Ulcerative Colitis: Symptoms, Complications, and Ayurvedic support

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What Ulcerative Colitis Is?

In Ayurveda, Ulcerative Colitis is viewed as Pittaja Grahani or chronic bowel disease caused by the fire element, which is correlated with Raktatisara (severe diarrhea) and Pittaja Pravahika (mucosal inflammation). Ulcerative Colitis is a part of inflammatory bowel disease and is connected to Crohn’s disease. It causes long-lasting inflammation and ulcers in the innermost lining of your large intestine and rectum. 

Ulcerative Colitis is rooted in the Purishavha Srotas, or the body channels responsible for feces. It is caused by Pitta dosha imbalance, where increased pitta or metabolic heat contaminates the Rakta (blood) and the colon lining with Ama (toxins), which further leads to a burning sensation and chronic inflammation. Ayurvedic management focuses on Sheeta (cooling), Grahi (binding), and Ropana (wound- healing therapies). Ayurvedic therapies can reduce the dependency on steroids, but they cannot replace the disease completely. 

Understanding these terms can make it easier to recognise signs of the disease: 

Rectal Bleeding

Rectal bleeding means blood coming from the rectum or lower digestive tract, which may appear during or after passing stool. In ulcerative colitis, inflammation and sores in the rectal or colon lining can cause bleeding because chronic inflammation makes colon tissue easily tearable. The blood may appear bright red, mixed with stool, or on toilet paper. The amount can range from mild to heavy bleeding, and it gets worse during a flare-up.

Urgency And Tenesmus

Urgency is a strong need to have a bowel movement that can be difficult to control. In ulcerative colitis, inflammation of the rectum can make the bowel feel like it needs to empty more often. And Tenesmus is a feeling that you still need to pass stool even after having a bowel movement. It can happen when inflammation in the rectum creates a persistent sensation of needing to empty the bowel. It is a painful straining sensation and a false feeling of needing to empty the bowels.

Toxic Megacolon

Toxic megacolon is a rare but serious complication of ulcerative colitis in which severe inflammation causes the colon to become significantly widened and stops it from working normally. It can cause severe abdominal swelling or pain, fever, rapid heartbeat, and frequent bloody diarrhoea. It requires serious medical treatment because the swollen colon can tear and lead to serious infection.

Remission And Relapse

Remission is a period when ulcerative colitis symptoms are controlled or absent, and inflammation is low or inactive. Relapse is a return or worsening of symptoms and inflammation after a period of remission. It may cause diarrhoea, bleeding, urgency, or abdominal pain.

Typical Bowel Symptoms

Symptoms can develop slowly or come suddenly, ranging from mild to severe. Common bowel symptoms of Ulcerative colitis are: 

• Rectal bleeding or Gudapaaka
• Abdominal pain or Shula
• Diarrhoea
• Ulcers 
• Bowel urgency 
• Excessive thirst or Trishna

Symptoms Outside The Gut

Roughly 25 % of people are affected by symptoms outside the gut or extraintestinal manifestations. Common symptoms are:

• Anemia 
• Blood loss and weight loss 
• Severe fatigue
• Joint pain and stiffness in the knees, wrists, ankles, and spine.
• Itchy or burning eyes, including severe conditions like iritis and uveitis.
• Red bumps, rashes, or serious lesions like erthema nodosm and pyoderma gangrenosm.
• Inflammation in the liver and bile duct.

Proctitis, Left-Sided And Extensive Colitis

Ulcerative colitis can affect different parts of the large intestine. Proctitis, left-sided, and extensive colitis are different parts of Ulcerative colitis. The type is mainly named according to how far the inflammation extends from the rectum.

• Ulcerative Proctitis: The inflammation is limited to the rectum (closest to the anus). Common symptoms include bleeding from the rectum, urgency, frequent bowel movements, and constipation.
• Left-sided colitis: The inflammation starts in the rectum and spreads up the left side of the colon. It can cause bloody diarrhoea and abdominal cramps, bowel urgency, and constipation. It's also called tenesmus.
• Extensive colitis: The inflammation extends beyond the left side and affects a larger part of the colon, sometimes the entire colon. Symptoms can include frequent bloody stools, abdominal pain, tiredness, and weight loss. It's also called Pancolitis. 

How Severity Is Assessed

The severity of Ulcerative colitis is assessed using a combination of symptoms, test results, and the amount of inflammation seen in the colon. Doctors consider stool frequency, rectal bleeding, urgency, abdominal pain, and symptoms that occur frequently. Blood tests may help check the inflammation and anaemia, while stool tests such as faecal calprotectin can help show active intestinal inflammation. Colonoscopy and sigmoidoscopy can show how inflamed the bowel lining is. Doctors may also use scoring systems to measure disease activity and monitor changes over time. 

Tests Used To Diagnose It

There is no single test that can diagnose ulcerative colitis on its own. Doctors usually combine a group of these tests to measure the injury and the inflammation:

• Blood tests: Check for infection, inflammation, and anemia, which may mean that the bleeding in the colon and rectum is ongoing, and other signs that support diagnosis.
• Stool tests: Look for intestinal inflammation and help rule out infection that can cause similar symptoms.
• Colonoscopy: Allows the doctor to examine the lining of the rectum and the entire colon for inflammation, ulcers, bleeding, and other changes
• Sigmoidoscopy: Examines the rectum and lower part of the colon, especially when the symptoms are in this area.
• Imaging tests: MRI and CT scan may be used when doctors need to picture the complications in the colon and rectum. These tests show severe or moderate inflammation and complications like megacolon or perforation.

Medical Treatment Overview

Medical treatment for ulcerative colitis depends on how active the disease is. How much of the colon is affected and how well the person responds to treatment.

• 5-ASA medicines are often used for mild to moderate ulcerative colitis to reduce inflammation and help maintain remission.
• Corticosteroids may be used short-term; they are fast-acting drugs used during flare-ups. They are not safe for long-term use.
• Immunomodulators are medicines such as azathioprine that may be used in some cases to help maintain remission or help lower inflammation.
• Biologic medicines such as anti-TNF and anti-integrin may be used when the disease is moderate to severe or does not respond well to other treatments.
• Surgery or removal of the entire colon and rectum may be considered when medicines do not control the disease or when serious complications develop.

Food And Hydration During Symptoms

• Eat small, frequent meals instead of large meals because they are not easy to digest.
• Choose foods that are soft, well cooked, and easy to digest.
• Rice, potatoes, bananas, and other simple foods may be easier on the body during diarrhoea.
• If fibre worsens symptoms, temporarily reduce high-fibre foods during a flare.
• Avoid foods that trigger your existing symptoms.
• Drink water regularly to replace lost fluids.
• Oral rehydration solutions can help replace fluids and electrolytes when diarrhoea is frequent.

Ayurvedic Support: Safe Role And Limits

• Ayurveda may be used as a supportive approach alongside standard Ulcerative colitis treatment. Ayurvedic treatment focuses on balancing Agni (digestive fire) and cooling down the colon. It supports overall well-being and aims to improve quality of life.
• Ayurveda focuses on supportive care through Ahara (diet), Dinacharya (daily routines), and lifestyle practices.
• Pathya Ahara, or a suitable diet, is recommended and can be adopted according to symptoms and individual tolerance.
• Practices like Yoga and meditation are suggested to reduce stress, as it triggers UC flare-ups 
• Herbs like curcumin, which have anti-inflammatory properties, are recommended. 
• Ayurvedic herbs and formulations should be taken under supervision to correct the disrupted Pitta and Raktatisara.
• Evidence that Ayurvedic treatment reduces inflammation is limited, and it cannot alone replace medical treatment completely.
• Ayurveda is not equipped to handle acute, life-threatening complications of UC such as rectal bleeding, bowel perforation, and toxic megacolon 

Complications And Urgent Warning Signs

Ulcerative colitis can sometimes lead to complications, especially when inflammation is severe or remains uncontrolled. Most symptoms can be managed with proper treatment, but certain changes need proper medical attention: 

• Heavy or ongoing rectal bleeding 
• Severe dehydration
• Toxic megacolon due to severe inflammation
• Anemia or loss of red blood cells
• Osteoporosis or bone loss
• Tear in the colon 
• Strictures 
• Severe abdominal pain or swelling
• Inflammation of the skin, eyes, and joints
• High fever and rapid heartbeat
• Fatigue, dizziness, and fainting

Reference

Effects of Ayurvedic treatment on forty-three patients of ulcerative colitis - PMC

Ulcerative Colitis - NIDDK

Diagnosis of Ulcerative Colitis - NIDDK

Ulcerative colitis: an update - PMC

Eating, Diet, & Nutrition for Ulcerative Colitis - NIDDK