Types of Ulcerative Colitis (UC)

Ulcerative colitis is a form of inflammatory bowel disease (IBD). It is a chronic condition that causes inflammation in the large intestine (colon). It can also cause signs and symptoms in other parts of the body outside of the large intestine.

Ulcerative colitis is treated with medications, lifestyle changes, and, in about 10%–15% of cases, surgery to remove the colon. The different forms of ulcerative colitis have varying symptoms and affect specific parts of the colon.

This article will discuss the different types of ulcerative colitis, complications that can occur, and when to see a healthcare professional.

Types

Ulcerative colitis can be a progressive disease. The inflammation in the colon starts in the last part—the rectum. The disease may go on to affect more sections of the colon. The symptoms and treatments you need will change based on how extensive the inflammation becomes.

Topical treatments (such as enemas, injecting liquid into the rectum and colon) might be used for disease located at the end of the colon. Systemic treatments (such as oral medications, injections, or infusions) might be used for disease that extends to more parts of the colon.

It’s not always true that milder symptoms mean that less of the colon is affected, particularly when it comes to symptoms affecting quality of life. Less-extensive inflammation can still cause symptoms that negatively affect quality of life. In about 15% of people diagnosed with ulcerative colitis, the disease is severe at the time of diagnosis.

Ulcerative Proctitis

When inflammation affects only the rectum, and no other parts of the colon, it is called ulcerative proctitis.

This form of ulcerative colitis is often considered less severe than others because it doesn’t involve more sections of the large intestine. However, it still causes symptoms that can negatively affect quality of life. This can include blood in the stool, pain in the rectum, and diarrhea or constipation. 

Ulcerative colitis is often thought of as a condition that causes unrelenting diarrhea. However, in people who have proctitis, constipation may be more common than diarrhea. Ulcerative proctitis might be diagnosed in anywhere between 30% and 60% of patients.

Proctosigmoiditis

This type of ulcerative colitis is diagnosed when there is inflammation in the rectum and the last part of the colon, the sigmoid colon.

Proctosigmoiditis symptoms can include diarrhea, bloody diarrhea, a cramping pain, feeling you need a bowel movement even when the bowels are empty (tenesmus), and left-sided abdominal pain.

Left-Sided Colitis

This type of ulcerative colitis is sometimes called distal or limited colitis. As the inflammation takes over more sections of the colon, it can lead to left-sided colitis. The parts of the large intestine affected include the rectum, sigmoid colon, and descending colon.

The symptoms can include diarrhea, bloody diarrhea, lack of appetite, and weight loss. Abdominal pain may be more severe and is felt on the left side.

Pancolitis

Pancolitis is diagnosed when the entire colon is affected by inflammation. The symptoms can include diarrhea, a cramping pain, more significant weight loss, and severe abdominal pain. Some patients with extensive disease may also experience fevers. 

Anywhere between 14% and 35% of ulcerative colitis patients have pancolitis. Having pancolitis, along with being diagnosed at a younger age and having deeper ulcers in the colon, is a risk factor for having a more aggressive disease course.

Complications

Some of the complications of ulcerative colitis include the disease relapsing (coming back), hospitalization, colon cancer, and surgery.

Many studies on ulcerative colitis patients show that the disease tends to come back again in the first year after diagnosis in about half of all patients. A small percentage, around 1%–5%, have disease that continues to be chronic, without remission. Within 10 years, about two-thirds of patients have a relapse of ulcerative colitis. 

About half of all patients with ulcerative colitis are hospitalized for the disease at some point. Those who have more extensive disease are at greater risk of needing to be treated in the hospital.

People with IBD have an increased risk of colon cancer if there is disease in the colon. Being diagnosed young, having severe disease, and having long-standing disease (10 or more years) are risk factors.

Surgery is a valid treatment option for ulcerative colitis. The need for surgery, including removing the colon (colectomy), has decreased in recent years. This may be due to earlier diagnosis and more effective treatment options. The rate varies based on several factors, but it’s estimated that surgery is needed in less than 20% of patients.

When to See a Doctor

People who live with any form of ulcerative colitis should have a close relationship with a gastroenterologist (a medical doctor specializing in digestive system conditions).

Other specialists, such as a colorectal surgeon, may also be part of the medical team. A gastroenterologist will help monitor your condition and offer you an understanding of the probabilities of relapse.

There are some symptoms, however, for which it is crucial to see a doctor sooner. These include:

• Blood in the stool
• Bowel movements have stopped
• Prolonged diarrhea
• Severe abdominal pain

Summary

Ulcerative colitis is a chronic condition that causes inflammation the large intestine. Different types include ulcerative proctitis, which is limited to the rectum; proctosigmoiditis, with inflammation in the rectum and sigmoid colon; left-sided colitis, which can involve the rectum, sigmoid colon, and descending colon; and pancolitis, affecting the entire colon.

A Word From Verywell

Ulcerative colitis is a chronic condition, and there is currently no cure. However, treatments are improving. People with ulcerative colitis now are more likely to go into remission and to avoid complications than was possible in the past.

By taking advantage of treatments and working to get the disease under control, complications can be avoided. Most people with ulcerative colitis do not have severe disease and are able to live full, productive lives.