Living with Ulcerative Colitis: What You Can Do

Imagine having open sores on the lining of your large intestine (colon), rectum, or both. The first signs you might notice are bellyaches, cramps and blood in the stool. Ulcerative colitis (UC) is one of the two common forms of inflammatory bowel disease (IBD) that can be controlled with medical therapy and or surgery. While UC is limited to the colon, Crohn’s disease – the other form of IBD – can cause inflammation anywhere between the mouth and anus. 

In Malaysia, IBD’s crude incidence rates were 0.68, 0.46, and 0.20 per 100,000 persons. While the prevalence rates are low, UC cases appear to be increasing in the region.

Symptoms and Complications

UC is a chronic disease characterised by symptoms like abdominal pain, bloody diarrhoea, poor appetite, nausea, and vomiting. Other symptoms, which may arise later, include blood or pus in bowel movements, skin rashes, mouth sores, joint pain, red eyes, and liver disease.

As this illness frequently relapses, it can cause major disruption of the gastrointestinal (GI) tract, leading to nutritional complications – for example, decrease in dietary intake, avoidance of eating, malabsorption, and nutrient inadequacies. In addition, anaemia is also a prime concern due to blood loss resulting from ulceration in the digestive tract lining. Inadequate iron, folate, and vitamin B12 can also worsen the condition. In addition, severe cases of UC can increase the chances of developing colon cancer. 

Anyone regardless of age can get UC – even children as young as two years old. Individuals between the ages of 15 and 30 are at a higher risk for this disease. According to statistics, 20% of patients are diagnosed before they are 20 years old.

While the exact cause of UC remains unknown in modern medicine, Traditional Chinese Medicine (TCM) links the disease to pathogenic factors like wind, cold, dampness, heat, qi (vital life energy) stagnation, and blood stasis. These factors are often caused by a stressful lifestyle and unhealthy dietary habits. Consequently, all of these can lead to problems in the small and large intestines, heart, liver, spleen, and stomach.

Treatment Options

Treatment of ulcerative colitis depends on the location, severity, and pattern of the disease, as well as the presence of complications. However, there is no cure for UC and medications, or treatments only aim to relieve the inflammation and maintain remission so that patients can have a better quality of life. Doctors will also prescribe an individualised treatment plan based on the patient’s response and tolerance to the therapies. More importantly, the success of managing the disease requires continuous care and medical follow-ups.

Medications

Below are some of the medications that can help alleviate the symptoms:  

• Aminosalicylates – for mild to moderate UC 
• Corticosteroids – for severe cases  
• Immunomodulators – to calm an overactive immune system 
• Biologics – for moderate to severe conditions 
• Janus kinase (JAK) inhibitors – to prevent triggering inflammation

Surgery

Surgery is an option if medicines do not work or if you develop complications of UC such as bleeding or abnormal growths. About 30% of patients with UC have to undergo surgery at some point in their lifetime. Surgery involves removing the colon and rectum and forming an ileostomy. An ileostomy is an opening made on your abdomen that connects to the small intestine and drains the waste. Then, a bag is placed at the ileostomy site to collect the waste throughout the day, which needs to be drained and cleaned intermittently. As the diseased part of the intestine is removed, surgery relieves pain and cramping caused by UC. In some cases, the surgeon may reconstruct the rectum so that the patient can pass stools normally through the anus once the intestines heal.

TCM

“TCM can also help treat and manage the symptoms through TCM herbal medication, acupuncture, moxibustion, cupping, and tuina, which are all formulated carefully by a TCM physician to address specific body constitution of every individual patient,” says Senior TCM Physician Brandon Yew from Real Health Medical clinic in Singapore.

According to Physician Yew, several types of herbs and formulas that can help ease the condition include:  

• Sargent gloryvine stem 红藤 
• white flower patrinia herb 败酱草 
• Chinese pulsatilla root 白头翁 
• parslane herb 马齿苋 
• Chinese coptis 黄连 

• ash bark 秦皮 
• rhubarb 大黄 
• figwort flower picrorhiza rhizome 胡黄连 
• agrimonia pilosa 仙鹤草 
• heartleaf houttuynia herb 鱼腥草 

• cockscomb flower 鸡冠花 
• san huang xie xin tang 三黄泻心汤 
• shao yao tang 芍药汤 
• ge gen qin lian tang 葛根芩连汤 
• bai tou weng tang 白头翁汤 

• xiang lian wan 香连丸 
• wu mei wan 乌梅丸 

However, physician Yew reminds to not self medicate without first undergoing a thorough consultation and proper assessment by a TCM practitioner.

Acupuncture and Acupressure as a UC Remedy

Clinical research has shown that acupuncture can also be an effective remedy for UC. Moreover, this therapy helps relieve various UC symptoms like abdominal pain, diarrhoea, constipation, bloating, and nausea. It also assists with reducing inflammation and improving the function and integrity of the intestinal lining.

Acupressure

Apart from acupuncture, UC patients can also consider using acupressure. Some of the acupoints that may help include:  

• Hegu LI4: On the dorsum of the hand, between the 1st and 2nd metacarpal bones 
• Quchi LI11: With the elbow flexed, the point is on the lateral end of the transverse cubital crease, at the midpoint between LU 5 and the lateral epicondyle of the humerus 
• Tianshu ST25: On the abdomen, three fingers breadth away from the frontal midline, the same level as the umbilicus 
• Shuidao ST28: 4 fingers-breadth directly below ST25 
• Shangjuxu ST37: On the anterior aspect of the lower leg, eight fingers breadth below the outer depression of the knee joint, one finger breadth from the anterior crest of the tibia 

• Xiajuxu ST39: One finger breadth directly below ST37 
• Zusanli ST36: On the anterior aspect of the lower leg, four fingers breadth below the outer depression of the knee joint, one fingerbreadth (middle finger) from the anterior crest of the tibia 
• Zhongwan RN12: On the anterior median line of the upper abdomen, the midpoint between the tip of the xiphoid process and the umbilicus 
• Yinlingquan SP9: On the medial aspect of the lower leg, in the depression of the lower border of the medial condyle of the tibia 
• Lougu SP7: On the medial aspect of the lower leg, eight fingers breadth above the tip of the inner ankle bone, on the posterior border of the medial aspect of the tibia 

• Sanyinjiao SP6: On the inner lower leg, four fingers breadth above the tip of the inner ankle bone, just behind the shin bone

Living with Ulcerative Colitis

While medication can help control the symptoms, UC patients must also be proactive when it comes to preventing relapse or flare-up. This includes paying attention to diet and nutrition, reducing stress, and regularly checking in with your healthcare provider. If you notice changes in your symptoms like persistent diarrhoea, blood in your stool, or fever, contact your doctor immediately.

“It is a good idea to cut down on alcohol and smoking if you suffer from UC. From a TCM perspective, oily, fried, fatty, spicy, sugared, and processed foods can worsen the symptoms. Instead of cold and sweet beverages, you can drink warm water, unsweetened plain tea, or tea without milk to prevent the formation of the various pathogenic factors that cause the condition,” Physician Yew explains, adding that regular and healthy meals, exercise, and sufficient sleep will also help along the way.

Living with ulcerative colitis can be a challenge. However, an appropriate treatment plan and medication can keep the condition under control. With the addition of TCM remedies, most patients are able to alleviate UC symptoms or flare-ups and lead a normal, productive life.