Dr Tina Mehta, Consultant Gastroenterologist at Circle Bath, talks us through her approach to treating Ulcerative Colitis.
People often come to see me already knowing they have ulcerative colitis, but for others it can be a new and daunting diagnosis. The symptoms would usually include an increase in bowel frequency, commonly in the form of diarrhoea, often with the passing of blood, and also with a sense of urgency (needing to pass stool rapidly). Ulcerative Colitis (UC) is a form of Inflammatory Bowel Disease; it is an auto-immune condition that generally is life-long. Whilst I have seen patients of all ages with the condition, the peak ages of onset are in your teens or in your forties.
Ulcerative Colitis isn’t purely genetic (you won’t necessarily inherit the condition just because a parent has it). Although there is a genetic tendency, in that you may be more likely to get the condition if a blood relative also suffers from it, faults in the immune system and most likely an environmental trigger play a role.
Ulcerative Colitis affects the large bowel (known as the colon). For an accurate diagnosis, the gold standard investigation is a colonoscopy. This procedure involves the use of a thin, flexible tube containing a camera in its tip, passed through the anus into the large bowel to examine the colon and look for inflammation. Often, biopsies (tiny tissues samples) are taken during the procedure and sent away for further analysis. Your bowel needs to be prepared beforehand, so laxatives are prescribed to ensure the bowel is clear.
A colonoscopy is often performed under sedation as an outpatient or day case procedure. Most of my patients find the bowel preparation to be the worst part. Although some people experience discomfort like trapped wind, this can be effectively managed with pain relief medication and Entonox (gas and air).
Due to the sedation, you may still be drowsy afterwards, so you should avoid driving, using machinery, or drinking alcohol for the next 24 hours. You will need to make appropriate transport plans for getting home and have a supportive adult available.
Despite there being no cure, once diagnosed, UC is generally well-managed with medication. This usually is treatment in the form of mesalazine tablets, before progressing to a steroid treatment if further management is needed. Those with a more severe disease might need treatment with immunosuppression as tablets and/or injections. This can all be explored during follow-up consultations as we find what works best for you.
My goals throughout your treatment are to ensure that you, as the patient, have a more regular bowel habit, that there is no active disease, and that your symptoms don’t infringe on your quality of life. Your care is personalised at every step throughout the treatment process, with regular follow-ups to suit your needs. Ideally, the aim is to get you into remission, where you are exhibiting no symptoms, but there may be flare ups periodically, and the severity of these can differ hugely from patient to patient. With personalised care and short waiting times, Circle helps you manage flares if they arise.
The majority of patients do not require surgery for ulcerative colitis, and the numbers of those who do has reduced over the years thanks to new treatments and medications available.
Currently, there is no evidence to suggest that a change in diet is needed to manage your condition. However, there are some medications that are best to avoid, which we can discuss once a full assessment has been carried out. Some alternative remedies and treatments, such as the use of probiotics, have been known to be effective too, and I support my patients in exploring these.
Lethargy and poor wellbeing can be associated with UC, particularly during a flare. You can also aid your management of the condition by maintaining a healthy lifestyle with a balanced diet. Stress is known to exacerbate symptoms in some patients, so it is a good idea to prioritise regulating your stress and anxiety levels in ways that work best for you.
If you have been experiencing symptoms such as abdominal pain, bloody diarrhoea, or a frequent and strong urge to go to the toilet, it can significantly impact your quality of life. Whatever the diagnosis, there are treatments available to reduce these symptoms, often to the point where they are no longer a major concern for you.
Perhaps you have already been diagnosed with Ulcerative Colitis and want an extensive treatment plan, catered to your individual needs. By booking an initial consultation with me, I can get to know your needs as well as the extent of your condition, drawing up a plan to manage your condition and give you back the best possible quality of life. With no waiting lists, we can start any potential treatment as soon as you are able to come in.