The Different Types of Ulcerative Colitis

Which Of These Forms Of Ulcerative Colitis Do You Have?

Large Intestine
The type of ulcerative colitis will depend on the part of the large intestine that is involved. Photo © A.D.A.M.

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 Form Of Ulcerative Colitis

It's important that you understand your ulcerative colitis and how it is affecting your body. The treatment you receive will depend greatly on what part of your colon is inflamed. If the entire colon is inflamed, your doctor may want to do different tests than if only part of the colon is affected. Your physician may also refer to your ulcerative colitis based on the primary area of the large intestine involved in your case, and you'll 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. If you have questions about your ulcerative colitis, speak to your gastroenterologist and get clarification on where you have inflammation in your 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 in each person. Education is a patient's best tool in working with physicians and understanding IBD. With a deeper understanding, you can become your own best advocate and ensure that you're receiving the care that you need to keep your disease in check.

Sources:

Health Information Publications. "Classifying Ulcerative Colitis." ehealthMD 17 Apr 2013. 24 Jan 2016.

Crohn’s and Colitis Foundation of America. "What is Ulcerative Colitis?" CCFA 2016. 24 Jan 2016.

Mark A Peppercorn, MD. "Patient information: Ulcerative colitis." UpToDate 9 Jan 2014. 24 Jan 2016.

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