• Rectal bleeding. Ulcerative colitis causes bloody diarrhea and mucus. Sometimes you can have rectal pain.  Blood can be red, black or tarry in texture.
• Diarrhea (or rectal urgency). Sometimes people may experience diarrhea up to 20 times per day. Some even wake up at night. But it can be changed by constipation from time to time.
• Loss of appetite and loss of weight. If you have no appetite and ongoing diarrhea then you are likely to loss weight.
• Constipation. It may develop or may not. Everything depends on what part of the colon is affected. This symptom is less common than diarrhea.
• Low amount of red blood cells (anemia). Some people may experience anemia because of low amount of iron levels that are caused by rectal bleeding or inflammation of the intestine.
• Belly pain (abdominal pain) and cramping usually disappear after a bowel movement. Sometimes there abdominal sounds as a gurgling or splashing sound that is heard over the intestine)
• Unexplained fever or other symptoms. In severe cases, fever or some other symptoms affecting the entire body may appear. If they last a day and more, then it is time to see a doctor.

   Some people who have ulcerative colitis may have more symptoms (sometimes called extra intestinal) as they involve other organs and areas of the body. There are the following symptoms:  eye pain and redness, joint pains, mouth ulcer, skin rash or other changes.
In some cases you should immediately seek medical care. There are serious symptoms which are evidence of a life-threatening condition. They are the following: inability to pass gas or stool, severe abdominal pain, vomiting or vomiting blood.

How to make Diagnosis of Ulcerative Colitis?

   The symptoms just give an approximate preliminary diagnosis as the same symptoms can indicate different diseases. The final diagnosis can be made only on the basis of common symptoms, endoscopic findings, histologic features and stool studies for infectious agents. Below the necessary tests will be described.

• Analysis of a stool sample. It helps to exclude infection and parasites. Infections of the colon sometimes can mimic ulcerative colitis. The analysis can give a doctor a reason to eliminate any bacterial, viral, or parasitic causes of diarrhea. The stool sample can also be checked for blood.
• Blood tests will show whether anemia, an elevated white blood cell count or sedimentation rate occur.  They indicate ongoing inflammation in the colon. Blood tests will show whether there is blood in the colon or rectum. It will also help to check markers that can cause infection or inflammation. Blood tests also give information about the kidneys function, liver function and others.
• Sometimes it is important to make a stool test for a protein (called calprotectin) which proves to be useful when identifying patients who can benefit from colonoscopy. Calprotectin is a sensitive marker of intestinal inflammation. This test is worth making only together with others because it cannot distinguish between various diseases. Different disease can cause inflammation so you should use it very carefully.
• It is necessary check the severity of a disease. That’s why you need colonoscopy or sigmoidoscopy. The test looks like as following: the doctor inserts an endoscope (a long and flexible tube with a camera at the end) into the anus. The endoscope is connected to a computer and monitor. It helps to see the inside of the colon and rectum to check whether any inflammation or bleeding occurs. The analysis allows to establish the diagnosis and to measure the extent of the colitis. The doctor can also take small tissue samples for tests with a microscope then.
• A barium enema X-ray is another test that helps to diagnose ulcerative colitis. It is less accurate than colonoscopy. The principle is the following. An enema is used to fill the colon with a chalky white solution (barium). The barium then shows up white on x-ray film. It allows the doctor to have a clear view of the colon where any ulcers or other abnormalities will be indicated.  Sometimes a barium enema is necessary to see how far the inflammation has spread.

   The correct diagnosis is very important for the doctor to choose the right treatment so all the factors should be taken into consideration.

How is ulcerative colitis treated?

   Nowadays there is no cure for ulcerative colitis. All treatments known at the moment are aimed to ease the symptoms. Usually patients with ulcerative colitis experience the following periods: relapse (worsening of inflammation), remission that can last for months or years. Medications and surgery are used to manage the symptoms of ulcerative colitis. Medications have different purposes: to cause remissions, sustain remissions, make side effects of treatment minimal, improve the quality of life, and minimize risk of cancer. These medications are known as anti-inflammatory agents such as:

• Topical 5-ASA compounds such as sulfasalazine (Azulfidine prevents and treats inflammatory bowel disease), olsalazine (treatment for mild ulcerative colitis and prevention of further episodes), and mesalamine. They are effective only on condition they have direct contact with the inflamed tissues.
• For example, Asacol (Synonims: Lixacol, Mesalazine, Mesalamine) is an anti-inflammatory medication, favored in its class thanks to its efficiency. However, it is especially effective against inflammations of the stomach. Asacol helps to treat mild to moderate flares and maintain remission. Furthermore, Asacol is known for certain antioxidant properties that reduce the amount of free radicals in the body which leads to a great number of harmful effects to your health.  It cannot but be mentioned Asacol is quite a potent medication and it is important to choose the right dosage so as to avoid adverse side effect. Asacol is also characterized by one more important advantage in comparison to others mediations, that is taking only once per day. It is necessary for the tablet to be accompanied with a full drink of water. Take into consideration that the tablet should not be damaged before ingestion, as it is created to protect the stomach.
• Corticosteroids can decline inflammation throughout the body without necessity of direct contact with the tissue inflamed. Side effects are possible in case of long-term use.

       If these medications have failed to achieve the necessary effect then immunomodulators are given to the patients. They are used to suppress the immune system. Immunomodulators help to decrease the cells responsible for immunity and interfere with important in promoting inflammation proteins. Immunomodulators are becoming more important in cases when patient have no adequate response to anti-inflammatory agents. The examples of immunomodulators are the following: 6-mercaptopurine, azathioprine (Imuran), methotrexate (Rheumatrex,), cyclosporine (Neoral).
   Methotrexate is an immunomodulator. It is a drug that is created to weaken the immune system intentionally which is necessary for ulcerative colitis patients. The body and immune system react to ulcers as to an invader so the immune system is constantly activated as ulcerative colitis is a chronic disease. Methotrexate helps to relax the immune system and ease the symptoms.  Methotrexate can be recommended in case you have ulcerative colitis in conjunction with Chron's disease. It can be effective for patients who show no improvements after other forms of treatment. One of great advantages is that it can be taken orally or via injection.
Surgery can be performed in more advanced cases of ulcerative colitis. Sometimes it can be used in cases when the symptoms can be hardly controlled by medication. In most cases colon removal is required as the damage is considerable or there is a cancer threat.
There are some complementary treatments that can have a positive effect in conjunction with medical treatment. These methods are sometimes called alternative and they are: acupuncture, massage therapy, yoga. It is important to remember that they cannot replace medical care. Moreover, medical professionals should always monitor the patient’s condition as it allows evaluating the effect certain medications have and check whether any changes take place.

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