Different Types of SSDs: You Need to Know!
Do You Know the Different Types of UC?
From left-sided UC to proctosigmoiditis, learn how the types of this condition differ, and what that can mean for your symptoms.
By Quinn Phillips
Medically Reviewed by Kareem Sassi, MD
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If you have ulcerative colitis (UC), you know the range of symptoms the disease can cause — from extremely urgent bowel movements to passing blood in your stool to pain and cramping caused by inflammation. But you may be less familiar with the different types of UC, as well as how each can impact the symptoms you experience and how the disease develops.
Ulcerative colitis can be characterized both by its severity — how badly inflamed the colon is at the site of disease activity — and by what areas of the colon it affects. These two factors, in combination, can explain a lot about why you experience certain symptoms.
Tests to Evaluate the Severity of UC
Ulcerative colitis can be roughly grouped into the categories of mild, moderate, and severe, according to Daniel Stein, MD, associate professor and director of the inflammatory bowel disease program at Froedtert and the Medical College of Wisconsin in Milwaukee. Your doctor can determine the severity of the disease based on symptoms, lab tests, and the results of a colonoscopy.
According to Dr. Stein, the main symptoms doctors look at when rating UC severity are the number of bowel movements per day, amount of blood in the stool, weight loss, and reports of a poor appetite.
Important lab tests for determining the severity of a person’s UC can identify nutritional markers, like iron and protein stores, which indicate more severe disease when they’re lower. Doctors can also check for markers of inflammation in the blood, such as C-reactive protein.
A colonoscopy can help doctors to see how much ulceration and bleeding has occurred in the mucosa, the lining of the colon.
In addition to reported symptoms, lab tests, and colonoscopy results, some people receive CT (computerized tomography) scans to assess inflammation in the colon, although the role of these scans is currently more limited in UC than in Crohn’s disease.
If the UC is in remission, the severity of the disease — determined using a rating system based on colonoscopy results — can help predict how likely it is to return to an active state, according to a study published in November 2019 in theJournal of Crohn’s and Colitis.
Determining the Extent of UC
Another way to categorize ulcerative colitis is by identifying what areas of the colon it affects, as seen in a colonoscopy. According to Stein, UC always affects the rectum, the lowest section of the colon. But it may also affect other, higher-up parts of the colon.
There are four main types of UC based on how much of the colon is affected:
Ulcerative ProctitisThis form of UC usually affects less than 6 inches of the rectum and is found in about 30 percent of people at the time of diagnosis. Because of its limited extent, it tends to be associated with less severe disease and fewer complications.
ProctosigmoiditisThis form of UC affects the rectum as well as the sigmoid colon, located just above the rectum. Proctosigmoiditis tends to be more severe than ulcerative proctitis, frequently causing symptoms such as bloody diarrhea, cramps, and tenesmus—constantly feeling the need to pass stool.
Left-Sided ColitisInflammation extends even farther up the colon in this form of UC, to a point where it bends near the spleen. It tends to be more even severe, with common symptoms including diarrhea, bleeding, loss of appetite, weight loss, and severe abdominal pain on the left side.
Pan-Ulcerative ColitisThis form of UC involves inflammation throughout the entire colon, and tends to be the most severe variation with the greatest risk of complications that require surgery. Symptoms often include severe diarrhea, bleeding, cramps, abdominal pain, and weight loss.
Ulcerative colitis can become more extensive — affecting a larger area of the colon — over time. In a review published in the June 2019 issue of Alimentary Pharmacology and Therapeutics,researchers analyzed results from 30 different studies and found that overall, 17.8 percent of people with UC saw their disease become more extensive over five years — with the number growing to 31 percent over 10 years.
People under age 18, and those who lived in North America rather than Europe, were more likely to see their UC spread.
Outlook Based on UC Type
While Stein notes that greater involvement of the colon usually means more severe UC, that doesn’t always hold true. “You could have somebody with very limited disease, just in the rectum, but very severe disease with deep ulceration and marked swelling and bleeding.”
In such cases, though, the person is still far less likely to experience certain problems — like malnutrition and weight loss — than someone with more extensive UC, Stein says.
On the other hand, “You can also see somebody whose entire colon is involved, but with very mild disease,” says Stein. “And they may only have three or four bowel movements a day and not see any blood in their stool.”
In general, Stein says, the level of inflammation in the rectum — rather than higher-up areas of the colon — accounts for the greatest share of UC symptoms that people report. “If the rectum is relatively healthy compared to the rest of the colon,” he says, “people can often control their symptoms a little bit better.”
How much of your colon is affected probably won’t have an enormous impact on how your doctor recommends treating the condition, says Stein. “The anatomic features do have a factor in it,” he says, but are just one element among several: “The whole clinical picture, from symptoms to laboratory abnormalities to how inflamed the colon looks, will guide us to which clinical therapies we choose.”
Regardless of the extent or severity of the UC, Stein emphasizes the importance of receiving proper treatment. “Many physicians, including myself, feel that ulcerative colitis, if left untreated, will progress over time,” he says.
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