Managing ulcerative colitis

Donya Betancourt, Pediatrician, drdonya@hotmail.com

Ulcerative colitis involves inflammation of the lining of the colon and rectum throughout a lifetime.

A flare-up is when the rectum and/or colon become inflamed. During a flare-up, acute symptoms such as bloody diarrhea, rectal bleeding, abdominal pain or cramping, and an urgent need to go to the bathroom are present.

Flare-ups can vary in duration and intensity.

Remission is the time between flare-ups when people experience few or no symptoms. Periods of remission vary in duration, anywhere from a matter of days to a number of years.

Ulcerative colitis is a lifelong condition, flare-ups can be controlled and periods of remission extended with medication. This condition affects people of all ages, but often is diagnosed during early adulthood.

The causes of this condition are unknown, but may involve heredity factors, infection, or the immune system. There is no known cure for ulcerative colitis except for removal of the colon. Taking your medication as prescribed by your doctor is an important part of managing the symptoms of ulcerative colitis. And taking your medication, even when you think you feel fine can help you reduce the risk of a flare-up and lengthen your time in remission.

What benefits can you gain from remission therapy?

* Treating inflammation to control symptoms of ulcerative colitis, such as bloody diarrhea and abdominal pain/cramping.

* Reducing the risk of flare-ups.

* Extending the time between flare-ups.

Steroids have a vital role in the medical management of ulcerative colitis. Topical steroids, in the form of foams or enemas (hydrocortisone), are among the commonly used.

In some instances where a patient does not respond to this therapy, oral steroids such as prednisolone are prescribed. For more severe cases, your doctor can administer IV-administered steroids (hydrocortisone or methylprednisolone).

Steroids are generally not considered for maintenance therapy once a flare has been brought under control.

Once an acute attack of ulcerative colitis is controlled, a maintenance regimen is usually required. Non-steroid medications such as mesacol (mesalamine) class of drugs (oral and/or topical) are recommended since they are proven options for long-term maintenance (or remission) therapy.

Your diet does not cause ulcerative colitis. There is no current evidence that diet causes ulcerative colitis but paying attention to the food you eat may help you to manage your symptoms.

Your food choices will depend upon the severity of your disease, whether it is active or in remission, the medication you're taking, your individual nutrient needs, and your individual food tolerances. What you can do is determine your own food intolerance. Keep a careful food diary that tracks what you eat and your associated symptoms. Some food to watch closely includes dairy products, high-fiber food, and food that might cause an obstruction such as nuts, seeds, and popcorn.

This can be a challenge, especially during flare-ups. There is no evidence that dairy products or high-fiber foods aggravate ulcerative colitis symptoms in all patients. It is a common recommendation that people with ulcerative colitis should follow a low-fiber, dairy-free diet. However, new research indicates that this traditional approach may unnecessarily restrict your food choices.

Again, it's important to track your own reactions to these foods and discuss this with your health care team.

Here are some recommendations.

* Drink plenty of fluids. Reducing fluid intake can leave the patient weak and exhausted because of the water loss through diarrhea. Make sure to drink ample fluids (six to eight eight- ounce glasses of water per day or more) Fruit juices or decaffeinated soft drinks are fine but try to drink as much water as possible.

* Try smaller meals and snacks. You may find that it's easier to meet all nutritional needs, and possibly minimize symptoms, by eating frequent small meals and snacks throughout the day.

Managing nutrition is critical for those who are living with ulcerative colitis. It's important to help the body replace the nutrients it loses and it's important to supply the body with the strength to promote faster healing.

It is also important to determine what foods worsen the ulcerative colitis symptoms and then eliminate those from the diet.