New To Ulcerative Colitis

I started noticing bowel irregularities, mainly diarrhea, in October of last year, and at first thought I was lactose intolerant (my brother and dad both are, my dad to a near violent extent). Cutting milk products out of my diet didn’t alleviate the symptoms, and I began to wonder if I was celiac or intolerant to gluten. Again, removing the suspect food did not change my symptoms, but as they were limited to some sporadic evening diarrhea, I didn’t think much of them.

Around Thanksgiving I began to notice blood and mucus in my stools, and got blood and stool samples anaylzed for gluten, infection, parasites (I blamed the carefully cooked dining hall cuisine) and whatever else comes in the panel. Again, nothing, and I got to kick off my winter break with a colonoscopy.

So, I have UC, and currently have very cramped, bloody bowel movements, on average 5 times a day. I’ve only been taking the hydrocortisone for two weeks, and the mesalamine for 3 days, and am noticing marginal, if any, improvement. I’m talking to my doctor again on Monday, and am really hoping the mesalamine helps, because I’m apprehensive of prednisone. Then again, I’m open to whatever will help. Its frustrating to not be able to sit through a lecture without running to the bathroom.

I guess I’m looking for any advice people may have (or encouraging words), especially experience with drugs, probiotics, or other remedies. Has anyone tried vsl 3, and had success? I’ve been reviewing any medical literature I can find and it seems promising.

current medications: 3.6 g mesalamine, 60 ml hydrocortisone suppository, fish oil, saccharomyces boulardii capsules

– Dan (19 year old college student)

12 thoughts on “New To Ulcerative Colitis”

    1. Hey Dan,
      I wouldn’t consider myself a runner, but I did do some running/training for the Vegas half marathon that was dec ’09. I had a flare up happen after I was training for a little while, so I stopped running and just did longer walks to train for it. I really can’t tell you though if it helps/hurts during a flare. My best guess is its proably better to take a few steps back when you’re not feeling well and conserve your energy, or at least slow down your excersie program until you’re in a better way.
      Hopefully some others will have some better ideas based off their experiences. Are you a big runner/fitness person?

    2. You may want to be careful about doing too much sweat-inducing activity in the middle of a flare. My concern is that with a flare you’re already at an increased risk for dehydration – add running to the mix and you may end up pretty sick.

    3. Dan,

      I’m fairly new into this also. My symptoms (along the same line as yours) started last May when my time on my bike ramped up from pedaling for an hour / day to 2-3 hours / day. My doctor mentioned ischemic colitis, which he learned about firsthand in patients in NY after they ran the NY Marathon. The theory was that the legs are competing with your colon for bloodflow and the lack of blood to the colon can eventually result in UC.

      My symptoms abated after all the pre-colonoscopy laxatives, and the doctor is doing another procedure in the spring (pre bike race season) to try and get more of a sense of chronic versus acute. The specimen from the first colonoscopy indicated chronic, but I’d been inflamed for several months at that point, and the doctor stated that with an indication of chronic, it doesn’t define if the inflammation has been present for 3 months or a year.

      So, all I can suggest is google ischemic colitis and see if it seems to fit your circumstances.

      Good luck.

      Jason A.

    4. This excerpt is from the above web page. Seems to pertain–

      Gastrointestinal complications related to high endurance sports are known to be quite common. In particular, watery diarrhea, crampy abdominal pain, and bloating are frequently reported (4). These symptoms are usually mild and more prevalent early in training and during races. It has often been postulated that these symptoms may be related partly to transient mesenteric ischemia. Mesenteric blood flow has been shown to decrease by as much as 80% during peak exercise (5). This shunting is most likely related to high sympathetic tone induced by strenuous activity. The reduction of mesenteric blood flow appears to be much more dramatic in unconditioned athletes, which may explain why gastrointestinal symptoms often improve with training. In addition to heightened sympathetic tone, other factors such as hypovolemia, hyperthermia, and the accumulation of vasoactive metabolites certainly contribute to intestinal ischemia (6).

      Occult gastrointestinal bleeding associated with endurance sports is common and presumed to be in part related to mesenteric ischemia. Occult bleeding has been found in 8–30% of athletes after competition (7, 8, 9, 10, 11, 12). Quantified fecal hemoglobin has also been found to increase after races, strongly suggesting a temporal relation to extreme exertion (9). Not surprisingly, high endurance athletes have been shown to have lower levels of serum iron and ferritin compared with controls (13, 14, 15, 16). Although it is presumed that this blood loss is related to ischemic injury, other factors such as NSAID use may be contributors.

      In contrast to occult bleeding, frank gastrointestinal hemorrhage as a result of running is an uncommon event. Endoscopic evaluation in runners with gross bleeding has revealed a variety of potential bleeding sources including gastritis, hemorrhoids and, as in this case, ischemic colitis (1, 2, 3, 17, 18, 19, 20). Our review of the literature identified six cases of running-associated ischemic colitis, all of which occurred in amateur athletes (3, 12, 17, 18, 19, 20). With the exception of one case in which the patient required emergency subtotal colectomy for perforation (20), the clinical presentation and clinical course were similar to that observed in our patient. Apart from our patient’s status as an elite class runner, the most distinguishing feature of this case relates to the pattern of ischemic injury. In the previously reported cases, segmental involvement of the proximal colon was observed in five patients and pancolitis in the sixth. The predilection for the proximal colon is typical of ischemic colitis occuring in other low flow states (e.g., shock) and is believed to be the consequence of a vasospastic reflex and shunting (21). Isolated segmental involvement of the proximal rectum and sigmoid, as observed in our case, has not been reported in association with running, but is common in the setting of localized nonocclusive ischemic injury (22). The atypical pattern of involvement provided the rationale for obtaining the MRA/MRV study, which failed to demonstrate anatomic abnormalities in the major branches of the inferior mesenteric artery but does not exclude the possibility of an anomalous distribution of flow in the smaller branches.

      The role of hypercoaguable states in running-associated colitis is not known. Previous reports predate recent advances in our understanding of the clotting cascade. Our patient had an extensive hypercoaguable state evaluation that included assays for protein C, protein S, antithrombin III, lupus anticoagulant, anticardiolipin, and factor V Leiden. Our patient’s use of oral contraceptives was of special concern, as estrogen-based birth control pills have been linked to spontaneous ischemic colitis in young women (23). Recent evidence suggests that a specific factor V mutation, referred to as the factor V Leiden mutation because of its high prevalence among women in the Leiden region of Germany, is strongly linked with thrombotic events associated with oral contraceptive use (24, 25). Despite the absence of a factor V Leiden mutation in our patient, we recommended the discontinuation of her oral contraceptives. Another possible contributing factor was our patient’s mild polycythemia, which may have been secondary to high altitude training. It is conceivable that mild polycythemia in the setting of hypovolemia and low splanchnic blood flow may have augmented the ischemic process.

      We conclude that our patient developed segmental ischemic colitis as a direct result of vigorous, high intensity, long distance running. This conclusion is based on the strong temporal relationship to running, the absence of an antecedent history of a chronic diarrheal illness and the absence of pathogens on stool analysis and culture. It is likely that the ischemic process actually developed 4–6 wk before the marathon during her peak training phase at high altitude, when she first noted the onset of crampy abdominal pain and diarrhea. Supporting this contention was the presence of mucopurulent exudates endoscopically, which suggest chronicity and the early onset of symptoms during the race (mile 4). Contributing factors on the race day may have included profound exercise-related shunting of mesenteric blood, chronic dehydration, and possibly some element of hypercoagulability secondary to polycythemia. Although there was no evidence of a hypercoagulable state or factor V Leiden mutation, the role of oral contraceptives in this case remains unknown. Moreover, although the MRA/MRV demonstrated normal flow in the celiac, superior mesenteric, and inferior mesenteric vessels and their major branches, it does not rule out the possibility of small vessel occlusive disease or anatomic anomalies. Nevertheless, the fact that the patient fully recovered, both clinically and endoscopically, with conservative treatment and has remained well despite resuming a vigorous training schedule argues strongly in favor of a reversible nonocclusive etiology

  1. Hi Dan, thanks for the info. What brand of S.boulardii do you use? Here in the UK it is known as DiarSafe, I think we can access imported American brands but they tend to be much more expensive. I personally think S.boulardii is an absolute life saver – it works far better than other probiotics that I have tried.

    1. Hi Vicky,

      I have a bottle of Jarrow’s, its on Amazon for a much better price than florastor. Though I’m not sure if its helping or not because I’ve only used it a couple days and am not entirely sure what a proper dose is.

  2. Hi Dan,

    I hope you’re feeling better! I’ve had UC for 13 years and am on Lialda and Canasa to help combat the symptoms, although they don’t seem to be as effective right now. I just ordered “Breaking the Vicious Cycle” that talks about altering your diet to regulate the disease. Based on the reviews it seems to work for a majority of people, so that might be an option. I’m a runner and it’s been difficult as of late, so I try to run on a treadmill or where I know there are stops along the way. Cross training has been helpful as it’s less jarring and doesn’t seem to incite as much of a physical reaction. Hope that helps!

  3. Hey, have uc for over 10 years, been on almost every med out there, they work for a couple of months then I am back to bloody bowls. It’s not fun and I hate it. Diet does work, cut out greasey foods and junk and eat a balance meal with high fibre and iron, because if you lose too much blood when you have a flare up your iron go’s down. I have my doctor test my iron every couple of months. Am on iron pills and eat high iron foods. Being anemic is partly caused by my uc because when I have a flare up it’s just blood. I still have flare ups when I go off my diet and eat junk and grease, because I tell you now it is hard to cut the foods you love but diet for me is better than pills, because once your body get used to the pills they won’t work anymore.

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