Ulcerative colitis - discharge
Inflammatory bowel disease - discharge; Ulcerative proctitis - discharge; Colitis - discharge
You were in the hospital to treat ulcerative colitis which is a type of inflammatory bowel disease (IBD). This is a swelling (inflammation) of the inner lining of your colon and rectum (also called your large intestine). This article tells you how to take care of yourself when you return home.
Crohn disease, also called regional enteritis, is a chronic inflammation of the intestines which is usually confined to the terminal portion of the small intestine, the ileum. Ulcerative colitis is a similar inflammation of the colon, or large intestine. These and other IBDs (inflammatory bowel disease) have been linked with an increased risk of colorectal cancer.
Living with ulcerative colitis can be a constant gamble. You run to the grocery store, hoping this won't be the day when your disease flares up. You might get lucky, or your disease could hit again in the middle of the store, leaving you in a search for a bathroom. Let's talk about ulcerative colitis. Ulcerative colitis is a type of inflammatory bowel disease. It's caused by a malfunction in the body's immune system. Normally, the immune system protects against bacteria and other foreign invaders. But in people with ulcerative colitis, it mistakenly attacks the rectum and intestines, causing them to swell up and thicken. As a result, people with ulcerative colitis have bouts of severe abdominal pain and diarrhea. They can lose weight without meaning to. If you've been experiencing any of these symptoms, your doctor can test for ulcerative colitis with a colonoscopy. Your doctor can take a sample of your intestines, to diagnose ulcerative colitis and check for colon cancer, a risk associated with ulcerative colitis. Medicines can help with the symptoms of ulcerative colitis. There are medicines to control diarrhea, and pain relievers to help with the abdominal cramps. There are also medicines that quiet the overactive immune response that causes ulcerative colitis. Changing your diet may help control your immune system from attacking your intestines. Changing your diet can limit diarrhea and gas, especially when you're having active attacks. Your doctor may recommend you eat small meals throughout the day, drink plenty of water, and avoid high-fiber foods and high-fat foods. You may feel worried, embarrassed, or even sad or depressed about having bowel accidents. Other stressful events in your life, such as losing a job or a loved one, may make your symptoms worse. Your doctor can help you manage your stress. If your symptoms are severe, surgery to remove your large intestine may be the best way to cure your ulcerative colitis. If you're experiencing any ulcerative colitis symptoms-like stomach pain, diarrhea, or unplanned weight loss, call your doctor. Although surgery is the only cure, treatments can relieve some of the uncomfortable symptoms, and help you to lead a more normal life-free from the constant stress of having to search for the bathroom.
When You're in the Hospital
You were in the hospital because you have ulcerative colitis. This is a swelling of the inner lining of your colon and rectum (also called your large intestine). It damages the lining, causing it to bleed or ooze mucus or pus.
You probably received fluids through an intravenous (IV) tube in your vein. You may have received a blood transfusion, nutrition through a feeding tube or IV, and medicines to help stop diarrhea. You may have been given medicines to reduce swelling, prevent or fight infection, or help your immune system. Treatment usually involves long-term medicines that block the immune system from causing inflammation. This may be by pill, infusion, or injection. These medicines will be continued at home.
You probably had blood tests, stool tests, and imaging tests such as CT or MRI. These help look for problems from your ulcerative colitis.
You may have undergone a colonoscopy. A colonoscopy is a lighted flexible tube placed through the rectum to look at the whole colon in high definition, on a video screen. The colonoscopy tells the extent of your disease (all of the colon vs part of the colon) and the severity of your inflammation.
You also may have had surgery. If so, you may have had either an ileostomy or colon resection (colectomy). Sometimes a special pouch is created near the old rectum (called a J-pouch). Depending on your type of surgery and details about your disease, you may be sent home to have a second surgery months later.
What to Expect at Home
Most people will have long breaks between flare-ups of their ulcerative colitis if they take their prescribed medicines. The goal of treatment is to induce remission (cause the disease to get better) and maintain remission (keep flares away).
Self-care
When you first go home, you will need to drink only liquids or eat different foods from what you normally eat. Ask your health care provider when you can start your regular diet. You should eat a well-balanced, healthy diet. It is important that you get enough calories, protein, and nutrients from a variety of food groups.
Certain foods and drinks can make your symptoms worse. These foods may cause problems for you all the time or only during a flare-up. Avoid foods that make your symptoms worse.
- Too much fiber may make your symptoms worse. Try baking or stewing fruits and vegetables if eating them raw bothers you.
- Avoid foods that are known to cause gas, such as beans, spicy food, cabbage, broccoli, cauliflower, raw fruit juices, and fruit (especially citrus fruits). Avoid or limit alcohol and caffeine. They may make your diarrhea worse.
Eat smaller meals, and eat more often. Drink plenty of liquids.
Ask your provider about extra vitamins and minerals you may need, including:
- Iron supplements (if you are anemic). Sometimes iron is given intravenously.
- Nutrition supplements especially if you haven't been eating well. You may have developed some vitamin deficiencies. Speak with your provider before taking any supplements.
- Calcium and vitamin D supplements to help keep your bones strong.
Talk with a dietitian, especially if you lose weight or your diet becomes very limited.
Immunosuppressive medicines for IBD can make you stay at higher risk of getting other infections. Make sure to speak with your provider about getting the appropriate vaccinations to decrease your risk. Live vaccinations are not given while on those medicines, so follow your provider's guidance.
If you are planning to get pregnant in the near future, discuss this with your provider. It is best to have your ulcerative colitis under control (be in remission) before pregnancy.
Stress
You may feel worried about having a bowel accident, embarrassed, or even feel sad or depressed. Other stressful events in your life, such as moving, job loss, or the loss of a loved one, can cause problems with your digestion.
These tips may help you manage your ulcerative colitis:
- Join a support group. Ask your provider about groups in your area.
- Exercise. Talk with your provider about an exercise plan that is right for you.
- Try biofeedback to reduce muscle tension and slow your heart rate, deep breathing exercises, hypnosis, or other ways to relax. Examples include doing yoga, listening to music, mindfulness, reading, or soaking in a warm bath.
- See a mental provider for help. Having a chronic disease is difficult. There is no shame in wanting to speak with a professional.
- The Crohn's and Colitis Foundation of America provides education and supportive services to help manage the disease.
Drug Treatments
Your provider may give you some medicines to help relieve your symptoms. Based on how severe your ulcerative colitis is and how you respond to treatment, you may need to take one or more of these medicines:
- Anti-diarrhea medicines can help when you have very bad diarrhea. You can buy loperamide (Imodium) without a prescription. Always talk to your provider before using these medicines. Do not use them if you have a fever or bloody diarrhea.
- Fiber supplements may help your symptoms. You can buy psyllium powder (Metamucil) or methylcellulose (Citrucel) without a prescription.
- Always talk to your provider before using any laxative medicines.
- You may use acetaminophen (Tylenol) for mild pain. Medicines such as aspirin, ibuprofen (Advil, Motrin), or naproxen (Aleve, Naprosyn) may make your symptoms worse. Talk to your provider before taking these medicines. You may also need a prescription for stronger pain medicines.
There are many types of medicines your provider may use to prevent or treat attacks of your ulcerative colitis.
Follow-up
Your ongoing care will be based on your needs. Your provider will tell you when to return for an exam of the inside of your rectum and colon through a flexible tube (sigmoidoscopy or colonoscopy). IBD can increase your risk of colon cancer so at some point, your provider will put you in a colonoscopy screening program. Follow-up bloodwork and stool tests are usually done.
When to Call the Doctor
Contact your provider if you have:
- Cramps or pain in your lower stomach area
- Bloody diarrhea, often with mucus or pus
- Diarrhea that cannot be controlled with diet changes and drugs
- Rectal bleeding, drainage, or sores
- Fever that lasts more than 2 or 3 days, or a fever higher than 100.4°F (38°C) without an explanation
- Nausea and vomiting that lasts more than a day
- Skin sores or lesions that do not heal
- Joint pain that keeps you from doing your everyday activities
- A feeling of having little warning before you need to have a bowel movement
- A need to wake up from sleeping to have a bowel movement
- Failure to gain weight, a concern for a growing infant or child
- Side effects from any medicines prescribed for your condition
References
Ahmed M, Kinnucan JA, Farraye FA. Inflammatory bowel disease: Crohn disease and ulcerative colitis. In: Kellerman RD, Rakel DP, Heidelbaugh JJ, Lee EM, eds. Conn's Current Therapy 2024. Philadelphia, PA: Elsevier; 2024:247-255.
Ananthakrishnan AN, Reguerio MD. Management of inflammatory bowel disease. In: Feldman M, Friedman LS, Brandt LJ, eds. Sleisenger and Fordtran's Gastrointestinal and Liver Disease. 11th ed. Philadelphia, PA: Elsevier; 2021:chap 116.
Crohn's & Colitis Foundation website. What is ulcerative colitis?
Fergus KB, Kattah MG, Wick EC. Management of chronic ulcerative colitis. In: Cameron J, ed. Current Surgical Therapy. 14th ed. Philadelphia, PA: Elsevier; 2023:186-190.
Feuerstein JD, Isaacs KL, Schneider Y, Siddique SM, Falck-Ytter Y, Singh S; AGA Institute Clinical Guidelines Committee. AGA Clinical Practice Guidelines on the management of moderate to severe ulcerative colitis. Gastroenterology. 2020;158(5):1450-1461. PMID: 31945371
Lichtenstein GR. Inflammatory bowel disease. In: Goldman L, Cooney KA, eds. Goldman-Cecil Medicine. 27th ed. Philadelphia, PA: Elsevier; 2024:chap 127.
Version Info
Last reviewed on: 10/30/2024
Reviewed by: Jenifer K. Lehrer, MD, Gastroenterologist, Philadelphia, PA. Review provided by VeriMed Healthcare Network. Also reviewed by David C. Dugdale, MD, Medical Director, Brenda Conaway, Editorial Director, and the A.D.A.M. Editorial team.
