Ulcerative Colitis – Types of Ulcerative Colitis

Inflammation of the colon is known as colitis. The colon is also known as the large intestine. It is the part of digestive system where water and salts from solid wastes are extracted. Here waste material is stored. Colon is anatomically divided into ascending colon, descending colon, transverse colon and sigmoid colon. It is continued until where the rectum meets the anus. Thus the rectum is the end of the colon adjacent to the anus.

Ulcerative colitis is the more intense form of colitis where the lining of the rectum and the colon is inflamed and affected by sores or ulcers. It is accompanied by rectal bleeding and diarrhea. A patient whose rectum or a short segment of rectum is inflamed have milder symptoms than a patient who has widespread inflammation of the colon. Ulcerative colitis is classified into
5 types according to the location and the extent of inflammation.

Ulcerative Proctocitis
Here the inflammation is limited to the rectum. In patients with ulcerative proctocitis, mild rectal bleeding may be the only symptom. Some may experience rectal pain, urgency to defecate and sometimes tenesmus.

Here the inflammation is spread to rectum and the sigmoid colon. It is somewhat widespread than proctocitis. All the above symptoms are seen. Some patients may also develop cramps and bloody diarrhea.

Watch the video below to see how the condition of ulcerative colitis comes across in an endoscopy.

Left-sided colitis
Left-sided colitis involves inflammation of the rectum extending up to the left colon (which includes the sigmoid colon and the descending colon). Symptoms include bloody diarrhea, weight loss, abdominal cramps, and left-sided abdominal pain.

Pancolitis or Universal Colitis
Here the entire colon (right colon, left colon, abdominal colon, traverse colon and the rectum) is inflamed or affected. All the above symptoms are seen. Additional symptoms include fatigue, fever, night sweats and weight loss. It is somewhat of a severe form of ulcerative colitis than first three types. But this responds well to treatment with medications.

Fulminant colitis
It is the most severe form of ulcerative colitis. A patient with fulminant colitis is extremely ill with dehydration, protracted diarrhea, severe abdominal pain and the patient can even experience shock. This fulminant form is treated in hospitals. In case medications are ineffective, the doctor opts for surgery to remove the diseased colon to prevent colon rupture.


Characteristic presentations of ulcerative colitis depend on the section of the intestine that is affected. It is commonly accompanied by diarrhea and blood in stool.Other symptoms are:

  • Abdominal pain
  • Abdominal cramping
  • Loss of appetite
  • Loss of nutrients
  • Unintended weight loss
  • Fatigue
  • Skin lesions
  • Tenesmus (A strong urge to have a bowel movement but not able to do so)
  • Joint pain
  • Inability to thrive (in children)

Diagnosis of Ulcerative Colitis

Ulcerative colitis is diagnosed based on the symptoms. A detailed physical examination and past medical history is the first step in diagnosis of ulcerative colitis. Many other tests are done for confirmation such as:

  • Stool sample. Stool is examined to see if there is any infection and parasites.
  • Blood tests. White blood cell count, sedimentation rate are checked.
  • Sigmoidoscopy and colonoscopy. Flexible tubes area inserted into the rectum to measure the extent of the colitis.
  • Small tissue samples or biopsies determine the severity of the colitis.
  • Barium enema x-ray is used to see colon outline on x-ray pictures. It is more useful than direct visualization techniques.

Treatment of Ulcerative Colitis

Medications and surgery are used to treat ulcerative colitis. Medications may be given in one of the following ways:

  • Orally, that is by mouth.
  • Enema, that is an injection of liquid through the rectum.
  • As a suppository. Here a capsule of the medicine is inserted into the rectum and absorbed by the body.
  • Intravenously, that is injected onto the vein directly.
  • Medications for ulcerative colitis are taken under the supervision of a registered medical practitioner. Taking over-the-counter medications can only help for pain or diarrhea.
  • Surgery is needed in certain severe cases. About 25 to 40% of ulcerative colitis patients have to eventually have colon surgery for massive bleeding and severe illness.


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