Crohn's Disease and Ulcerative Colitis

Just like some people get arthritis which is an inflammation of the joints, it is also possible to get inflammation of the colon. Inflammation of the colon (large intestine) is called colitis. Germs can cause colitis. Poor blood supply can cause colitis. Some medications can cause colitis. In most cases, the cause of colitis is unknown; however, colitis is not infectious and cannot be passed from one person to another like the flu or a common cold.

When no other cause can be found for the inflammation, it falls into either one of two forms of inflammatory bowel disease – Crohn's disease or ulcerative colitis.

What is Crohn's disease?

Crohn's disease involves the entire thickness of the wall of the colon, and can also involve other parts of the intestines such as the small intestine. Since Crohn's disease can involve the entire thickness of the intestine, sometimes long ulcers are seen in the colon lining. These ulcers look as if someone had pulled a grass rake across the lining of the colon. They are called rake ulcers or bear claw ulcers. Crohn's disease can be patchy. It can be present in one part of the colon, absent in another, and then present in the next part.

In children, Crohn's disease slows growth and may delay sexual development.

Complications of Crohn's disease

Some complications of Crohn's disease can include:

  • bowel obstructions
  • inflamed ulcerous tracts
  • fistulas which form channels into adjacent intestinal segments or even into nearby organs such as urinary bladder, vagina or surface skin.

In these cases, surgical treatment may be indicated; however, inflammation often returns to sites of surgical intervention.

The colitis associated with Crohn's disease is often associated with anal problems whereas ulcerative colitis never causes anal problems.

What is ulcerative colitis?

Ulcerative colitis causes inflammation only in the mucosal (superficial) lining of the colon, thus not affecting the small intestine. Ulcerative colitis generally starts in the rectum and spreads from the rectum toward the first part of the colon in a steady progression.

An endoscopic image of ulcerative colitis.
An endoscopic image of ulcerative colitis.

The last one to two feet of the small intestine is called the ileum. As previously mentioned, ulcerative colitis does not affect the small intestine, so If ulcers and extensive inflammation are seen in the ileum, the colitis is likely due to Crohn's disease.

Treatment

Diet and psychological factors do not cause ulcerative colitis or Crohn's disease, and no germs have been found to cause either of these conditions.

Ulcerative colitis can be cured by removing the entire colon, if necessary. Crohn's disease, however, can never be completely cured. If areas of the small intestine or colon which are involved with the Crohn's disease are removed, the surgery will generally relieve the person's symptoms for a while, sometimes for many years. But at some point in the future, symptoms are likely to recur.

Whether colitis is due to ulcerative colitis or Crohn's disease, it is generally not important unless surgery is required. If surgery is required, then ulcerative colitis is treated differently than Crohn's disease. If surgery is not required, ulcerative colitis is generally treated with medications in the same manner as is Crohn's disease.

If the medications do not control the colitis, or if the side effects from the medical treatment become intolerable, then physicians consider surgery. Symptoms of colitis can include rectal bleeding, abdominal pain, diarrhea, passage of mucus and bloody stools. Indications for surgery include rupture of the colon, severe bleeding, very frequent diarrhea, severe weight loss and chronic illness which never gets better.

Sometimes surgeons must bring a portion of the intestine through the abdominal muscles out to the skin. This is called either an ileostomy (if the small intestine is used) or a colostomy (if the colon is used). The intestinal contents come out through the opening of the skin (stoma) and are collected in a bag worn on the surface of the body.

Fortunately, with today's techniques, a permanent stoma is only necessary if the anal sphincters are permanently damaged by, for example, cancer, infection or inflammation.

Participants at a CCFA Take Steps annual fundraising walk.
Participants of all ages enjoy themselves at
CCFA Take Steps Annual Fundraising Walks.

Ileal Pouch for Ulcerative Colitis

There is one surgical technique that can cure ulcerative colitis without the need for a colostomy or ileostomy bag.

The Ileal Pouch technique is a surgical procedure which removes the entire colon, from the point of its attachment at the small intestine to the point of its attachment at the anus. The anal sphincter muscles and the anus are left intact. The last 10 inches of the small intestine (the ileum) are then used to make a U-shaped sac (pouch) which is attached to the anus at the anal opening.

This pouch acts as a new rectum. The anal sphincter is left in place so that the person can still control his bowel movements. A person generally moves his bowels 4 to 8 times per day following this operation. However, he has reasonably good control, and no longer has any symptoms of the colitis.

The ileal pouch procedure requires two operations. During the first operation, the surgeon removes the entire colon, creates the pouch and hooks it to the anus. He makes an ileostomy, which means that the person must temporarily wear a bag on the abdomen to collect stool. This prevents bowel contents from entering the pouch until it is healed. After about three months, the surgeon removes the ileostomy. The pouch then begins to function as a rectum, and the person no longer needs the ileostomy bag.

No Pouch for Crohn's Disease

Because Crohn's disease can attack the small intestine as well as the colon, the pouch is not used for Crohn's disease. When surgeons tried the pouch for Crohn's disease, the complication rate was very high. In most cases, the Crohn's disease attacked the pouch and it could no longer be used.

For those with Crohn's disease, if the colon is very diseased but the rectum is not, then the colon can be removed except for the rectum, and the small intestine can be connected directly to the rectum. In many cases, if the Crohn's disease involving the rectum is not severe, it can be controlled with Rowasa enemas or Rowasa suppositories.