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Ulcerative Colitis : Symptoms
   
Western Medicine Chinese Medicine

Major symptoms of ulcerative colitis are diarrhea, rectal bleeding, the passage of mucus, and abdominal pain. The onset of symptoms is usually slow and insidious and often symptoms have been present for weeks or even months before patients seek medical help. Patients often experience frequent bowel movements of small volume and fecal incontinence. Other symptoms include fever, pain and weight loss.

In general, the severity of symptoms correlates with the severity of the disease. More generalized symptoms such as fever, fatigue, and weight loss are more common if inflammation is extended to all or most of the colon. If the disease is confined to the rectum, the only symptoms may be persistent desire to empty the bowel or spasm of the rectum with or without bloody diarrhea. Some patients, especially elderly patients or those with inflammation confined to the rectum, may complain of constipation and hard stools.

Classification of disease severity
Severity of disease is categorized as mild, moderate, or severe according to clinical symptoms.

Mild: diarrhea and rectal bleeding are usually the only symptoms. Patients experience less than four stools daily, with or without blood.

Moderate: typical symptoms are five or six bloody bowel movements per day and bloody diarrhea is often associated with large amount of mucus and pus. Incontinence is often a problem especially when the rectum is severely inflamed. Abdominal pain may also be present in addition to low-grade fever and fatigue.

Severe: patients experience frequent episodes of bloody diarrhea (more than six bloody stools daily) and they may become anorectic and nauseated. In severe attacks, patients may vomit and experience symptoms of anemia such as breathlessness, ankle swelling, and fatigue. Weight loss, fever, fast heartbeat, dizziness, and severe cramping or abdominal pain can also occur with severe cases of the disease.

Other organ systems affected by ulcerative colitis

Skin: most rashes are related to drug therapy, which can cause an allergic skin reaction or photosensitivity reaction to sulfasalazine and 5-aminosalicylic acid (5-ASA). A condition called pyoderam gangrenosum, an inflammatory bacterial dermatitis with pus and ulceration, is a rare skin condition that occurs in patients with ulcerative colitis and it occurs principally on the trunk or the limbs.

Mouth: oral ulcers occur in about ten percent of patient s with active ulcerative colitis.

Eyes: inflammation of the eyes occurs in approximately five to eight percent of patients with active ulcerative colitis. Corticosteroid eye drops are useful for controlling symptoms of inflammation.

Joints: in approximately ten to fifteen percent of patient s with an acute attack of ulcerative colitis, larger joints (knees, hips, ankles, wrists, and elbow) become hot and swollen. This condition resolves as the disease goes into remission.

Liver disease: in severe attacks of ulcerative colitis, minor elevations in liver enzymes are common and the level returns to normal once remission is achieved. However, in about three percent of patients with ulcerative colitis, a major liver complication can occur in which chronic inflammation of the bile duct can lead to progressive liver disease. The cause of this liver disease is unknown and there is currently no satisfactory treatment for this condition.

TCM identifies ulcerative colitis according to the severity and symptoms exhibited in each individual; these are then allotted into different disharmony patterns or syndromes. Basically, physicians pay special attention to bowel habits such as frequency, quantity, nature, form, color and smell of the stools, as well as the presence of accompanying physical sensations.

Damp-heat in the large intestine
There is usually acute onset of this type. The diarrhea is violent and foul smelling and with a large amount of pus or blood. There is a burning feeling in the anus, abdominal pain and cramps, a rumbling noise and distention that diminishes after defecation. Other accompanying signs are fever or alternating chills and fever, poor appetite, dry mouth, and scanty yellow urine.

Damp-cold in the spleen
Diarrhea with excessive mucus or watery thin stools, tenesmus, abdominal cramps and rumbling noise are also experienced. There are accompanying signs like a bland taste in mouth, stomach stuffiness, no appetite, headache, generalized heaviness, and clear urine.

Qi and Blood stagnation
Diarrhea with alternative solid or loose stools, sticky with mucus or darkish bloody contents; straining to pass a small amount of stools may occur each time; there are also constant stabbing pains at a fixed location that can be aggravated by pressure. Other accompanying signs may be abdominal masses, distention, chest fullness, poor appetite and a darkish facial complexion.

Liver stagnation and spleen weakness
Symptoms are always triggered by emotional stimulation. Usually, diarrhea immediately comes after abdominal cramps; there are loose stools full of mucus with some pus or blood. There are also tenesmus, chest oppression, sighing, irritability, poor appetite and frequent passage of gas. Some individuals may present with alternating diarrhea and constipation.

Spleen qi deficiency
Individuals develop alternating diarrhea and loose bowels, and undigested foods may present in the stools. The loose bowels and frequency are worsened by poor lifestyle habits or consumption of greasy foods. The abdominal cramps are dull in nature and can be relieved by palpation. Other accompanying signs are lack of appetite, gastric fullness after meals, fatigue, sallow complexion, frequent passage of gas, irregular menstruation or even rectal prolapse.

Spleen and kidney deficiencies
Individuals develop a chronic persistent diarrhea that usually contains undigested foods. Diarrhea typically occurs early in the morning after an episode of colic around the navel, and then throughout the day. Other symptoms include fatigue, cold body and extremities, soreness in the lumbar and knees, abdominal dull pain that diminishes with exposure to warmth, profuse clear urine or frequent urination at night.

It should be noted that during the course of ulcerative colitis, the above syndrome patterns may appear alone or in complex form. An experienced physician can accurately identify the pattern.