. Ulcerative colitis is broadly defined as inflammation in the colon, but there is a great deal more to this disease. Scientists are beginning to understand that aside from the forms described above, there could be many variations of this disease, which is why treatments work differently for each person. Education is a patient's best tool in working with physicians and understanding IBD. With a deeper understanding, patients can become their own best advocate and ensure that the right care plan is put in place to keep the disease in check.

Sources:

Health Information Publications. "Classifying Ulcerative Colitis." ehealthMD 17 Apr 2013. 

Crohn’s and Colitis Foundation of America. "What is Ulcerative Colitis?" CCFA 2016. 

Mark A Peppercorn, MD. "Patient Information: Ulcerative Colitis." UpToDate 9 Jan 2014. 

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