ULCERATIVE COLITIS

Ulcerative Colitis, as the name suggests is a gastrointestinal disease that causes ulcers in the colon or the large intestine and also the rectum. It is a disease that causes inflammation of the lining of the large intestine and the rectum and is therefore known as an inflammatory bowel disease.

Ulcerative colitis is an inflammatory disorder of the colonic mucosa characterized by relapses and remissions. Ulcerative colitis is one among inflammatory bowel disease of autoimmune origin, the other being Crohn’s disease. The lesions in ulcerative colitis mainly involve the rectum and may spread to sigmoid colon. In rare cases, the entire colon may get involved, a condition called pancolitis. Ulcerative colitis runs a relapsing and remitting course with periods of flare-ups and remission.

Although there is not much awareness about the disease, it is quite common and affects the young people more as compared to the old people.

In fact, it is the most common in the age group of 15-35 years of age. The second highest incidence is in the age group of 50-70.

Etiology of Ulcerative colitis

The exact cause of ulcerative colitis is not yet known. Stress has been identified as a big contributory factor though why it affects some and not others is also poorly understood. Family history of ulcerative colitis tends to affect one more than others who do not have a similar family history.

It has been observed in patients that those who have a poor immunity are likely to get affected much more than others whose immunity is better.

Any and every factor that causes the immunity of a person to be compromised tends to cause an aggravation in the symptoms of this disease.

It believed to be a disease of autoimmune origin. Autoimmune disorders refer to a group of diseases where the immune cells of a person start destroying its own tissues out of a misdirected immune response.

In ulcerative colitis, the body’s immune cells, that are meant to be activated while fighting an infection, get activated in the absence of a real infection out of a misdirected response. As a result, they start to destroy the lining of the colon, resulting in inflammation and ulcers in the colon and a set of other symptoms. 

Autoimmune factor

Even though exact mechanism of ulcerative colitis is not clear, there are some factors which may point out at autoimmune reaction.

Dysfunctional immunoregulation

In the intestinal wall results in inappropriate production of cytokines. This creates an imbalance between various interleukins resulting in inflammatory changes.

Psychosomatic and personality factor

Ulcerative colitis is more common in western women. Emotional stress, family stress, stress from divorce are the contributing factors.

Dietary factors

Westernization of the diet which is rich in red meat has been blamed. Vegetarian diet is supposed to protect the colon’s mucosa.

Allergy to milk protein is responsible for ulcerative colitis in few patients.

Defective mucin production

Defective mucin production and a defective mucosal immunological reaction is considered as a chief factor responsible for ulcerative colitis.

Clinical features of Ulcerative Colitis

Onset is usually gradual. Bloody diarrhoea is the hallmark of the disease, though proctitis may present with rectal bleeding and constipation.

Urgency and crampy abdominal discomfort before defecation. Stool frequency is related to the severity of disease.

Systemic signs and symptoms mainly include

- Frequency of the stools is much more than normal and one has to go several times to relieve oneself. Everytime one eats or drinks something, one feels compelled to pass stool.

- Crampy pain in the abdomen is another symptom and is almost always followed by an urge for stool.

- Blood and mucous are often present in the stool, though it is not necessary that both may be present at the same time.

- The consistency of the stool may vary from watery to semi-solid and stool often contains undigested food particles.

- The persistent diarrhoea and loss of blood and mucous tends to cause loss of water and electrolytes.

- Patient complains of weakness, dehydration and loss of weight is also seen.

- Anemia is an almost constant accompaniment.

- Dry skin and sunken eyes are quite commonly seen in patients of ulcerative colitis.

- Some patients also have prolonged fever along with the gastrointestinal symptoms.

- Anorexia

- Weight loss

- Profound weakness

- Tachycardia

- Abdominal tenderness

- Distension of the abdomen

- Malnutrition

- Hypoprotienaemia

Investigations

Sigmoidoscopy and rectal biopsy

The appearance can be graded as mild, moderate, and severe.  Characteristic microscopic features are a chronic inflammatory infiltrate, glandular distortion, goblet cell depletion and crypt abscesses.

Plain abdominal radiography

In only severe disease, to assess faecal distribution, to exclude colonic dilatation. It is also helpful in demonstrating proximal constipation in patients with very distal disease.

Colonoscopy and barium enema

colonoscopy is always preferable in initial investigation of bloody diarrhoea, because it provides better mucosal definition and allows biopsies. Colonoscopy however is dangerous in acute episode; flexible Sigmoidoscopy after phosphate enema is then the procedure of choice.

Other investigations

- Stool examinations to exclude pathogens

- Full blood count and ESR or C-reactive protein to evaluate severity

- Liver function investigation once in remission

- Complications of ulcerative colitis

- Toxic megacolon – it is an abdominal emergency encountered with fulminating colitis, severe abdominal pain and tenderness, toxemia, high fever, tachycardia, leucocytosis, toxemia are the features.

Massive hemorrhage – per rectum is uncommon. It is treated by blood transfusion.

Perforation is to be treated as peritonitis with resection of colon. Mortality rate is around 25-50%.

Carcinoma of colon – routine Sigmoidoscopy and biopsy have to be done when the disease is present for more than 10 years.

Recurrent Perianal abscess, resulting in Perianal fistula.

General complications

- Protein malnutrition

- Skin ulceration

- Conjunctivitis

- Iritis

- Arthritis involving large joints

- Bile duct cancer

Homeopathic treatment of "Ulcerative Colitis":

Homeopathy is one of the most popular holistic systems of medicine. The selection of remedy is based upon the theory of individualization and symptoms similarity by using holistic approach. This is the only way through which a state of complete health can be regained by removing all the sign and symptoms from which the patient is suffering.

The aim of homeopathy is not only to treat ulcerative colitis but to address its underlying cause and individual susceptibility.

As far as therapeutic medication is concerned, several well-proved medicines are available for ulcerative colitis treatment that can be selected on the basis of cause, condition, sensation and modalities of the complaints.

For individualized remedy selection and treatment, the patient should consult a qualified homeopathic doctor in person.

There are following well proved medicines which are much helpful for the treatment of ulcerative colitis:

Merc sol

- A very close relationship with the pathology of ulcerative colitis.

When there is too much bleeding with tenesmus and other symptoms, Merc Sol is one of the best homeopathic medicines for ulcerative colitis.

- There are frequent stools with blood being discharged almost every time.

- The patient is a sweaty sort of patient who keeps on sweating most of the time.

- Creeping sort of chilliness may be felt in the back.

- I have found of immense help in ulcerative colitis treatment is Merc Sol.

- The symptoms presented by person needing Merc Sol are very similar to Merc Cor including diarrhea, passage of blood/mucus from rectum and tenesmus. But when it comes to making a choice between these two medicines, I have realised that Merc Sol is indicated when intense bleeding from rectum over shadows other symptoms.

- Along with bleeding , stool may or may not be loose. The color of stool may vary from yellow, green, grayish white to brown.

- Corrosive burning at the anus may also appear. Along with above symptoms chilliness, shivering and exhaustion may also be present.

Mercurius Corrosives

- It is an effective remedy in the treatment of burning ulceration of the mucous. Frequent stools with mucus tinged with blood.

Merc Cor is one of the top grade homeopathic medicines for ulcerative colitis.

- I have successfully treated a number of cases of ulcerative cases with Merc Cor when tenesmus is a marked symptom. 

- The major symptom that indicate the use of Merc Cor are loose stool with blood, mucus and tenesmus. But amongst these symptoms tenesmus stands out more prominently.

- This means that a person needing Merc Cor has a constant urge to pass stool. He feels persistent pressing and straining in rectum.

No satisfaction follows after stool evacuation. This feeling is typically called as a ‘never get done feeling’. 

- For Merc Cor to be used symptoms of cutting, colicky abdominal pain and burning in rectum can also be present.

Phosphorus

- When there is intense thirst for cold water, Phosphorus is one of the best homeopathic medicine for ulcerative colitis.

- The patient is usually tall and thin.

- The diarrhoea is copious.

- Stool is watery and profuse bleeding may be present.

- Patient feels too weak and more so after passing a stool.

- While treating ulcerative colitis, Phosphorus has given satisfactory results to me in cases presented with complaint of copious diarrhea.

- There is sudden, gushing and forcible passage of stool. As soon as anything is eaten the urge for stool appears.

- Urgency of stool is also marked.

- Bleeding with stool is also present. Blood is mainly bright red in color.

- Mucus especially green colored may also be passed with stool.

- Debility and weakness appear predominantly from copious diarrhea.

Colchicum:

- I have noticed remarkable results in ulcerative Colitis with use of Colchicum when mucus quantity in stool is very copious.

- The mucus is transparent and jelly like.

- White shred like particles in large quantity may also appear in stool.

- Pain in rectum and tenesmus may also accompany stool .

- Colchicum is also highly suitable when joint pains are present in ulcerative colitis.

Ignatia

- Remarkable remedy for ulcerative colitis, since the emotional element is uppermost in Ignatia, relationship of this physical irritation first needs to be established.

- To resolve this emotional state Ignatia is much helpful.

Natrum Mur

- In chronic of Ignatia. Ill effects of grief, fright and anger aggravations by consolation are the characteristic features.

- Cutting pain in abdomen and the abdominal ring, burning and stitching pain in the rectum after a copious diarrhoea.

Arsenic Alb

- When the predominant symptoms are the mental symptoms of anxiety and restlessness, Arsenic Album is one of the best homeopathic medicines for ulcerative colitis. 

- The patient gets anxious, worried and restless for no reason.

- There may be weakness which may be disproportionately more than the problem.

- There is increased thirst for water, though the patient takes a small quantity or a sip at a time.

Aloe

- Treats involuntary loss of feces, bleeding diarrhea, and rumbling in the stomach.

Staphisagria

- It is a nervous personality with marked irritability.

- This irritability is reflected in temper as well as in function of the digestion.

- The peristalsis is aggravated with the emotional outburst.

Baptisia

- When there is low grade fever present along with other symptoms, Baptisia is one of the best homeopathic remedy for ulcerative colitis.

- The patient has great muscular soreness all over the body as if bruised and beaten.

- Appetite is reduced or next to nil.

- At the same time, there is constant desire for water.

- Stools are very offensive, thin and watery.

Aurum Met

- It has feeling of self-condemnation and utter worthlessness, profound despondency that affects the digestion.

Nux Vomica

- Excellent medicine for ulcerative colitis, if one studies the Nux Vomica, one sees a clear picture of this condition.

- Nux Vomica is next wonderful homeopathic medicine for Ulcerative Colitis treatment.

- I have seen excellent results from using Nux Vomica in ulcerative colitis treatment.

- The redline symptom for selecting Nux Vomica in ulcerative colitis is ineffectual urging for stool. 

- Patient passes little scanty stool at very frequent intervals.

- Stool is always unsatisfactory.

- There is feeling of incomplete bowel evacuation.

- Another essential symptom guiding use of Nux Vomica is abdomen pain before passing stool.

- This abdomen pain is temporarily relieved from passing stool even if it is scanty.

- Nux Vomica can also be considered for acute aggravation of symptoms in ulcerative colitis from alcohol intake, coffee or spicy food.

- When the problem has occurred from living a high life, Nux Vomica is one of the best homeopathic remedies for ulcerative colitis.

- Excess of alcohol, stimulants like tea and coffee, late night partying and other habits incident to modern lifestyle can contribute to such a problem.

- The patient is usually a chilly sort of patient who cannot tolerate cold.

- He is unusually angry and that too at trifles.

Apart from the treatment through the remedies, a lot of counseling and appropriate diet regimen is required.

Correction of dehydration and electrolyte losses through intravenous fluids may often be required which may not be possible at home and need admission to the hospital.

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Dr. Mayur Modi

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