Top Questions to Ask Your Gastroenterologist About Ulcerative Colitis

Because ulcerative colitis (UC) is a chronic condition that requires ongoing treatment, you’ll likely establish a long-term relationship with your gastroenterologist.

Not matter where you are in your UC journey, you’ll periodically meet with your doctor to discuss your treatment and overall health. For each appointment, it’s important to ask your doctor questions and gain a better understanding of your condition.

This disease may impact the quality of your life, but relief is possible. The more you know about UC, the easier it’ll be to cope. Here are the top nine questions to discuss with your gastroenterologist about UC.

1. What causes UC?

Asking this question to your doctor may seem unnecessary — especially if you’ve already done your own research or have been living with the disease for some time. But it’s still helpful to see if anything specific led to your diagnosis. While the exact cause of UC is unknown, some experts believe it’s caused by an immune system problem. The immune system mistakes good bacteria in your gut as an invader and attacks your intestinal tract. This response causes chronic inflammation and symptoms. Other possible causes of UC include genetics and the environment.

2. What are my treatment options?

Remission is possible with treatment. Your doctor will recommend a treatment based on the severity of your symptoms.

People with mild UC may achieve remission with an anti-inflammatory medication known as aminosalicylates.

Moderate to severe UC may require a corticosteroid and/or an immunosuppressant drug. These medications reduce inflammation by suppressing the immune system.

Biologics therapy is recommended for people who don’t respond to traditional therapy. This therapy targets proteins responsible for inflammation, in order to decrease it.

A newer option is tofacitinib (Xeljanz). It works in a unique way to reduce inflammation in people with moderate-to-severe ulcerative colitis.

People who develop life-threatening complications from UC may need surgery to remove their colon and rectum. This surgery also involves reconstruction to allow waste removal from the body.

3. Should I change my diet?

UC affects the gastrointestinal tract and causes abdominal discomfort, but food doesn’t cause the disease.

Some foods may worsen flare-ups, so your doctor may recommend keeping a food diary and eliminating any foods and drinks that complicate your symptoms. This may include vegetables that trigger gas such as broccoli and cauliflower, and other high-fiber foods.

Your doctor may also suggest eating smaller meals and low-residue foods. These include white bread, white rice, refined pasta, cooked vegetables, and lean meats.

Caffeine and alcohol may worsen symptoms too.

4. How can I improve my condition?

Along with eliminating certain foods from your diet and taking your medication as directed, certain lifestyle changes may improve symptoms.

Smoking can increase inflammation throughout your body, so your doctor may recommend quitting.

Because stress can worsen symptoms of UC, your doctor may suggest steps to reduce your stress level. These include relaxation techniques, massage therapy, and physical activity.

5. What happens if my symptoms return?

It can take several weeks for symptoms to disappear after beginning treatment. Even after your symptoms disappear, your doctor may recommend maintenance therapy to keep your disease in remission. If your symptoms return while on maintenance therapy, contact your doctor. The severity of UC can change over the years. If this happens, your doctor may need to adjust your medications or recommend a different type of therapy.

6. What are complications of UC and how do you screen for them?

UC is a life-long condition, so you’ll have frequent follow-up appointments with your gastroenterologist. UC can increase the risk of colon cancer, so your doctor may schedule periodic colonoscopies to check for cancerous and precancerous cells in your colon. If your doctor discovers a mass or tumor, a biopsy can determine whether the mass is malignant or benign.

Immunosuppressant medications taken for UC can weaken your immune system and make you more susceptible to infections. If you have signs of an infection, your doctor may order a stool, blood or urine sample to identify the infection, and prescribe an antibiotic if necessary. You many also need an X-ray or CT scan. There is also the risk of intestinal bleeding, so your doctor may monitor you for iron deficiency anemia and other nutritional deficiencies. A multivitamin may help compensate for deficiencies.

7. Is anything that is related to my UC life-threatening?

UC itself isn’t life-threatening, but some complications can be. This is why it’s important to take your medication as directed, with the goal to achieve remission. Eating a healthy diet, regular exercise, and maintaining a healthy weight can lower the risk of colon cancer.

Toxic megacolon is another serious complication of UC. This happens when inflammation causes excessive gassiness. Trapped gas can trigger colon enlargement so that it can no longer function. A ruptured colon can lead to a blood infection. Symptoms of toxic megacolon include abdominal pain, fever, and a rapid heartbeat.

8. Are there any medical procedures for UC?

Surgery is recommended for severe UC that doesn’t respond to therapy or those with life-threatening complications. If you have surgery to correct UC, there are two options to allow waste removal from your body. With an ileostomy, a surgeon creates an opening in your abdominal wall and diverts the small intestines through this hole. An external bag attached to the outside of your abdomen collects waste. An ileo-anal pouch may be surgically constructed at the end of your small intestines and attached to your anus, allowing for more natural waste removal.

9. Can I get pregnant with UC?

UC doesn’t usually affect fertility, and many women who become pregnant have a healthy pregnancy. But experiencing a flare-up while pregnant can increase the risk of premature birth. To lower this risk, your doctor may recommend achieving remission before becoming pregnant. You should also avoid certain medications prior to getting pregnant. Some immunosuppressants increase the risk of birth defects. You may also need to adjust your medications during pregnancy.

The takeaway

Living with UC may affect your ability to work, travel, or exercise, but establishing a good relationship with your doctor can help you live a full life. The key is taking your medication as directed and meeting with your doctor if you have any questions or concerns about your health. Education and knowing what to expect from this condition can help you cope.