Ulcerative Colitis With Constipation

ARUN SWAMINATH: Hi, everyone.

I'm Dr. Arun Swaminath.

I'm the Chief

of Gastroenterology

and the Director

of the Inflammatory Bowel

Disease Program

at Lenox Hill Hospital,

Northwell Health.

I'm here today to answer some

of the internet's most commonly

asked questions

about ulcerative colitis.

Let's get started.

[MUSIC PLAYING]

All right.

So our first question is, can

someone explain how

ulcerative colitis is

different from Crohn's disease?

I'm really confused

about the two.

So it's a fair question.

And there's no one test--

imaging test, blood test,

colonoscopy-- that can really

say that this is one

or the other,

or this is the diagnosis.

It's often information that

is a combination of what

the patient tells me.

What are their symptoms?

How long have they

been happening?

Along with a combination

of blood tests, imaging like CT

scans or MRIs, and finally,

with a colonoscopy and biopsies

of tissues that look abnormal,

comes together as a diagnosis

of one or the other.

Now, the bigger question of what

is ulcerative colitis look like

and what does Crohn's

look really

has to do

with colonoscopic appearance.

In ulcerative colitis,

the moment I put in a camera--

essentially the colonoscope--

into the rectum, so

from the back end, we're looking

at the rectum

going up into the descending

colon, the transverse,

ascending colon,

and the terminal ileum, which

is small intestine.

The moment I put in the camera,

it is inflamed.

All of the mucosa is involved.

So it's circumferential

and it's continuous.

It's abnormal all the way up

until either it involves

the whole colon

or it involves the portion.

So it may just

be abnormal to here.

And then the rest of the colon

is fine.

That's different from Crohn's

distribution of inflammation,

which can be patchy.

So we call those skip areas.

So I put in the camera,

it looks OK.

But then I get to one spot

that's abnormal.

Then keep going.

It looks fine.

And I get to another area that

looks abnormal.

And those are called

skip lesions.

And the other interesting part

about Crohn's is it can be

in places

outside the large intestine.

And, in fact, the most common

place it's going to be involved

is the terminal ileum

and the beginning

of the large intestine called

the cecum.

So that is ileal colonic

Crohn's disease.

All right.

Next question.

I think I'm having symptoms

of ulcerative colitis,

but I'm only 15.

What age do most people

get diagnosed

with ulcerative colitis?

And can it happen to younger

people like me?

Yes, it can happen really

at any age.

And if you think about it

as a distribution, so younger

people-- less common-- as you

get more into your 20s

and seconds, the much more

common peak.

And then as you get older,

it kind of goes down all the way

up into your 60s, 70s or 80s.

And I've made diagnoses in older

patients all the time.

So the age really

doesn't matter.

It's the symptoms.

So if the symptoms really are

persistent and troubling,

you got to get in

front of

a pediatric gastroenterologist

or an adult gastroenterologist.

Depends on if you're younger

than 18 or older than 18.

But yes, the symptoms can happen

really at any time.

[VIDEO PLAYBACK]

- Why does ulcerative

colitis happen?

It's one of the biggest

googled questions about UC.

The truth-- UC doesn't just come

from one thing.

It's usually a combination

of three deeper problems--

inflammation,

microbiome dysbiosis,

and a leaky gut.

I call this the gut health

triangle, and it's at the heart

of every flare

and of every healing journey.

[END PLAYBACK]

ARUN SWAMINATH: Yeah, this

is a really complex idea of how

does this injury happen

in colitis.

And she's exactly right.

So it is something that has

triggered the immune system

to become active,

which may be a reasonable thing.

But the thing

in ulcerative colitis

is that activity doesn't stop

when the problem is taken

care of.

And we're not quite sure why.

So the immune system keeps

attacking even

though the invader is no

longer there

and the injury is

to normal tissue.

And that is the definition

of an autoimmune disease.

[VIDEO PLAYBACK]

- People often ask, isn't

it autoimmune?

And there's a lot of debate

around that.

Some believe that the body would

never turn on itself--

and I get that.

But the reality

is that the immune system is

responding to something.

It's overwhelmed, and the gut

is at the center of all

that confusion.

So where do food, stress,

antibiotics, and parasites

come in?

They don't cause

ulcerative colitis, but they can

trigger it if your gut is

already inflamed, leaky,

or lacking in the good bugs

that it needs.

[END PLAYBACK]

ARUN SWAMINATH: So this

is a chicken or the egg

question-- so which came first.

And it's not clear.

But we know that in patients

with the diagnosis of colitis

or Crohn's

that the bacteria that comprise

normal healthy bacteria

are different in the

two populations,

meaning that patients with IBD

have very different looking

bacteria than patients

who have

a normal, healthy,

uninflamed gut.

We see this in mice

and we see this in humans.

Now, whether just replacing

the bacteria from

something that--

to something that looks more

normal, actually fixes

the problem--

it doesn't seem like it is.

So what's probably happening

is that the bacteria are

a reflection of the inflammation

and overall changes

that are happening to the gut.

All right.

Here's the next question.

Is it normal to feel completely

wiped out all the time?

Even when I'm not flaring,

I feel like I got hit

by a truck.

Is this just part

of ulcerative colitis,

or should I be checking

for other stuff?

This is such a common complaint,

and here's the way that I think

about it.

So if you put this

under the bucket of fatigue--

so exhaustion, tiredness,

lacking energy for the things

that you normally are

able to do, but you can't do,

and certainly patients who

do not yet have

their inflammation under control

are the most likely to feel

this complaint.

But what gets more interesting

is that even patients who

go from being ill to completely

healthy and under

control, and even have

a normal colonoscopy,

a fraction of those patients

still have complaints

of fatigue.

So step one means get

the inflammation under control.

So if you're not there,

that's the first thing.

After that, if you still feel

fatigue, then your doctor

is often going to do

other testing, which may be

blood, or looking

into your specific medical

problems, or medications,

or sleep habits, or diabetes,

or obesity,

or any of these other things

that can contribute to feeling

like you don't have

enough energy even

though the disease is

under control.

So the short answer is-- step

one, get the disease

under control.

And step two, if you're still

there, if you're still feeling

fatigued and the disease

is under control--

keep asking questions

and say, what else can we

do to look at how I'm feeling.

How do you know when it's

an emergency?

At what point

do you go to the emergency room?

I'm scared to wait too long,

but I also don't want

to overreact.

It's a great question.

It is definitely scary.

You sit down,

you're trying to have a bowel

movement, and then you look

and there's blood.

So the main thing to remember

is that even though it might

look like a lot of blood,

that you're not going to die

from bleeding to death.

Your body is very strong

and can replace the blood

that you lose as long as there's

enough iron.

So what makes someone want

to go to the ER,

or benefit from going to the ER,

if there's a big change

in symptoms or severity

of symptoms.

So there is a lot of bleeding,

or it's persistent bleeding that

doesn't stop, or it's combined

with other things--

a fever, worsening

abdominal pain, nausea,

vomiting-- these are all things

where, rather than wait

for an appointment a week

from now,

that it's better to get

it checked out now,

with an emergency room.

And often, in an emergency room,

they can give fluids,

they can check your blood

counts, they might do a CT scan,

depending on what

your complaints are, to make

sure there's nothing that

requires urgent--

meaning

immediate-- intervention.

So it's OK to go.

And if you don't need to be

admitted to a hospital, they're

going to send you back home

with a fast appointment.

If you do need to be admitted,

then you're going to be

in a place

where you have all

of the experts that are required

to get you feeling better.

Next question.

My flares seem to line up

with my cycle.

Can UC affect periods

or hormones?

So it's an interesting question.

And there is plenty of data

that the menstrual cycle

in healthy patients

affects the GI tract.

And it's probably

for multiple reasons including

the change

in hormones-- estrogen

and progestin.

And part of it

is that those hormones can

affect gut motility and

gut function.

So it's pretty common to have

things like cramps or diarrhea

during the menstrual cycle.

Now, if a patient has UC

and it's a woman of menstruating

age, then how do you know

whether this is a UC problem

or this

is common with menstruation?

And how do you tell

the difference?

I think that patients,

over time,

can start to understand which

is related

and which is not related.

And not every symptom

is necessarily related

to a flare of colitis.

So typically, a flare is going

to be associated with bleeding,

or urgency, or abnormal blood

tests, or stool tests that we

can check.

So if you're not actually sure,

oftentimes I'll say, hey, let's

do this test.

And it's oftentimes I like

to use something called

a fecal calprotectin.

So this is a stool test.

And I'll say, what if you're not

sure if your symptoms are

related to inflammation or not?

Do the stool test when you have

the symptom.

And that way, I can connect it

to say, what?

The stool test was

absolutely normal.

I know that you were having

some cramping and urgency,

but this is more related

to a normal range of symptoms

during menstruation.

Or I could say, what?

You seem to be actually flaring

more commonly

during your menstrual cycles,

during your periods

versus not, and that we need

to treat you better

or get you into a

deeper remission,

so

that

your remaining

asymptomatic, regardless

of the menstrual cycle.

That's all for now.

It's been a pleasure answering

your questions.

Thank you so much for watching.

[MUSIC PLAYING]