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Hemorrhagic rectocolitis (UC or ulcerative colitis) Causes, Symptoms and Treatment

The ulcerative colitis as well as the Crohn’s disease is an inflammatory disease chronic intestinal (IBD) of the colon and rectum If Crohn’s disease can occur anywhere in the gastrointestinal tract and reach the deep tissue, colitis ulcer is a superficial involvement of the mucosa, which starts at the level of the rectum to go up in the colon. It is also known as ulcerative colitis.

There are 4 forms of ulcerative colitis, depending on the extent of the disease:

  • the ulcerative proctitis , which is limited to the rectum;
  • the proctosigmoiditis , which affects the rectum and sigmoid colon;
  • the distal colitis , which affects the portion of the colon on the left side of the body (the rectum up to the top of the descending colon);
  • The pancolitis, which affects the entire colon.

In Canada, it is estimated that almost 2 out of every 1,000 people (men, women and children) have ulcerative colitis.
In France, the incidence of UC has declined to 3.5 / 100,000 while it increases for Crohn’s disease. In Europe it is 1.7 to 20.3 / 100 000 and is more frequent in Northern Europe than in the South (Norway / Portugal gradient) (source EPIMAD)

The disease is a disease of the “young” subject, diagnosed mainly in people aged 30 to 40, but it can be declared at any age. Men and women are affected in almost the same proportions, but not at the same ages. This could be related to the status of smoker or former smoker. There is a female predominance for Crohn’s disease, with a lower male predominance for UC.

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Causes of Hemorrhagic rectocolitis

There is a genetic predisposition to ulcerative colitis.

The ulcerative colitis (UC) is due to a disorder of the immune system  that attacks the body’s own cells.

Scientists believe that inflammation of the colorectal mucosa is due to an excessive immune response of the body against viruses or bacteria in the gut. According to the most probable hypothesis, this autoimmune reaction would be directed against the “harmless” bacteria normally present in the digestive tract (the intestinal flora).

HCR could also be linked to environmental factors that have not yet been elucidated.

The stress  and  food intolerance  can trigger symptoms in some people, but these factors are not the cause of the disease.


Ulcerative colitis progresses from the rectum to the colon and evolves by relapses (or seizures).

Inflammation leads to the formation of ulcers, or diffuse erosion without healthy mucosal interval, which can bleed and produce mucus or pus, by healing mechanism, hence functional discomfort (urgent defecatory urge with little stool and nocturnal awakenings.

The disease lasts a lifetime unless you have surgery to remove the entire colon. The severity of the disease differs from person to person; many have few symptoms and can live without constant treatment. Often, symptoms can go away for months and even years, inevitably, to reappear.

Possible complications

The ulcerative colitis may be accompanied by disorders of the joints (axial or extremities), skin (erythema nodosum), inflammation of the eyes or problems with the liver (sclerosing cholangitis). These disorders are related to the autoimmune reaction involved in the disease.
The most serious acute complication of ulcerative colitis is called toxic megacolon. It occurs when the inflammation of the colon is so great that it dilates and may perforate. Severe pain, fever, vomiting and swelling of the abdomen occur. A doctor should be consulted urgently in the presence of these symptoms to prevent the colon from perforating and peritonitis to occur. Fortunately, this complication only rarely occurs (in less than 2% of cases).

People with ulcerative colitis should be aware of the risk of anemia . When the disease is severe, blood loss can be so high as to cause anemia, which can be compensated with iron supplements.

Many complications related to the long-term use of certain drugs, such as corticosteroids or immunosuppressants, may occur. Thus, the use of corticosteroids over long periods makes it more prone to osteoporosis ,  cataracts , hypertension ,  type 2 diabetes … Corticosteroids and immunosuppressants can also increase the risk of infection.

Warning    The IBD require regular monitoring as they increase the risk of colorectal cancer. The more the disease is spread in the colon and the more time passes, the more the risk of cancer increases; if the whole colon is affected (pancolitis), the risk could be 32 times greater than the normal risk. About 5% of people with colitis eventually develop colorectal cancer .

Symptoms of Hemorrhagic rectocolitis

The symptoms appear by seizures:

  • Of abdominal cramps painful, especially in the lower abdomen;
  • The blood in the stool (or bleeding in case of serious thrust);
  • Chronic diarrhea;
  • Frequent stools , even during the night ;
  • An urgent need to defecate , even if there is little or no stool to evacuate (rectal tenesmus);
  • loss of weight due to reduced appetite and poor nutrient absorption in the intestine;
  • The tiredness , often caused by anemia;
  • The fever , especially in the case of colitis with significant symptoms;
  • In children, severe ulcerative colitis can hinder development (stunting, delayed puberty …).

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 People at risk for Hemorrhagic rectocolitis

  • Some populations are at higher risk than others because of their genetic heritage. Whites are 2 to 5 times more affected by ulcerative colitis than blacks or Asians. The Jewish community (of Ashkenazi origin) is 4 to 5 times more affected by this disease than other populations ;
  • Up to 20% of people with ulcerative colitis have a loved one with Crohn’s disease or only 6% with ulcerative colitis, suggesting a genetic predisposition. If two parents are affected; the risk of developing IBD in the course of life would be 36%

Risk factors

There is no known

  • Living in an urban environment or in an industrialized country increases the risk of suffering from ulcerative colitis;
  • Nonsteroidal anti-inflammatory drugs (NSAIDs, anti-inflammatory drugs other than corticosteroids) and oral contraceptives may be incriminated but this remains to be confirmed. NSAIDs are not recommended for RCH;
  • Dietary factors are incriminated insofar as this disease affects the countries of Europe and North America. (Strong consumption of sugar, red meat). The disease affects more and more the Maghreb which reinforces a role of food. (change of diet in young people, soda, coca);
  • Isotretinoin (Accutane), a drug used to treat severe acne, may be involved in triggering certain ulcerative colitis. Although the cause-and-effect relationship has not been proven, studies report cases of ulcerative colitis following the use of isotretinoin.
Is food a risk factor?

Although experts generally agree that ulcerative colitis is not caused by diet, two studies have found an association between the consumption of certain foods and the risk of developing colitis. This is preliminary data.

  • A five-year Swedish study of 600 people found that the risk of colitis was four times higher among people who ate junk food at least twice a week. The consumption of refined sugarsalso increases the risk.
  • In a Dutch study of more than 1,200 people, there was an increase in the risk of colitis with the consumption of chocolate and cola drinks, but a reduction in risk due to citrus fruits .

Prevention of ulcerative colitis (ulcerative colitis)

Measures to prevent disease
Since the precise causes of ulcerative colitis are still relatively unclear, we do not know how to prevent it.
Measures to prevent complications
It is recommended that people with inflammatory bowel disease for 5 years or more make an appointment with their gastroenterologist every year. Various tests are available to quickly detect abnormalities in the digestive tract, including colorectal cancer. See our Colorectal Cancer fact sheet
Preventive measures on a daily basis
In case of outbreaks of the disease:

Dietary advice has no scientific validation. This disease is not of food origin, so it is useless to impose restrictions.

Dietary advice is common sense

  • Do not take foods and drinks that aggravate your symptoms.
  • Avoid spicy foods, alcohol, some vegetables (cabbage, broccoli, beans) and beverages and foods that contain caffeine. These tend to cause  bloating ;
  • Pay special attention to milk and some dairy products, which cause diarrhea, pain and flatulence in some people with lactose intolerance. There is, however, no proven link between lactose intolerance or milk protein allergy and ulcerative colitis;
  • Limit the consumption of dietary fiber. Although dietary fiber is an important component of a healthy diet, it often worsens the symptoms of ulcerative colitis. Preferably eat cooked fruits and vegetables rather than raw ones;
  • Eat several small meals during the day rather than 2 or 3 hearty meals ;
  • Consume a good amount of liquid, preferably water , avoiding carbonated drinks, alcoholic drinks and those containing caffeine;
  • In the event of a serious crisis, doctors can also introduce a “residue-free” diet, excluding any source of vegetable fibers, animal residues and greasy residues, to put the colon at rest for a few days during the push.

Between periods of symptoms  :

  • Eat foods rich in dietary fiber to regulate intestinal transit. Dietary fiber also has the advantage of facilitating the growth of bacteria normally present in the intestines. See “Prebiotics” in the Complementary Approaches section;
  • Focus on protein from lean meats, poultry, fish and eggs. It is important to adopt a healthy diet that contains good fats;
  • Practice relaxation techniques and exercise to better manage your stress. If stress does not cause ulcerative colitis, it can worsen its symptoms as it impairs normal digestive function. Exercise also helps regulate intestinal transit. Relaxation methods can also help control pain in times of symptoms.

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Medical treatment of ulcerative colitis (ulcerative colitis)

There is no medicine to cure ulcerative colitis; however, several treatments can reduce inflammation and symptoms when the disease is active, and reduce their recurrence by maintaining remission.


Anti-inflammatory. It is usually the first treatment prescribed to treat ulcerative colitis. They understand :

  • Aminosalicylates. These drugs are similar to aspirin and decrease inflammation in the colon. The commonly used aminosalicylates are sulfasalazine (Azulfidine) and mesalazine or mesalamine (Pentasa, Rowasa, Fivasa Canasa, Asacol Apriso, Lialda). Newer drugs, balsalazide (Colazal) and olsalazine (Dipentum), are also used. They are administered  orally , rectally or enema and are used both to relieve relapses and to maintain remission. The most common side effects are nausea, vomiting and headache;
  • Corticosteroids. Treatment almost inevitable in the treatment of RCH, Corticosteroids stop inflammation, but have their share of side effects.
  • The most commonly prescribed corticosteroids for treating ulcerative colitis are prednisone, methylprednisolone and hydrocortisone.
  • They are prescribed to patients with moderate or severe ulcerative colitis who do not respond to aminosalicylates.
  • They are administered either by way digestive, oral or rectal(foam, suppository, enema) in moderate crises, left colic or rectal, or by intravenous route in case of serious crisis.
  • Their  side effects are numerous,which limits their long-term use. They are usually prescribed for short periods: maximal dose over 10 -15 days then the decrease should be gradual.
  • Budesonide or beclomethasone dipropionate administered rectally are corticosteroids that act almost exclusively in the colon. They are little or no absorbed by the mucosa, and therefore cause fewer side effects than other corticosteroids. They have no indication in induction therapy or maintenance of remission. They are used for less severe cases of ulcerative colitis because they are a little less potent.
  • Never interrupt treatment brutally.

Immunosuppressants . Immunosuppressive drugs suppress inflammation by acting directly on the immune system, that is, by reducing the immune response that causes the inflammation. They are prescribed to people with poor response to aminosalicylates and corticosteroids or those who must take high doses to maintain a remission. The most common are azathioprine (Imuran Imurel) and 6-mercaptopurine (Purinethol). Cyclosporine (Neora, Sandimmune) is sometimes used in case of a serious outbreak. Immunosuppressants relieve the symptoms of ulcerative colitis, but take a long time to work. It takes a minimum of 3 months before the molecule is fully effective. They also have their share of side effects, since they reduce resistance to infections and cancers.

The Methotrexate   can be effective in people with resistant or intolerant to azathioprine. It is administered intramuscularly.

Anti-TNF alpha agents .  Anti-TNF alpha agents are recent drugs targeting a pro-inflammatory substance, tumor necrosis factor (TNF). The use of TNF alpha antagonists has been shown to reduce the need for surgery, the number of hospitalizations, allow for corticosteroid withdrawal, better mucosal healing and improve quality of life by maintaining remission of the disease. Infliximab (Remicade®) is used in people with moderate to severe attacks that are resistant to conventional therapies.

Symptomatic treatments 

Antidiarrheal.  These medicines should not be used without the advice of your doctor, as they may increase the risk of  toxic megacolon . They slow down the transit of food in the intestine and thus prevent diarrhea. Imodium is effective but should be used with caution under medical supervision.

Antispasmodic. These medications can be used occasionally to relieve abdominal pain, but they are generally not very effective. Their action against the spasms can be exerted on the nerve fibers, the muscular fibers, or on both.

Contraindication: Taking nonsteroidal anti-inflammatory drugs such as aspirin, ibuprofen (Advil, Motrin) or naproxen (Aleve) may make the symptoms of ulcerative colitis worse. To relieve mild abdominal pain, use acetaminophen (Tylenol) instead.


Experimental treatment: transdermal patches of nicotine . This is an uncommitted treatment strategy!

The idea of ​​this treatment came from an observation: people with ulcerative colitis who start or start smoking often see their condition improve. Several clinical studies have been conducted to assess the suitability of using nicotine (per patch) to control symptoms of ulcerative colitis and promote remission. In 2004, an analysis of available studies concluded that nicotine patches were more effective than placebo in inducing remission, but not superior to mesalamine or corticosteroids. Side effects (nausea and dizziness) were more likely with the patch than with other treatments.

Note . Of course, doctors do not advise their patients to smoke despite the beneficial effects of nicotine on ulcerative colitis because tobacco has all the other side effects on the arteries and the risk of cancer.

Supporting food

Supportive feeding aims to correct possible malnutrition in terms of calories and micronutrients. Lack of appetite and frequent weight loss are the consequences of abdominal pain and diarrhea. In addition, ulcerative colitis and surgical procedures can lead to poor absorption of nutrients, which causes deficiencies in protein, vitamins (A, B9, B12, C, D, E and K) and minerals (calcium, copper, iron, magnesium, selenium and zinc). These deficits are easily treated by a balanced Dietrich in macro and micronutrients. The nutritional strategy will be developed in collaboration with the doctor.

In case of anemia, the treatment will be oral by way of iron supplements, vitamin complexes and minerals or in the form of high caloric liquids. If the bowel is too irritated, in the serious forms of the disease, it will be used rather the intravenous way. Adequate nutrient intake is especially important for children, who are growing.


Some people with ulcerative colitis will have to undergo surgery to remove the entire colon when medications can no longer control symptoms, in the case of complicated severe acute colitis (colectasia, hemorrhage, perforation), or in patients at risk. Colorectal cancer.

  • The  colorectal Proctectomy , is surgery of removing the colon and rectum, only way to cure ulcerative colitis. The surgeon proceeds to:
  • An  ileoanal anastomosis, a reference procedure in which the surgeon removes the diseased colon and rectum, while maintaining the anus and the external muscles of the rectum. It then connects the ileum (the last segment of the small intestine) to the anus, creating a pocket (the ileal reservoir) where the stool will accumulate before being evacuated almost normally. This procedure can result in a  pouchitis , that is to say inflammation of the ileal reservoir, which is treated with antibiotics.
  • An ileal rectal anastomosiscan be proposed in case of conservable rectum in the elderly, with poor sphincter function, or in case of doubt diagnosis (the drug team does not know for sure whether it is a ulcerative colitis or Crohn’s disease) and women wanting pregnancy.

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