Colitis Treatment and Symptoms: Can I live a normal life with ulcerative colitis?

The colon is that part of the intestine that contains the stool. It stores and conveys these completely altered food contents, now the waste products, from that part of the intestine where the digestive work is performed to the rectum, from which they are passed out. This portion of the intestine has little important function other than absorbing water and holding the stool. One can live without most or all of this part of the bowel.

The length of the small intestine is several times that of the colon. It is called small because its lumen is narrower than that of the colon. All the digestive processes are completed in the small intestine. In its wall and lumen the digestive juices of the liver, pancreas and intestine act on the food to convert it to the basic nutrients required for growth and nutrition. Normal nutrition requires that several feet of the small bowel exist and function normally.

Colitis is an inflammation of the intestine. The terminal part of the small intestine and the colon are most often involved. There are specific types of colitis due to bacteria, parasites, and low forms of microorganisms. This is one variety of colitis.

In most cases, however, the exact cause of the inflammation cannot be clarified. Many cases have an associated emotional component which triggers it off. Symptoms appear at any age, but it is most common in young adulthood and early middle age. The spectrum of the disease can vary from occasional diarrhea, with expulsion of mucus, to severe cramps, uncontrollable diarrhea and bleeding. One can view it as varying from the "snotty nose" type of inflammation to that resembling a severe burn. Only the complicated problems of either type are involved in surgical consultation.

I always have diarrhea under tension. Is that colitis? 

It need not be. Diarrhea is the response to rage or fear in many people. It is as common in the soldier approaching a tense situation as it is in the well heeled investor watching his stocks fluctuate.

How do you tell if it is colitis? 

Colitis is suspected if the diarrhea is accompanied by cramps, blood or mucus in the stool, fever and weight loss. The diagnosis is made by an internal inspection of the rectum and lower colon with the sigmoidoscope and by X-ray examination of the area.

How advanced is the disease at this time? 

In the advanced stage the diarrhea is disabling and interferes with normal activities. The bowel movements may be loose and so frequent that there can be a loss of control and a sense of urgency compelling the patient always to be near a toilet. The bleeding can be severe enough to cause anemia. The inflammation can produce peritonitis and extend to other organs, especially to the bladder area. Furthermore, the disease can produce secondary involvement of the liver, joints, skin and eyes. If these symptoms are present, the disease is advanced.

Shall I change my job, divorce my wife, or take a long vacation to straighten myself out? 

In the less advanced stage of the disease some patients are helped by making personal readjustments. A vacation alone usually does not solve the problem; most people just take their problems with them to another place. There is an advantage to getting skilled guidance from a counseling source who may be a good friend, minister, psychologist, doctor or guidance counselor.

Shall I see a psychiatrist? 

That is one acceptable approach. There is no possible disadvantage to getting another opinion. For, in the early stages, there is only a thin line between anxiety and the disease, and successful treatment of the anxiety sometimes arrests the symptoms. Generally, these are difficult cases for even the most skilled therapist to cure.

Does this have the implication that I am mentally unsound? 

No! It only means that you are reacting strongly to something. You've seen how people get red in the face and tremble with anger. Well, it may be that your problems are putting the same redness and trembling into your intestines and that is why you have colitis.

Does colitis always have to be operated on? 

Of course not. The majority of cases are mild, often not diagnosed, and labeled as nervous tension. Even severe cases can be managed by diet adjustments, cortisone medication, certain kinds of sulfa drugs, along with medication to reduce excessive intestinal motility. Surgery is considered only for those with the uncontrolled complications.

Can this be coming from bad teeth? 

We no longer believe that a form of infection in the teeth can produce disease of the intestine. In times past many patients underwent extensive dental extractions in the hope that this would cure colitis, gallstones and ulcer disease. It was futile.

Why do you ask for a sample of my stool? 

This is examined to be certain that the problem is not dysentery caused by bacteria or colitis caused by an amoeba. The examination will also indicate whether there is a concealed blood loss in the stool.

When can surgery no longer be avoided? 

There are two categories of patients in this group. The first requires fairly prompt surgery because of uncontrolled bleeding, infection or impending perforation of the intestine, or severe involvement of the other organs. The second group has found the disease so disabling because of its chronicity, recurrences and inability to function fruitfully that it seeks a surgical cure.

What will be the nature of my operation? 

There are at least two major types of colitis and the surgery will depend on which type it is. They are referred to as ulcerative colitis and granulomatous colitis. With ulcerative colitis the surgery is directed at actually removing all the hopelessly and irreversibly diseased colon, but almost no small intestine is sacrificed. All surgeons try to be very conservative when operating for granulomatous colitis, not only because it involves the vital small intestine, but also because the disease frequently recurs. Therefore, in this form of colitis an effort is made to avoid removing long portions of the intestine. A reasonable, effective approach is to detour the bowel contents from one normal segment to an adjacent normal segment in anticipation that, if this is done, the intervening diseased area will heal. This bypass procedure is very often effective.

Can I live and grow normally with the entire colon removed? 

Yes. All the true intestinal work of digestion is carried out in the small intestine.

Do you remove the rectum? 

This is sometimes necessary depending on how badly diseased it is. We can usually tell in advance of opening the abdomen whether this will be required.

What happens to my bowel movements if the rectum is removed? 

You will need to have a permanent abdominal opening through which the bowels will be evacuated. In some instances this can be a colostomy, but usually it is an ileostomy.

What is an ileostomy? 

The ileum is the last part of the small intestine. An opening is made for this to discharge the waste material into a special appliance, which must be worn at all times. The appliance is specially fitted to each patient and is glued to the skin beneath the undergarments. The bag is emptied through a lower spigot about twice a day, and the bag itself is changed about twice a week. Each patient is advised in detail how this is done and after a short time is completely able to manage it.

That's horrible! I don't want to go around with a bag for the rest of my life. If this can be avoided, obviously it will not be done. However, you should be aware that this may be the only way to save you. The appliance is concealed. Nobody need know that it is there. When you are completely rid of the disease, you will become stronger, gain weight, and have the full vigor of your age. In this situation you can carry on full social, athletic, sexual and business activities. Many women are now, after the operation, able to become pregnant. It is a big price to pay, but the dividends in health and recovery from this disease are permanent and thousands of people have found it worthwhile. With the proper attitude by all concerned, viewing this only as an inconvenience and not as a disability, you will make a rapid adjustment.

Is it possible to leave the rectum and later to rehook it? 

This can only rarely be done, but one sometimes has this hope.

Does this change the method of urination? 

No, that is as usual.

How long will I be disabled? 

Many patients who require surgery for the complications of colitis are very sick. They are debilitated, anemic, have lost weight, and harbor the smoldering infection in the intestine and the abdomen. The anemia results from the chronic infection as well as the blood loss. Therefore, such an individual will require time for the correction of these problems in the preoperative period. The postoperative period may be long because of complications or the need to learn how to manage an external opening or a draining area. The in hospital stay averages about four to six weeks, but it depends on the type of surgery. It can be much longer. General rehabilitation procedures can be initiated or continued during the hospital stay.

A surgeon who undertakes the operative management of a paitent with colitis has this patient with him for a long time. This is one surgical problem that requires continuous and continuing rapport between physician and patient and infinite patience on both sides.


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