Understanding the different types of ulcerative colitis and how they affect the body is extremely important, especially if you or your loved one is diagnosed with this type of inflammatory bowel disease (IBD). This is one of the vital aspects that physicians consider when determining the diagnostic procedures and treatment methods that an ulcerative colitis patient must undergo.
Ulcerative colitis may occur at any part of the large intestine, which is why it’s classified depending on how much of the large intestine is actually affected by inflammation and ulcers. There are four broad classifications of this disease. While some forms of ulcerative colitis may not fall into one of these classifications, they can still help physicians and patients understand the severity of a particular case and determine possible ways to control its symptoms when flaring.
Ulcerative proctitis is the mildest form of ulcerative colitis since it only affects a small area of the large intestine, specifically the rectal section. The inflammation and ulcers are usually located on the last 6 inches of the rectum. Even though the affected area for this type of ulcerative colitis is small, patients who are suffering from it may still experience painful and bothersome symptoms that may disrupt their daily lives, including rectal pain, bloody stool, diarrhea and tenesmus.1
Approximately 30 percent of people who are diagnosed with ulcerative colitis fall into this classification. It may also spread to other parts of the colon and turn into a more severe form of ulcerative colitis—this is experienced by around 30 to 50 percent of ulcerative proctitis patients.2
Due to its limited extent, ulcerative proctitis is associated with fewer complications compared to other types of ulcerative colitis. Its symptoms are also easier to manage, and the chance for long-term remission is high.3
Proctosigmoiditis affects the rectum and the sigmoid colon. It’s worse than ulcerative proctitis, as the extent of inflammation and ulcers is larger. However, it’s still not considered a severe type of ulcerative colitis. The symptoms of proctosigmoiditis are also similar to that of ulcerative proctitis, which include bloody diarrhea and tenesmus. In addition, patients may also experience moderate pain on the lower left side of their abdomen when the disease is flaring.4,5,6
Around 50 percent of ulcerative colitis patients have proctosigmoiditis. Its chance of spreading to other parts of the colon is slim, with only 10 percent of patients experiencing this deterioration in their condition within five years of diagnosis.7 There are several complications associated with proctosigmoiditis, including toxic megacolon and anemia. It may also lead to colorectal cancer, although the risk of developing this complication is fairly low.8
Left-sided colitis, also known as distal colitis, occurs on the left side of the colon. The inflammation and ulcers extend from the rectum to the descending colon and splenic flexure (the bend in the colon near the spleen).9 Since its extent is significantly larger than the two other types of ulcerative colitis mentioned above, it’s no surprise that distal colitis comes with more symptoms, which include:10
- Loss of appetite
- Weight loss
- Bloody diarrhea
- Severe pain on the left side of the abdomen
The risk of developing complications, such as toxic megacolon and excessive blood loss, is higher for people with left-side colitis than those with milder types of ulcerative colitis. Patients with left-side colitis are also more susceptible to colorectal cancer than the general population, but not as high as those with pan-ulcerative colitis.11,12
Pan-ulcerative colitis (also known as pancolitis, total colitis and universal colitis) refers to the inflammation of the entire large intestine. Just about 20 percent of patients who are diagnosed with ulcerative colitis fall under this category. Some of the symptoms that may be encountered with pan-ulcerative colitis include:13
Severe abdominal pain
Diarrhea with blood and mucus
Abnormal weight loss
Exhaustion or fatigue
Studies have shown that the risk of developing colon cancer is 4 to 5 percent higher in patients who are suffering from pan-ulcerative colitis for more than 10 years. In fact, 75 to 80 percent of ulcerative colitis patients who developed colon cancer actually have a history of pan-ulcerative colitis.14 Since its extent is severe, it requires extensive diagnostic and treatment methods to control the symptoms during flare-ups.
How Do You Find Out the Type of Ulcerative Colitis That You Have?
There are numerous tests and procedures that will help determine the form of ulcerative colitis that you have. Blood tests are one of the first procedures that you will undergo. A routine blood test can detect inflammation in the body whereas a fecal blood test indicates if there’s blood in your stool. Physicians also use antibody blood test to determine whether you have Crohn’s disease or ulcerative colitis.
Your doctor may also require you to undergo imaging tests to get a closer and clearer look at the condition of your large intestine and the location of the inflammation. Some of the common imaging tests used to identify this disease include endoscopy, magnetic resonance imaging (MRI), X-ray and computerized tomography (CT) scan.15
These tests, along with a detailed explanation of the symptoms that you’re experiencing, will help you and your physician develop a treatment plan that is specifically suited for the type of ulcerative colitis that you have.