How can you effectively manage ulcerative colitis pain. What are the best treatment options for UC discomfort. Which medications provide relief for ulcerative colitis symptoms. How does diet impact UC pain management. What lifestyle changes can help alleviate ulcerative colitis pain. Are there natural remedies for UC discomfort. How can stress reduction techniques benefit ulcerative colitis patients.

Understanding Ulcerative Colitis and Its Associated Pain

Ulcerative colitis (UC) is a type of inflammatory bowel disease characterized by chronic inflammation in the colon and rectum. This inflammation can lead to varying levels of pain, which can significantly impact a person’s quality of life. To effectively manage UC pain, it’s crucial to understand its nature and underlying causes.

What Causes Pain in Ulcerative Colitis?

The primary cause of pain in ulcerative colitis is the chronic inflammation that leads to open sores or ulcers in the innermost lining of the colon and rectum. The severity and location of this inflammation can determine where and how intensely a person experiences pain.

• Abdominal cramping
• Mild to severe pain in the abdomen and rectum
• Feelings of gripping or extreme pressure
• Gas pain and bloating
• Tenderness to touch (especially in left-sided ulcerative colitis)

Is pain always present in ulcerative colitis? Not necessarily. UC is characterized by periods of active disease (flares) and remission. During remission, symptoms may decrease or disappear completely. However, when the disease is active, pain can become a significant issue that requires management.

Medication Options for Ulcerative Colitis Pain Relief

Managing pain in ulcerative colitis often involves a combination of medications aimed at reducing inflammation and alleviating discomfort. The choice of medication depends on the severity of symptoms and the individual’s response to treatment.

Over-the-Counter Pain Relief

For mild pain, over-the-counter medications may provide relief. However, it’s important to choose the right type of pain reliever.

• Acetaminophen (Tylenol) is generally considered safe for UC patients
• Avoid nonsteroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen, aspirin, and naproxen, as they can trigger flares and worsen symptoms

Prescription Medications for UC Pain Management

When over-the-counter options are insufficient, prescription medications may be necessary to manage UC pain effectively.

1. Anti-inflammatory medications:
   • Corticosteroids (e.g., prednisone, hydrocortisone)
   • Amino salicylates (e.g., mesalamine, sulfasalazine, balsalazide, olsalazine)
2. Immunosuppressants:
   • Azathioprine
   • Mercaptopurine
   • Cyclosporine
3. Biologics:
   • Tumor necrosis factor alpha (TNF-alpha) inhibitors (e.g., infliximab)
   • Integrin receptor antagonists (e.g., vedolizumab)
4. Janus kinase (JAK) inhibitors

How do these medications work to relieve UC pain? Anti-inflammatory drugs target the root cause of pain by reducing inflammation in the colon. Immunosuppressants and biologics work by modulating the immune system to prevent it from triggering inflammation. JAK inhibitors block specific enzymes involved in the inflammatory process.

Dietary Approaches to Managing Ulcerative Colitis Pain

Diet plays a crucial role in managing ulcerative colitis symptoms, including pain. While there’s no one-size-fits-all diet for UC, certain dietary approaches can help reduce inflammation and alleviate discomfort.

Foods to Include in a UC-Friendly Diet

• Low-fiber fruits and vegetables
• Lean proteins (e.g., fish, poultry, tofu)
• Probiotic-rich foods (e.g., yogurt, kefir)
• Omega-3 fatty acids (e.g., salmon, chia seeds)
• Turmeric (known for its anti-inflammatory properties)

Foods to Avoid During UC Flares

• High-fiber foods (e.g., raw vegetables, whole grains)
• Dairy products (if lactose intolerant)
• Spicy foods
• Caffeine and alcohol
• Processed and fatty foods

Can dietary changes alone manage UC pain? While diet is an important component of UC management, it’s typically most effective when combined with other treatment approaches, such as medication and lifestyle modifications.

Stress Reduction Techniques for Ulcerative Colitis Pain Management

Stress can exacerbate UC symptoms, including pain. Implementing stress reduction techniques can be an effective complementary approach to managing ulcerative colitis discomfort.

Effective Stress Management Strategies for UC Patients

1. Mindfulness meditation
2. Deep breathing exercises
3. Progressive muscle relaxation
4. Yoga or tai chi
5. Regular exercise
6. Cognitive-behavioral therapy (CBT)
7. Biofeedback

How does stress reduction impact UC pain? Stress can trigger inflammation and exacerbate UC symptoms. By managing stress, patients may experience reduced inflammation and, consequently, less pain. Additionally, stress reduction techniques can improve overall well-being and coping mechanisms.

Natural and Complementary Therapies for Ulcerative Colitis Pain Relief

In addition to conventional treatments, many UC patients explore natural and complementary therapies to manage their pain. While these approaches should not replace prescribed treatments, they may offer additional relief when used in conjunction with standard medical care.

Promising Natural Remedies for UC Pain

• Probiotics
• Omega-3 fatty acid supplements
• Aloe vera
• Curcumin (from turmeric)
• Boswellia
• Acupuncture
• Hypnotherapy

Are natural remedies as effective as conventional treatments for UC pain? While some natural remedies show promise in managing UC symptoms, including pain, they generally don’t have the same level of scientific evidence as conventional treatments. It’s essential to discuss any natural or complementary therapies with a healthcare provider before incorporating them into your treatment plan.

Exercise and Physical Activity in Ulcerative Colitis Pain Management

Regular exercise can play a significant role in managing ulcerative colitis symptoms and improving overall well-being. However, it’s important to approach physical activity carefully, especially during flares.

Benefits of Exercise for UC Patients

• Reduced inflammation
• Improved immune function
• Stress reduction
• Better sleep quality
• Enhanced mood
• Improved bone density (important for those on long-term corticosteroids)

Recommended Exercises for UC Pain Management

1. Low-impact aerobic activities (e.g., walking, swimming, cycling)
2. Yoga
3. Pilates
4. Gentle strength training
5. Tai chi

How much exercise is beneficial for UC patients? The amount and intensity of exercise should be tailored to each individual’s condition and current health status. It’s generally recommended to start with low-intensity activities and gradually increase as tolerated. During flares, it may be necessary to reduce exercise intensity or focus on gentler forms of movement.

Monitoring and Tracking Ulcerative Colitis Pain

Effective pain management in ulcerative colitis often involves careful monitoring and tracking of symptoms. This can help patients and healthcare providers identify patterns, triggers, and the effectiveness of various treatments.

Tools for Tracking UC Pain and Symptoms

• Symptom diaries
• Pain scales
• Mobile apps designed for IBD management
• Regular check-ins with healthcare providers

What information should be included in a UC symptom tracker? Key elements to track include:
– Pain intensity and location
– Frequency and consistency of bowel movements
– Presence of blood in stool
– Fatigue levels
– Diet and potential food triggers
– Stress levels
– Medications taken and their effects
– Exercise and physical activity

By consistently tracking these factors, patients can gain valuable insights into their condition and work more effectively with their healthcare team to manage pain and other symptoms.

The Role of Sleep in Ulcerative Colitis Pain Management

Quality sleep is crucial for overall health and can significantly impact pain perception and management in ulcerative colitis. Poor sleep can exacerbate inflammation and increase sensitivity to pain, creating a cycle that can be challenging to break.

Strategies for Improving Sleep with UC

1. Establish a consistent sleep schedule
2. Create a relaxing bedtime routine
3. Optimize your sleep environment (cool, dark, quiet)
4. Limit screen time before bed
5. Avoid large meals close to bedtime
6. Practice relaxation techniques (e.g., deep breathing, meditation)
7. Consider using a wedge pillow to elevate the head and reduce nighttime reflux

How does sleep affect UC pain? Adequate sleep can help reduce inflammation, boost immune function, and improve pain tolerance. Conversely, sleep deprivation can increase inflammation and sensitivity to pain, potentially worsening UC symptoms.

By implementing these strategies and working closely with healthcare providers, individuals with ulcerative colitis can develop a comprehensive approach to pain management. This multifaceted strategy, combining medication, diet, stress reduction, exercise, and careful monitoring, can significantly improve quality of life and help maintain longer periods of remission. Remember that UC management is highly individualized, and what works best may vary from person to person. Regular communication with healthcare providers is essential to tailor the treatment plan to each individual’s needs and respond effectively to changes in symptoms or disease activity.

How to Manage UC Pain

If left untreated, the pain associated with ulcerative colitis can make it hard to work, exercise, or enjoy daily activities. Managing the disease with medication, stress reduction, and diet can help to manage and reduce pain.

Ulcerative colitis (UC) is a type of inflammatory bowel disease that can cause varying levels of pain.

UC is caused by chronic, long-term inflammation that leads to open sores known as ulcers in the innermost lining of your colon, or large intestine, and rectum. Having a higher level of pain can be a sign that the disease is flaring up or even getting worse.

How much inflammation you have in your colon and where it’s located can determine where you’re likely to feel pain. This pain may include abdominal cramping and mild to severe pain in the abdomen and rectum. The pain may be long-lasting or it may fade when the inflammation recedes.

Long periods of remission between flare-ups are common. During remission, your symptoms may decrease or disappear completely.

People with mild UC may experience pressure and cramping. As the disease progresses, as inflammation and ulcers in your colon increase, the pain may manifest as feelings of gripping or extreme pressure that tightens and releases over and over again.

Gas pain and bloating may also occur, which can make the sensation feel worse.

If you have a type of UC known as left-sided ulcerative colitis, your left side may also feel tender to the touch.

The pain associated with UC can diminish your overall quality of life. If you have chronic, unmanageable pain at any level, consider discussing the following treatment options with a doctor so that you can feel better.

Treatment can also get you back into the swing of your day-to-day activities. A doctor may recommend a combination of medications, dietary changes, and other complementary therapies to help manage your UC pain.

If you have mild pain, over-the-counter (OTC) medications such as acetaminophen (Tylenol) may be enough to help you feel relief.

If you have ulcerative colitis, avoid nonsteroidal anti-inflammatory drugs (NSAIDs). These OTC drugs shouldn’t be taken for UC pain, as they can cause flare-ups and make other symptoms, such as diarrhea, worse.

Medications to avoid can include:

• ibuprofen (Motrin IB, Advil)
• aspirin (Bufferin)
• naproxen (Aleve, Naprosyn)

Inflammation is the root cause of most UC-related pain. Certain medications can help reduce inflammation in your colon. A doctor can help you decide which kind is right for you based on which part of your colon is affected and your pain level.

Anti-inflammatory medications that may help can include corticosteroids, such as prednisone and hydrocortisone.

Amino salicylates are another class of anti-inflammatory medication. These are sometimes prescribed for UC pain. There are many kinds, including:

• mesalamine (Asacol, Lialda, Canasa)
• sulfasalazine (Azulfidine)
• balsalazide (Colazal, Giazo)
• olsalazine (Dipentum)

Anti-inflammatory drugs can be taken orally as tablets or capsules or be administered through suppositories or enemas. They can also be given intravenously. Most anti-inflammatory medications can cause side effects of varying kinds.

You may need to try more than one type of anti-inflammatory drug before you find one that is the best fit for your symptoms. Each medication is sold under a number of brand names.

Immunosuppressant drugs may be prescribed alone or in addition to anti-inflammatory medications. They reduce pain by working to stop your immune system from triggering inflammation. There are a number of different types, including:

• azathioprine (Azasan, Imuran)
• mercaptopurine (Purixan)
• cyclosporine (Sandimmune)

Immunosuppressant medications are typically used in people who don’t respond well to other types of drugs and are meant for short-term use. They can be damaging to the liver and pancreas.

They may cause serious side effects, including a lowered ability to fight off serious infections, and some cancers, such as skin cancer. Cyclosporine has been linked to fatal infections, seizures, and kidney damage.

Biologics

Biologics are another type of immunosuppressant medication. One type of biologic is tumor necrosis factor alpha inhibitors (TNF-alpha).

Anti-TNF alpha medications are now first-line treatments for people with moderate to severe UC. They’re typically reserved for people who haven’t had success with other therapies. They help stop pain by nullifying a protein produced by the immune system. One type of anti-TNF alpha medication is infliximab (Remicade).

Integrin receptor antagonists are another form of biologics. These include vedolizumab (Entyvio), which has been approved to treat UC in adults.

Biologics have been linked to serious forms of infection and tuberculosis.

Janus kinase (JAK) inhibitors

JAK inhibitors are oral medications that block a specific enzyme involved in inflammation. They can be effective in treating moderate-to-severe UC in instances where biologics are not effective. JAK inhibitors can include tofacitinib (Xeljanz) and Rinvoq (upadacitinib).

What you eat won’t cause UC, but certain foods may exacerbate your symptoms and can cause additional cramping and pain. Keeping a food diary can help you identify any food triggers you may have.

Common foods that people with UC typically avoid can include:

• dairy products high in lactose, such as milk
• high fat foods, such as greasy or fried items, beef, and sugary, high fat desserts
• processed foods, such as frozen dinners and boxed rice
• high fiber foods, such as whole grains
• gas-producing vegetables, such as Brussels sprouts and cauliflower
• spicy food
• alcoholic drinks
• caffeinated beverages, such as coffee, tea, and cola

It may help to eat several small meals a day rather than three large ones. You should also try drinking lots of water — at least eight 8-ounce glasses a day. This may put less strain on your digestive system, produce less gas, and help bowel movements move through your system smoothly.

Once thought to cause UC, stress may be a trigger for UC flare-ups in some people. Managing and reducing stress may help alleviate UC symptoms, such as inflammation, and pain.

Different stress-management techniques work for different people, and you might find that a simple walk in the woods and deep breathing are what benefit you the most. Yoga, mindfulness meditation, and exercise may also help reduce stress in some people with UC.

A 2019 review of research found that mindfulness interventions can be effective in relieving stress and depression and improving the quality of life in people with inflammatory bowel disease (IBD). However, it didn’t lead to significant symptom relief. More research specific to UC is needed.

In extreme cases, surgery may be the best way to eliminate UC and its pain. There are two different options for surgery to manage severe UC. Both options have pros and cons so it is best to discuss them with a doctor.

Proctocolectomy with end ileostomy

Also known as a full proctocolectomy, this surgery requires the removal of the entire colon, rectum, and anus.

A surgeon then forms a stoma using the end of the small intestine so that waste can be removed from your body.

Proctocolectomy with J-pouch formation

This surgery requires the removal of your entire colon and rectum.

During surgery, a pouch constructed from the end of your small intestine is attached to your anus. This allows for relatively normal waste elimination to occur, meaning you won’t have to wear an external bag.

Alternative treatments such as acupuncture may help reduce and regulate bowel inflammation, reducing UC pain.

Another form of alternative treatment called moxibustion may also have a positive effect on UC symptoms. Moxibustion is a type of heat therapy. It uses dried plant materials burned in a tube to warm the skin, often in the same areas targeted by acupuncture.

A 2016 review of several studies indicated that acupuncture and moxibustion may be effective when used alone, together, or as complements to medication. But the reviewers indicated that more research is needed before these techniques can be considered proven treatments for UC symptoms and pain.

Depending on the severity of UC symptoms, pain can range from mild to severe. You may experience long periods of remission from these symptoms followed by flare-ups where the symptoms return or worsen.

These symptoms can make it hard to perform your daily activities.

Medication can help reduce the symptoms of flare-ups and lengthen the time of remission. Diet, exercise, stress management, and other alternative therapies may also help.

If you’re experiencing pain due to UC, talk with a doctor about your treatment options to manage the condition and reduce pain.

Read this article in Spanish.

How to Manage UC Pain

If left untreated, the pain associated with ulcerative colitis can make it hard to work, exercise, or enjoy daily activities. Managing the disease with medication, stress reduction, and diet can help to manage and reduce pain.

Ulcerative colitis (UC) is a type of inflammatory bowel disease that can cause varying levels of pain.

UC is caused by chronic, long-term inflammation that leads to open sores known as ulcers in the innermost lining of your colon, or large intestine, and rectum. Having a higher level of pain can be a sign that the disease is flaring up or even getting worse.

How much inflammation you have in your colon and where it’s located can determine where you’re likely to feel pain. This pain may include abdominal cramping and mild to severe pain in the abdomen and rectum. The pain may be long-lasting or it may fade when the inflammation recedes.

Long periods of remission between flare-ups are common. During remission, your symptoms may decrease or disappear completely.

People with mild UC may experience pressure and cramping. As the disease progresses, as inflammation and ulcers in your colon increase, the pain may manifest as feelings of gripping or extreme pressure that tightens and releases over and over again.

Gas pain and bloating may also occur, which can make the sensation feel worse.

If you have a type of UC known as left-sided ulcerative colitis, your left side may also feel tender to the touch.

The pain associated with UC can diminish your overall quality of life. If you have chronic, unmanageable pain at any level, consider discussing the following treatment options with a doctor so that you can feel better.

Treatment can also get you back into the swing of your day-to-day activities. A doctor may recommend a combination of medications, dietary changes, and other complementary therapies to help manage your UC pain.

If you have mild pain, over-the-counter (OTC) medications such as acetaminophen (Tylenol) may be enough to help you feel relief.

If you have ulcerative colitis, avoid nonsteroidal anti-inflammatory drugs (NSAIDs). These OTC drugs shouldn’t be taken for UC pain, as they can cause flare-ups and make other symptoms, such as diarrhea, worse.

Medications to avoid can include:

• ibuprofen (Motrin IB, Advil)
• aspirin (Bufferin)
• naproxen (Aleve, Naprosyn)

Inflammation is the root cause of most UC-related pain. Certain medications can help reduce inflammation in your colon. A doctor can help you decide which kind is right for you based on which part of your colon is affected and your pain level.

Anti-inflammatory medications that may help can include corticosteroids, such as prednisone and hydrocortisone.

Amino salicylates are another class of anti-inflammatory medication. These are sometimes prescribed for UC pain. There are many kinds, including:

• mesalamine (Asacol, Lialda, Canasa)
• sulfasalazine (Azulfidine)
• balsalazide (Colazal, Giazo)
• olsalazine (Dipentum)

Anti-inflammatory drugs can be taken orally as tablets or capsules or be administered through suppositories or enemas. They can also be given intravenously. Most anti-inflammatory medications can cause side effects of varying kinds.

You may need to try more than one type of anti-inflammatory drug before you find one that is the best fit for your symptoms. Each medication is sold under a number of brand names.

Immunosuppressant drugs may be prescribed alone or in addition to anti-inflammatory medications. They reduce pain by working to stop your immune system from triggering inflammation. There are a number of different types, including:

• azathioprine (Azasan, Imuran)
• mercaptopurine (Purixan)
• cyclosporine (Sandimmune)

Immunosuppressant medications are typically used in people who don’t respond well to other types of drugs and are meant for short-term use. They can be damaging to the liver and pancreas.

They may cause serious side effects, including a lowered ability to fight off serious infections, and some cancers, such as skin cancer. Cyclosporine has been linked to fatal infections, seizures, and kidney damage.

Biologics

Biologics are another type of immunosuppressant medication. One type of biologic is tumor necrosis factor alpha inhibitors (TNF-alpha).

Anti-TNF alpha medications are now first-line treatments for people with moderate to severe UC. They’re typically reserved for people who haven’t had success with other therapies. They help stop pain by nullifying a protein produced by the immune system. One type of anti-TNF alpha medication is infliximab (Remicade).

Integrin receptor antagonists are another form of biologics. These include vedolizumab (Entyvio), which has been approved to treat UC in adults.

Biologics have been linked to serious forms of infection and tuberculosis.

Janus kinase (JAK) inhibitors

JAK inhibitors are oral medications that block a specific enzyme involved in inflammation. They can be effective in treating moderate-to-severe UC in instances where biologics are not effective. JAK inhibitors can include tofacitinib (Xeljanz) and Rinvoq (upadacitinib).

What you eat won’t cause UC, but certain foods may exacerbate your symptoms and can cause additional cramping and pain. Keeping a food diary can help you identify any food triggers you may have.

Common foods that people with UC typically avoid can include:

• dairy products high in lactose, such as milk
• high fat foods, such as greasy or fried items, beef, and sugary, high fat desserts
• processed foods, such as frozen dinners and boxed rice
• high fiber foods, such as whole grains
• gas-producing vegetables, such as Brussels sprouts and cauliflower
• spicy food
• alcoholic drinks
• caffeinated beverages, such as coffee, tea, and cola

It may help to eat several small meals a day rather than three large ones. You should also try drinking lots of water — at least eight 8-ounce glasses a day. This may put less strain on your digestive system, produce less gas, and help bowel movements move through your system smoothly.

Once thought to cause UC, stress may be a trigger for UC flare-ups in some people. Managing and reducing stress may help alleviate UC symptoms, such as inflammation, and pain.

Different stress-management techniques work for different people, and you might find that a simple walk in the woods and deep breathing are what benefit you the most. Yoga, mindfulness meditation, and exercise may also help reduce stress in some people with UC.

A 2019 review of research found that mindfulness interventions can be effective in relieving stress and depression and improving the quality of life in people with inflammatory bowel disease (IBD). However, it didn’t lead to significant symptom relief. More research specific to UC is needed.

In extreme cases, surgery may be the best way to eliminate UC and its pain. There are two different options for surgery to manage severe UC. Both options have pros and cons so it is best to discuss them with a doctor.

Proctocolectomy with end ileostomy

Also known as a full proctocolectomy, this surgery requires the removal of the entire colon, rectum, and anus.

A surgeon then forms a stoma using the end of the small intestine so that waste can be removed from your body.

Proctocolectomy with J-pouch formation

This surgery requires the removal of your entire colon and rectum.

During surgery, a pouch constructed from the end of your small intestine is attached to your anus. This allows for relatively normal waste elimination to occur, meaning you won’t have to wear an external bag.

Alternative treatments such as acupuncture may help reduce and regulate bowel inflammation, reducing UC pain.

Another form of alternative treatment called moxibustion may also have a positive effect on UC symptoms. Moxibustion is a type of heat therapy. It uses dried plant materials burned in a tube to warm the skin, often in the same areas targeted by acupuncture.

A 2016 review of several studies indicated that acupuncture and moxibustion may be effective when used alone, together, or as complements to medication. But the reviewers indicated that more research is needed before these techniques can be considered proven treatments for UC symptoms and pain.

Depending on the severity of UC symptoms, pain can range from mild to severe. You may experience long periods of remission from these symptoms followed by flare-ups where the symptoms return or worsen.

These symptoms can make it hard to perform your daily activities.

Medication can help reduce the symptoms of flare-ups and lengthen the time of remission. Diet, exercise, stress management, and other alternative therapies may also help.

If you’re experiencing pain due to UC, talk with a doctor about your treatment options to manage the condition and reduce pain.

Read this article in Spanish.

Frequently Asked Questions about IBD / Answers from an IBD Specialist

Diagnoses such as “ulcerative colitis”, “Crohn’s disease” or “inflammatory bowel disease” are at first frightening and even shocking for patients. This is due to the lack of reliable information about these diseases. As a rule, patients try to find answers to questions about the diagnosis on the Internet, where they are literally bombarded with reviews from other patients, recommendations from doctors and other data that often contradict each other. It is not surprising that after reading forums and near-scientific publics on social networks, the patient is lost in the flow of information and falls into despair.

This article is about frequently asked questions from patients with IBD. Andrey Kharitonov, one of the best specialists in this field, the gastroenterologist of the gastro-hepatocenter EXPERT, answers.

Crohn’s disease and ulcerative colitis

Conception, pregnancy, childbirth, breastfeeding

1. Can I get pregnant with a diagnosis of Crohn’s disease or ulcerative colitis?

Until now, there is an opinion among doctors and patients that Crohn’s disease and ulcerative colitis put an end to a full-fledged family life. “You can forget about pregnancy! Don’t give birth with Crohn’s disease! – sometimes, it is precisely such “recommendations” that are given to confused patients.

“You can get pregnant and give birth!” – such a conclusion can be made by analyzing the updated Consensus of the European Society for the Study of Crohn’s Disease and Colitis, dedicated to pregnancy with inflammatory bowel disease (IBD). The consensus, adopted by experts from 18 European countries, describes in detail the main aspects related to conception, pregnancy, childbirth, and breastfeeding.

However, in order for the pregnancy to proceed as comfortably and safely as possible, it is worth observing several important conditions. First of all, conception should occur during remission, this reduces the risk of exacerbation of the disease. Otherwise, there is a high chance of relapse. Moreover, in this state, the expectant mother can be until the very birth, and this will have a bad effect on the child. Therefore, it is important to plan pregnancy: discuss with your doctor the optimal timing of conception, taking into account the activity of the disease, the nature of therapy and the presence of complications.

If you become pregnant unexpectedly, or if you have IBD for the first time during pregnancy, you should immediately consult a specialist.

2. How do Crohn’s disease and ulcerative colitis affect a patient’s ability to conceive?

Another common myth is that men and women with IBD are infertile. However, it has been scientifically proven that the ability to conceive in patients with IBD is not lower than in healthy people. A temporary decrease in reproductive function is observed in women after operations (partial or complete removal of the colon, ileostomy or ileoanal anastomosis). In men, taking sulfasalazine may cause a temporary decrease in the number and motility of spermatozoa, which are restored 2 months after discontinuation of the drug.

At the same time, studies have shown that many women with Crohn’s disease and ulcerative colitis voluntarily give up motherhood. As a result, in patients with IBD, children are born 2 times less often than in healthy parents. As a rule, patients are afraid of passing the genes of the disease to their children or taking drugs during pregnancy that “may harm the baby”, etc. Therefore, it is very important to tell women that they can have children, and many of their fears have no basis in fact.

3. What drugs can be taken during pregnancy and breastfeeding?

Many IBD drugs can be used during pregnancy and breastfeeding. Some medicines have restrictions on the dose, form and time of their administration. There are also drugs that are prohibited for use by pregnant and lactating mothers (for example, methotrexate).

If you have an unplanned pregnancy, you should immediately consult with your doctor about the correction of therapy. In the case of pregnancy planning, these issues are discussed with a specialist in advance.

4. Which delivery option(s) should I choose?

Virtually all IBD patients without obstetrical restrictions. The only absolute contraindication for vaginal delivery is active Crohn’s disease with perianal lesions (with fistulous passages near the rectum and in the pelvis) or severe rectal involvement. In this case, a caesarean section is recommended. The presence of an ileoanal anastomosis is considered as a relative contraindication for natural delivery, the decision on the need for a caesarean section is taken individually.

5. Are there specialized maternity hospitals for patients with IBD?

There are no specialized maternity hospitals for women with ulcerative colitis or Crohn’s disease. They are not needed. The attending gastroenterologist will give all the necessary recommendations for therapy, both in the prenatal period and immediately after childbirth. This is important because after childbirth, the nature of the disease may change. It is known that exacerbation of ulcerative colitis may begin in the first days after childbirth.

6. What is the likelihood of developing IBD in a child if the parents have Crohn’s disease or ulcerative colitis?

Numerous studies show that children of parents with IBD are at greater risk of developing Crohn’s disease or ulcerative colitis. However, this risk is only significant when both parents have this diagnosis. The probability of developing the disease during the life of such a child increases by 30%.

7. Do IBD affect the course of pregnancy and the health of the child?

About 85% of women with IBD have a normal pregnancy. At the same time, the frequency of malformations in infants does not exceed 1% – as in children of healthy parents.

How the pregnancy will proceed largely depends on the period of the disease in which the conception occurred. If pregnancy occurs during an exacerbation, then the risk of premature birth, miscarriage and the birth of a baby with a low weight increases. When conceived during a period of remission or low disease activity, pregnancy usually proceeds normally.

Lifestyle

1. How does smoking affect Crohn’s disease and ulcerative colitis?

Tobacco smoking is an independent risk factor for the development of Crohn’s disease, as well as a factor that aggravates the course of the disease. This has been proven by numerous studies. Smoking increases the likelihood of developing complications of Crohn’s disease (abscesses, fistulas and strictures), perianal lesions, the need for surgery (doubling the risk) and the frequency of postoperative recurrence of the disease (3-6 times higher risk). People who smoke with Crohn’s disease need more aggressive therapy than non-smokers.

In addition to smoking, other factors that complicate the course of the disease have been identified, but smoking is the only one that can be excluded. Neither the doctor nor the patient can change the genetic predisposition, gender and age, while quitting smoking is quite realistic.

Tobacco smoking in Crohn’s disease is harmful!

What happens to the patient after quitting smoking?

More than 50% reduction in exacerbations. The overall risk of disease progression is also reduced.

2. Can oral contraceptives be used in inflammatory bowel disease (IBD)?

You can take hormonal contraceptives only as directed by your gynecologist. By themselves, the use of these drugs does not significantly affect the risk of exacerbation of ulcerative colitis or Crohn’s disease. It is important to remember that with an exacerbation accompanied by vomiting and / or diarrhea, the effectiveness of oral contraceptives may decrease.

3. How harmful is prolonged sun exposure?

IBD patients with low disease activity and in remission lead a normal life, work and play. Many are planning to spend their holidays in the south of Russia or in other countries of the world known for their resorts. The question arises – how harmful is sunburn for patients with IBD? The very presence of open sunlight can not be called harmful. On the contrary, short-term exposure to the sun promotes the synthesis of vitamin D, which in patients with ulcerative colitis and (to a greater extent) Crohn’s disease is often below normal.

At the same time, it is known that prolonged exposure to direct sunlight increases the risk of exacerbation of the disease. Therefore, while on the beach, a patient with IBD should use a sun umbrella, a hat and not sunbathe.

4. Can patients with IBD play sports?

Patients in remission of VKD feel significantly better and want to start or resume sports. The question to the doctor is quite justified – is it possible to exercise and to what extent?

There are few studies on the efficacy and safety of exercise in patients with IBD. However, good tolerability of non-intensive or moderate activities was revealed. Exercise is especially beneficial for patients with IBD who have joint disease, osteoporosis, low body weight, and chronic stress. The volume and nature of the load can only be prescribed by the attending physician, taking into account the diagnosis and disease activity. Excessive physical activity, which can lead to an exacerbation of the disease, should be avoided.

5. What vitamins should be used for IBD?

Vitamin deficiencies are common in IBD. This may be due to malabsorption in the small intestine and reduced dietary intake of nutrients due to poor appetite or fear of eating. The most common deficiency is vitamin D, B12, folic acid, a little less often – vitamins A, E, B1 and B2, etc.

Vitamin B12 deficiency often develops on the background of inflammation in the terminal (final) ileum or removal of this area. This vitamin is absorbed only in this part of the small intestine, and although there is a 2-3-year supply of the vitamin in the liver, its deficiency occurs over time. Most often, this manifests itself in a violation of hematopoietic processes – a decrease in the level of hemoglobin, leukocytes, erythrocytes and / or platelets, and in severe cases in the pathology of the nervous system. Therapy consists in intravenous or intramuscular administration of vitamin B12. When removing the terminal ileum, such vitamin replacement therapy should be carried out throughout life at certain intervals.

Lack of vitamin D, which is involved in the regulation of adaptive immunity, antibacterial response, is very common in IBD. According to various studies, a decrease in the level of vitamin D in the blood of patients with Crohn’s disease is observed in 8-100% of cases, with ulcerative colitis in 7-64% of cases. Deficiency is most pronounced in winter and less common during the sunny months. Some studies have shown that low levels of this vitamin in IBD are associated with inflammation in the gut and a greater need for hospitalization and surgery.

In general, the symptoms of vitamin deficiency are non-specific and require additional examination of their content in the blood. You should not take vitamins without the supervision of a doctor, since there is a possibility of their accumulation with the development of hypervitaminosis. An experienced gastroenterologist will give recommendations on the need for examination and taking vitamin preparations to correct an already developed deficiency or prevent it.

6. What painkillers/antipyretics are allowed for IBD?

Patients with Crohn’s disease, in addition to headache, toothache and other types of pain, may experience discomfort associated with extraintestinal joint lesions and require analgesics.

What drugs can be used in IBD to relieve pain or relieve high body temperature? Most non-steroidal anti-inflammatory drugs are not recommended for the treatment of IBD pain because they increase the likelihood of recurrence and increase disease activity.

A lower risk of exacerbation of ulcerative colitis and Crohn’s disease is observed with the use of selective cyclooxygenase 2 inhibitors from the group of coxibs (celecoxib, etoricoxib and rofecoxib). However, their appointment for any indication must be agreed with a gastroenterologist. Paracetamol, which can be used to reduce high fever, does not increase the risk of exacerbation of IBD.

Other questions

1. Does IBD affect life expectancy?

A very important question that worries patients with ulcerative colitis and Crohn’s disease – does their disease affect life expectancy? The concern is fueled by pseudo-scientific claims on popular websites and forums that these are “deadly diseases”. However, statistical studies from various countries refute this claim. If in relation to Crohn’s disease there is evidence of a slight reduction in life expectancy, then in ulcerative colitis it differs little from the average.

Risks of death from these diseases were considered separately. The results are mixed. In some countries, these risks are not higher than in healthy people, in others they are slightly higher than the average population. For example, in Finland, mortality from IBD is only 14% higher than the national average, while in Australia these rates are equal.

Undoubtedly, these data are approximate and depend not only on the diagnosis, but also on the severity of the course of the disease, the presence of complications and the nature of the therapy.

2. IBD and cancer: what are the risks?

Many patients are aware of the increased risk of developing cancer in ulcerative colitis and Crohn’s disease, but this knowledge is sometimes superficial and not always accurate.

Indeed, patients with IBD have an increased risk of developing oncopathology, which depends on the duration of the disease, the extent of the lesion, disease activity and ongoing therapy. For ulcerative colitis, the risk of colon cancer increases by 2% after 10 years, 8% after 20 years, and 18% after 30 years. Patients with widespread colitis have the greatest risk of developing such cancer compared with isolated involvement of the rectum. The lack of remission also increases the risks. Patients with ulcerative colitis suffering from primary sclerosing cholangitis are at a very high risk of developing a tumor of the bile ducts.

The risk of colon cancer in Crohn’s disease is significantly lower than in ulcerative colitis, although it remains higher than in people without IBD. However, the likelihood of developing oncopathology of the small intestine increases. Therefore, regular FCS (colonoscopy) is recommended – at least once a year.

Some drugs used in the treatment of IBD (azathioprine, mercaptopurine, tumor necrosis factor-alpha antagonists) may increase the risk of developing cancer (lymphoma, skin cancer), but this risk is high with long-term use of these drugs or their combination, and decreases after discontinuation of treatment.

Other medicines (eg mesalazine), in contrast, are prescribed to prevent the development of colon cancer.

Minimizing the risk of developing oncological complications in the diagnosis of “ulcerative colitis” and “Crohn’s disease” can only be monitored by a specialist.

Author of the article

Andrey Kharitonov

Gastroenterologist

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Treatment of mild and moderate ulcerative colitis

Presentation by Professor OS Shifrin. within the framework of the II International Internet Congress of specialists in internal medicine.

Professor Shifrin O.S.: – Good afternoon, dear colleagues. I will give a talk today on the topic of inflammatory bowel disease.

(00:13) Screensaver: 5-aminosalicylic acid preparations in the treatment of nonspecific ulcerative colitis.

Professor OS Shifrin: – And it will be dedicated to the treatment of ulcerative colitis: how to optimally use 5-aminosalicylic acid preparations in the treatment of this severe, difficult in diagnostic and therapeutic terms of the disease. What are the goals of the clinician in taking on the difficult task of managing a patient with ulcerative colitis? First of all, he must achieve clinical remission, but this is not enough. He should try to achieve clinical remission without the use of steroid drugs. Maintenance of clinical remission should be long-term. A very important key to the success of long-term maintenance of clinical remission is the achievement of endoscopic remission, and in the future we will strive to achieve histological remission as well. As is known, relatively few drugs are used in the treatment of inflammatory bowel disease. There is a tendency that a number of drugs that were previously used in the treatment of only Crohn’s disease are now being successfully used in ulcerative colitis. This applies to azathioprine, anticytokine drugs, and some antibiotics, which are also used in toxic forms of ulcerative colitis.

There are two approaches to the treatment of patients with ulcerative colitis and Crohn’s disease: either we prescribe drugs sequentially from the least strong effect and, accordingly, from the weakest side effects, to stronger drugs, which give more side effects. This approach seems to be the most reasonable. Another approach is when already in the early stages, and this is especially true for Crohn’s disease, anti-cytokine drugs are prescribed. These are drugs that do not change the natural course of the disease, but at the same time threaten the occurrence of many severe side effects. It should be remembered that first-line 5-aminosalicylic acid drugs for the treatment of ulcerative colitis have the highest degree of evidence of their effectiveness. Already by 2000, based on a large number of controlled randomized trials, it was shown that these drugs in their effectiveness were supported by the highest level of evidence – 1A.

The first 5-aminosalicylic acid preparation to be used in ulcerative colitis was Sulfasalazine, which consists of two parts: 5-aminosalicylic acid combined with sulfapyridine, which is used as a carrier of 5-aminosalicylic acid under the action of azoreductases produced by bacteria large intestine, the molecules of the drug break down into their original parts and exhibit a pharmacological effect. I will deal a little later on the many side effects of this remedy. And the appointment of “Sulfasalazine” now in the XXI century should be treated with great caution.

So, let’s recall the recommendations of the European Society for the Study of Colitis and Crohn’s Disease regarding the use of 5-aminosalicylic acid preparations in ulcerative colitis. With a common form of colitis, with total colitis, but with moderate activity, the appointment of at least 2 grams of mesalazine per day as a basic therapy for exacerbations is indicated. This is supported by the high level of evidence 1A. And what is very important, with total colitis, topical mesalazine preparations should also be used – this dramatically increases the effectiveness of treatment.

For moderately active left-sided colitis, a combination of oral mesalazine and topical agents is also indicated. This significantly increases the effectiveness of treatment with a level of evidence of 1B. With proctitis with mild to moderate activity, it is possible to initially prescribe mesalazine suppositories with a high level of evidence. But in the absence of an effect, this local therapy should be supported by the appointment of oral forms of the drug. Maintenance therapy with 5-aminosalicylic acid preparations is recommended for all patients in whom we managed to achieve clinical and endoscopic remission after the use of 5-aminosalicylic acid preparations as an exacerbation therapy.

Oral therapy constitutes the first line of maintenance therapy and should always be used in total colitis with oral formulations. For proctitis or left-sided colitis, only local forms of mesalazine can be used to maintain remission (not to induce remission). If it is not possible to achieve successful maintenance of remission only with local forms, the latter should be combined with tablets. And do not forget the minimum doses that are necessary to effectively maintain remission. They must be at least 1 gram. At the same time, topical mesalazine preparations, in particular suppositories, should be prescribed at least three times a week for distal colitis. Of course, recommendations are recommendations. And a clinician who has experience in treating such patients, of course, can independently resolve many issues about prescribing the drug. ECCO guidelines do not require scrupulous observance at all. First of all, the real clinical picture decides.

Thus, according to the experience of our clinic, it is very important to consider the clinical features of the onset of the disease. They also to some extent predispose to maintaining remission in the future with one or another drug. So, with a purely diarrheal variant of the onset (not diarrheal-hematochezial) of ulcerative colitis, 5-aminosalicylic acid preparations also turned out to be the most indicated. Preparations of 5-aminosalicylic acid are also important in relation to the prevention of the development of colorectal cancer, unfortunately, a frequent complication of ulcerative colitis is the decisive line of prevention of colorectal cancer. Screening, genetic studies have not yet been fully developed. Therefore, particular importance is attached to the long-term administration of 5-aminosalicylic acid preparations in order to prevent the development of colorectal cancer in our patients.

The first preparation of 5-aminosalicylic acid was Sulfasalazine. It showed an effect, but it also showed a high incidence of various side effects with its use. According to our data, 40% of patients with ulcerative colitis who took Sulfasalazine experienced some side effects. After “Sulfasalazine”, the so-called diazo compounds of 5-aminosalicylic acid were developed: “Olsalazin”, in which two molecules of 5-aminosalicylic acid are connected by a diazo bond and “Balsalazide”, in which 5-aminosalicylic acid is connected to a 4-amino-benzoyl-alanine residue. But, unfortunately, these drugs showed about the same frequency of side effects as Sulfasalazine.

Later release systems appeared, in the beginning predominantly pH dependent. That is, the release of mesalazine contained in the tablet depended primarily on the pH of the intestinal contents. The disadvantage of this group of drugs is that, since normal intestinal pH changes due to inflammation of the intestinal wall, these drugs often do not work. The situation has changed with the development of mesalazine preparations, namely mesalazine microgranules coated with ethyl cellulose, the release of which depends on the residence time of the substance in the intestine.

The release of Pentasa, which represents this form, begins already in the duodenum. That is, this drug is good for the treatment of not only ulcerative colitis, but is very suitable for the treatment of Crohn’s disease. The drug is evenly distributed in the small and large intestine. What is very important – it does not linger in the stomach, which avoids a sharp increase in the concentration in the blood. Due to the gradual release, the drug reaches the distal intestines. And the release rate of the drug remains constant over a wide range of pH intra-intestinal contents. That is, in this regard, the drug is very advantageous. The distribution of the drug has been repeatedly studied by various methods, in particular by scintigraphy. And here it is shown that mesalazine is released in both the small and large intestine. And the area of ​​\u200b\u200bthis drug is both Crohn’s disease and ulcerative colitis. Moreover, various forms are used for these diseases. When studying the distribution of the drug, we noted that the distribution of Pentas was very uniform and related both to the initial sections of the small intestine, starting from the duodenum, and to the distal sections of the large intestine.

Let me tell you about a case from our clinical practice. A 35-year-old patient came to our clinic with complaints: loose stools with an admixture of mucus, sometimes blood, up to 5-7 times a day, flatulence, weakness, weight loss for a year by almost 7 kg. Sick for two years. The young woman was quickly diagnosed with ulcerative colitis, unfortunately this is not always the case. As with Crohn’s disease, we have a big problem in the country with early detection of these diseases. Recently, a patient with Crohn’s disease was admitted to our clinic, who was not diagnosed during his 24 years of follow-up with a typical clinical picture. That is, of course, we must study the clinic of these diseases in more depth.

So, the patient developed hematochezia, diarrhea, and she began to lose weight. The correct diagnosis was made – ulcerative colitis. Doctors went mechanically along the path of increasing the dose of Sulfasalazine. At first she took 2 grams, then she began to take 3 grams and, finally, 4 – there was no effect. This patient had no side effects, fortunately. But the clinical effect of the appointment of “Sulfasalazine” was not achieved. In our clinic, a diagnosis of non-specific ulcerative colitis, total form, Truelove I activity was made, and it was confirmed. We widely use radiation research methods to confirm the diagnosis, in particular, computed tomography. The method of computer colonography allows you to clarify the lesion, at what stage the intestine is affected, the severity of the lesion, the thickness of the intestinal wall, to evaluate the fiber adjacent to the intestine, the presence of lymph nodes, and so on.

We prescribed the patient “Pentasa” – 3 g/day. As you know, this drug can be used once a day – this increases the patient’s compliance. Naturally, it is easier for a person to take medicine once than three times a day. And, accordingly, patients are more willing to follow the doctor’s recommendations. According to the perfect ECCO recommendations, therapy with an oral preparation – Pentasa tablets, had to be supplemented with a new form of Pentasa, which is now proposed and which we already have at our disposal – suppositories, Pentasa suppositories, which contain 1 gram of mesalazine. Candles “Pentas” can be used once, and not twice a day, as previously suggested to use them. And with the use of local and oral therapy, we managed to achieve an improvement in the clinical picture quite quickly.

But I have already said that our goal is not only to achieve clinical remission, but also to achieve endoscopic remission. To assess the dynamics of the state in this regard, we use the clinical and endoscopic Mayo index, which combines both clinical indicators and endoscopic indicators. After treatment with Pentasa tablets and suppositories, the patient’s stool frequency returned to normal, rectal bleeding and hematochezia disappeared, and the endoscopic picture returned to normal.

What we have as a result: disease activity 0 points, we have achieved clinical and endoscopic remission. Should we stop therapy? No. And according to our experience and the recommendations of the ECCO, recommendations of the American Gastroenterological Association, maintenance therapy should be continued, but the dose of the drug can be reduced. We gradually reduced the Pentasa tablets from 3 grams of the drug per day to 1 gram. We suggested that the patient use Pentasa suppositories three times a week. What can be the conclusion? 5-aminosalicylic acid preparations remain the first line of treatment for ulcerative colitis. Fortunately, new and more effective drugs containing mesalazine appear at the disposal of doctors.

(17:25) Screensaver.

Professor OS Shifrin: – Several questions were received: “What is the terrible side effect of using mesalazine?”

I must say that this is a fairly safe drug. If we compare it with drugs of other groups, this is perhaps the safest drug. It can give cephalalgia, it can give abdominalgia, it can give stool disorder. Sometimes it causes such pancreatic reactions, but this happens infrequently. And I repeat, this drug is the safest among all other drugs used in the treatment of inflammatory bowel diseases.

Question: Should I take probiotics to treat ulcerative colitis?

This is a controversial issue that is being discussed.