Ulcerative Colitis

Ulcerative Colitis
What is ulcerative colitis?
Ulcerative colitis is a chronic, relapsing form of inflammation of the part of large intestine called Colon, that may leads to the formation of ulcers. This inflammation produces tiny sores called ulcers on the lining of the colon. It usually begins in the rectum and spreads upward. It rarely affects the small intestine beyond the lower portion.
The colon is the part of the digestive system where water is removed from undigested material, and the remaining waste material is stored. The rectum is the end of the colon adjacent to the anus. In patients with ulcerative colitis, ulcers and inflammation of the inner lining of the colon lead to symptoms of abdominal pain, diarrhea, associated with bleeding per rectum.
What is the large intestine?
The large intestine is part of the GI tract( gastro-intestinal tract), a series of hollow organs joined in a long, twisting tube from the mouth to the anus(an opening through which stool leaves the body). The last part of the GI tract, called the lower GI tract, consists of the large intestine—which includes the appendix, caecum, colon( ascending, transverse and descending, sigmoid colon),rectum and anal canal with anus. The intestines are sometimes called the bowel.

The large intestine is part of the GI tract.
The large intestine is about 5 feet long in adults and absorbs water and any remaining nutrients from partially digested food passed from the small intestine. The large intestine converts waste from liquid to a solid matter called stool. Stool passes from the colon to the rectum. The rectum is located between the sigmoid colon and the anus. The rectum stores stool prior to a bowel movement, when stool moves from the rectum to the anus and out of a person’s body.

Same like the Ulcerative colitis, one more condition is closely related to another condition of inflammation of the intestines called Crohn’s disease. Together, they are frequently referred to as Inflammatory bowel disease (IBD). Ulcerative colitis and Crohn’s diseases are chronic conditions.
Crohn’s disease can affect any portion of the gastrointestinal tract, including all layers of the bowel wall. It may not be limited to the GI tract, as it may affect the liver, skin, eyes, and joints. UC only affects the lining of the colon (large bowel). Men and women are affected equally. They most commonly begin during adolescence and early adulthood, but they also can begin during childhood and later in life.
UC found worldwide, but is most common in the United States, England, and northern Europe. It is especially common in people of Jewish descent. Ulcerative colitis is rarely seen in Eastern Europe, Asia, and South America, and is rare in the black population. For unknown reasons, an increased frequency of this condition has been observed recently in developing nations.First degree relatives of people with ulcerative colitis have an increased lifetime risk of developing the disease, but the overall risk remains small.

Although UC has no known cause, there is a presumed genetic risk. This may also involve infective pathology with low immune response .
Like Crohn’s disease, UC is both classified as and managed as an autoimmune disease.
The inflammation causes the bowel to move its contents rapidly and empty frequently. As cells on the surface of the lining of the bowel die, ulcers form. The ulcers may cause bleeding and discharge of mucus and pus.
Ulcerative colitis facts
• Ulcerative colitis (UC) is an inflammation of the large intestine (colon).
• The cause of ulcerative colitis is unknown.
• Intermittent rectal bleeding, crampy abdominal pain and diarrhea often are symptoms of ulcerative colitis.
• The diagnosis of ulcerative colitis can be made with a barium enema, but direct visualization (sigmoidoscopy or colonoscopy) is the most accurate means of diagnosis.
• Long-standing ulcerative colitis is a risk factor for colon cancer.
• Treatment of ulcerative colitis may involve both medications and surgery.

Endoscopic image of a bowel section known as the sigmoid colon afflicted with ulcerative colitis. The internal surface of the colon is blotchy and broken in places.
What are the symptoms of ulcerative colitis
Common symptoms of ulcerative colitis include:
• rectal bleeding and pain
• abdominal pain
• diarrhea
• Urgency to defecate
• Inability to defecate despite urgency
• Weight loss
• Fatigue
• Fever
• Cramping pains in the abdomen
Tiredness and fatigue
Feeling generally unwell or feverish
Loss of appetite and weight lossAnaemia (a reduced level of red blood cells).
• In children, failure to grow
but there is a wide range of symptoms among patients with this disease. Variability of symptoms reflects differences in the extent of disease (the amount of the colon and rectum that are inflamed) and the intensity of inflammation. Generally, patients with inflammation confined to the rectum and a short segment of the colon adjacent to the rectum have milder symptoms and a better prognosis than patients with more widespread inflammation of the colon. The different types of ulcerative colitis are classified according to the location and the extent of inflammation:
1. Ulcerative proctitis refers to inflammation that is limited to the rectum. In many patients with ulcerative proctitis, mild intermittent rectal bleeding may be the only symptom. Other patients with more severe rectal inflammation may, in addition, experience rectal pain, urgency (sudden feeling of having to defecate and a need to rush to the bathroom for fear of soiling), and tenesmus (ineffective, painful urge to move one’s bowels caused by the inflammation).
2. Proctosigmoiditis involves inflammation of the rectum and the sigmoid colon (a short segment of the colon continuous to the rectum). Symptoms of proctosigmoiditis, like that of proctitis, include rectal bleeding, urgency, and tenesmus. Some patients with proctosigmoiditis also develop bloody diarrhea and cramps.
3. Left-sided colitis involves inflammation that starts at the rectum and extends up the left colon (sigmoid colon and descending colon). Symptoms of left-sided colitis include bloody diarrhea, abdominal cramps, weight loss, and left-sided abdominal pain.
4. Pan colitis or universal colitis refers to inflammation affecting the entire colon (right colon, left colon, transverse colon and the rectum). Symptoms of pancolitis include bloody diarrhea, abdominal pain and cramps, weight loss, fatigue, fever, and night sweats. Some patients with pan colitis have low-grade inflammation and mild symptoms that respond readily to medications. Generally, however, patients with pan colitis suffer more severe disease and are more difficult to treat than those with more limited forms of ulcerative colitis.
5. Fulminant colitis is a rare but severe form of pan colitis. Patients with fulminant colitis are extremely ill with dehydration, severe abdominal pain, protracted diarrhea with bleeding, and even shock. They are at risk of developing toxic megacolon (marked dilatation of the colon due to severe inflammation) and colonic rupture (perforation). Patients with fulminant colitis and toxic megacolon are treated in the hospital with potent intravenous medications. Unless they respond to treatment promptly, surgical removal of the diseased colon is necessary to prevent colonic rupture.
While the intensity of colon inflammation in ulcerative colitis waxes and wanes over time, the location and the extent of disease in a patient generally stays constant. Therefore, when a patient with ulcerative proctitis develops a relapse of his or her disease, the inflammation usually is confined to the rectum. Nevertheless, a small number of patients (less than 10%) with ulcerative proctitis or proctosigmoiditis can later develop more extensive colitis. Thus, patients who initially only have ulcerative proctitis can later develop left-sided colitis or even pancolitis.
Signs and symptoms
Crohn’s disease Ulcerative colitis
Defecation
Often porridge-like
sometimes steatorrhea
Often mucus-like
and with blood
Tenesmus
Less common More common

Fever
Common Indicates severe disease
Fistulae
Common Seldom
Weight loss Often More seldom
Causes
There are no direct known causes for ulcerative colitis, but there are many possible factors such as genetics and stress.
Genetic factors
A genetic component to the etiology of ulcerative colitis can be hypothesized based on the following:
• Aggregation of ulcerative colitis in families.
• Identical twin concordance rate of 10% and dizygotic twin concordance rate of 3%
• Ethnic differences in incidence
• Genetic markers and linkages
Environmental factors
Many hypotheses have been raised for environmental contributants to the pathogenesis of ulcerative colitis. They include the following:
• Diet: as the colon is exposed to many dietary substances which may encourage inflammation, dietary factors have been hypothesized to play a role in the pathogenesis of both ulcerative colitis and Crohn’s disease.
• Breastfeeding: There have been conflicting reports of the protection of breastfeeding in the development of inflammatory bowel disease.
Autoimmune disease
Ulcerative colitis is an autoimmune disease characterized by T-cells infiltrating the colon. In contrast to Crohn’s disease, which can affect areas of the gastrointestinal tract outside of the colon, ulcerative colitis usually involves the rectum and is confined to the colon, with occasional involvement of the ileum. This so-called “backwash ileitis” can occur in 10–20% of patients with pancolitis and is believed to be of little clinical significance. Ulcerative colitis can also be associated with co morbidities that produce symptoms in many areas of the body outside the digestive system.

Diagnosis of ulcerative colitis
The diagnosis of ulcerative colitis is suggested by the symptoms of abdominal pain, rectal bleeding, and diarrhea. As there is no gold standard for diagnosis, the ultimate diagnosis relies on a combination of symptoms, the appearance of the colonic lining at the time of endoscopy, histologic features of biopsies of the colonic lining, and studies of stool to exclude the presence of infectious agents that may be causing the inflammation.
• Stool specimens are collected for analysis to exclude infection and parasites, since these conditions can cause colitis that mimics ulcerative colitis.
• A complete blood count is done to check for anemia(a low red blood count ), an elevated white blood cells (thrombocytosis), a high platelet count, is occasionally seen, and/or an elevated erythrocytes sedimentation rate (commonly referred to as “ESR rate”). An elevated white blood cell count and ESR rate both reflect ongoing inflammation that may be associated with infection or with any type of chronic inflammation including UC and Crohn’s disease. Anemia, especially in a young male with chronic pain and diarrhea should raise the clinician’s suspicion for IBD.
• Other blood tests also may be checked including Electrolyte studies and renal function tests, as chronic diarrhea may be associated with hypokalemia, hypomagnesemia and pre-renal failure.
• Liver function tests are performed to screen for bile duct involvement: primary sclerosing cholangitis .
• Urinalysis
• Stool culture, to rule out parasites and infectious causes.
• C-reactive protein can be measured, with an elevated level being another indication of inflammation.

• Confirmation of ulcerative colitis requires a test to visualize the large intestine. Flexible tubes inserted through the rectum (colonoscope) permit direct visualization of the inside of the colon to establish the diagnosis and to determine the extent of the colitis. Small tissue samples called biopsies can be obtained during the procedure to determine the severity of the colitis.
• A barium enema X-ray also may indicate the diagnosis of ulcerative colitis. During a barium enema, a liquid substance is administered into the rectum and injected into the colon. Barium is so dense that X-rays do not pass through it so the outline of the colon can be seen on X-ray pictures. A barium enema is less accurate and useful than direct visualization (sigmoidoscopy or colonoscopy) in the diagnosis of UC. If a barium enema is performed and ulcerative colitis is suspected, a colonoscopy is needed to verify the diagnosis.
• CT and MRI enterography are imaging techniques which use oral liquid contrast agents consisting of PEG solutions or low concentration of barium to provide more adequate distension of the colon and small intestine. These have been reported to be superior to standard imaging techniques in the evaluation of small bowel pathology in patients with Crohn’s disease. They have also been shown to provide adequate estimations of disease severity in ulcerative colitis

Complications of ulcerative colitis
Patients with ulcerative colitis limited to the rectum (proctitis) or limited to the end of the left colon (proctosigmoiditis) usually do quite well. Brief periodic treatments using oral medications or enemas may be sufficient. Serious complications are rare in these patients.
In those with more extensive disease, blood loss from the inflamed intestines can lead to anemia and may require treatment with iron supplements or even blood transfusions. Rarely, the colon can acutely dilate to a large size when the inflammation becomes very severe. This condition is called toxic megacolon. Patients with toxic megacolon are extremely ill with fever, abdominal pain and distention, dehydration, and malnutrition. Unless the patient improves rapidly with medication, surgery usually is necessary to prevent colonic rupture.
Other complications of ulcerative colitis
Complications of ulcerative colitis can involve other parts of the body.
• Ten percent of the patients can develop inflammation of the joints (arthritis).
• Some patients have low back pain due to arthritis of the sacroiliac joints.
• Ankylosing spondylitis (AS) is a type of arthritis that affects the vertebral joints of affected individuals. There seems to be an increased incidence of ankylosing spondylitis among patients with inflammatory bowel disease.
• Rarely, patients may develop painful, red, skin nodules (erythema nodosum). Others can have painful, red eyes (uveitis, episcleritis). Because these particular complications can risk permanent vision impairment, eye pain or redness are symptoms that require a physician’s evaluation.
• Diseases of the liver and bile ducts also may be associated with ulcerative colitis. For example, in patients with a rare condition called sclerosing cholangitis, repeated infections and inflammation in the bile ducts can lead to recurrent fever, yellowing of skin (jaundice), cirrhosis, and the need for a transplantation of the liver.
• Finally, patients with ulcerative colitis also might have an increased tendency to form blood clots, especially in the setting of active disease.

Treatments for ulcerative colitis
Both medications and surgery have been used to treat ulcerative colitis. However, surgery is reserved for those with severe inflammation and life-threatening complications. There is no medication that can cure ulcerative colitis. Patients with ulcerative colitis will typically experience periods of relapse (worsening of inflammation) followed by periods of remission (resolution of inflammation) lasting months to years. During relapses, symptoms of abdominal pain, diarrhea, and rectal bleeding worsen. During remissions, these symptoms subside. Remissions usually occur because of treatment with medications or surgery, but occasionally they occur spontaneously, that is, without any treatment.
Severity of disease
In addition to the extent of involvement, people may also be characterized by the severity of their disease.
• Mild disease correlates with fewer than four stools daily, with or without blood, no systemic signs of toxicity, and a normal erythrocyte sedimentation rate (ESR) or C-reactive protein (CRP). There may be mild abdominal pain or cramping. Patients may believe they are constipated when in fact they are experiencing tenesmus, which is a constant feeling of the need to empty the bowel accompanied by involuntary straining efforts, pain, and cramping with little or no fecal output. Rectal pain is uncommon.
• Moderate disease correlates with more than four stools daily, but with minimal signs of toxicity. Patients may display anemia (not requiring transfusions), moderate abdominal pain, and low grade fever, 38 to 39 °C (100 to 102 °F).
• Severe disease correlates with more than six bloody stools a day or observable massive and significant bloody bowel movement, and evidence of toxicity as demonstrated by fever, tachycardia, anemia or an elevated ESR or CRP.
• Fulminant disease correlates with more than ten bowel movements daily, continuous bleeding, toxicity, abdominal tenderness and distension, blood transfusion requirement and colonic dilation (expansion). Patients in this category may have inflammation extending beyond just the mucosal layer, causing impaired colonic motility and leading to toxic megacolon. If the serous membrane is involved, a colonic perforation may ensue. Unless treated, the fulminant disease will soon lead to death.
Extraintestinal features:

( Apthous ulcer in the buccal cavity)
Patients with ulcerative colitis can occasionally have aphthous ulcers involving the tongue, lips, palate and pharynx
As ulcerative colitis is believed to have a systemic (i.e., autoimmune) origin, patients may present with comorbidities leading to symptoms and complications outside the colon. The frequency of such extraintestinal manifestations has been reported as anywhere between 6 and 47 percent. These include the following:
• Aphthous ulcer of the mouth
• Ophthalmic (eye involvement)
o Iritis or uveitis, which is inflammation of the eye’s iris
o Episcleritis
• Musculoskeletal:
o Seronegative arthritis, which can be a large-joint oligoarthritis (affecting one or two joints), or may affect many small joints of the hands and feet
o Ankylosing spondylitis, arthritis of the spine
o Sacroiliitis, arthritis of the lower spine
• Cutaneous (related to the skin):
o Erythema nodosum, which is a panniculitis, or inflammation of subcutaneous tissue involving the lower extremities
o Pyoderma gangrenosum, which is a painful ulcerating lesion involving the skin
• Deep venous thrombosis and pulmonary embolism
• Autoimmune hemolytic anemia
• Clubbing, a deformity of the ends of the fingers.
• Primary sclerosing cholangitis, a distinct disease that causes inflammation of the bile ducts
The most common disease that mimics the symptoms of ulcerative colitis is Crohn’s disease, as both are inflammatory bowel diseases that can affect the colon with similar symptoms. It is important to differentiate these diseases since the course of the diseases and treatments may be different. In some cases, however, it may not be possible to tell the difference, in which case the disease is classified as indeterminate colitis.
Diagnostic findings
Crohn’s disease Ulcerative colitis
Terminal ileum involvement Commonly Seldom
Colon involvement Usually Always
Rectum involvement Seldom Usually
Involvement around
the anus
Common Seldom
Bile duct involvement No increase in rate of primary sclerosing cholangitis
Higher rate
Distribution of disease Patchy areas of inflammation (skip lesions) Continuous area of inflammation
Endoscopy Deep geographic and serpiginous (snake-like) ulcers
Continuous ulcer
Depth of inflammation May be transmural, deep into tissues[7][13]
Shallow, mucosal
Stenosis
Common Seldom
Granulomas on biopsy May have non-necrotizing non-peri-intestinal crypt granulomas[7][37][38]
Non-peri-intestinal crypt granulomas not seen

(Ayurvedic view of Ulcerative Colitis)
Ulcerative Colitis is an inflammatory bowel disease, which causes inflammation and ulceration of inner lining of the colon and rectum. The inflammation usually begins in the rectum and sigmoid colon and spread upward to the entire colon. Ulcerative colitis rarely affects the small intestine. It can occur at any age but its onset is most common among people between ages of 15 – 40. Ulcerative colitis affects male and females equally and appears to run in some families.
Ayurvedic view – According to Ayurveda, ulcerative colitis is primarily a disease of Pitta dosha with varying degrees of Vata involvement. The latter determines how extensively the inflammatory process will spread proximally and the development of extraintestinal manifestations.
The natural qualities and actions of Pitta are manifested wholly or partially and can be observed.
The inherent paittika qualities are: heat, sharpness, liquidity, light, slight unctuousness, sour or pungent smell, acidic or sour taste, red, yellow, and dark blue colors.
The natural actions of Pitta include: burning sensation, heat, pus formation (suppuration), perspiration, putrification, itching, bleeding (raktasrava), anger, and intensity.
The excessive consumption of paittika ahara (Pitta-aggravating foods) and Pitta-aggravating regimens initially damages both rakta dhatu and mamsa dhatu. Vata dosha in the lower colon is also aggravated and in the early stages blocks the Pitta and Kapha channels causing further inflammation, mucous accumulation and edema.
According to ayurvedic classics, the condition of Inflammatory bowel disease or especially chron’s disease or ulcerative colitis can be compared with Rakta aatisara or Adhogata Raktapitta. It is also mentioned that the people having pitta pradhana prakruti or constitution and the people who are involved in pitta pradhana aahara-vihara( diet and life style ) are more prone to the ulcerative colitis.
Causes of Ulcerative Colitis according to Ayurveda –
All the factors that imbalance ‘Pitta( bio-energy ) are responsible for developing Ulcerative Colitis. These include indulgence in too many arguments, eating while watching TV or walking, watching too many violent movies, excessive heat or exposure of the sun, excessive alcohol and smoking, excessive mental activity, skipping meals, spicy, sour or stale and infected foods etc. In Pitta constitution persons, Pitta gets aggravated very quickly with the above factors and patients develop diarrhea followed by bloody diarrhea.

Treatment:
In our clinic, we offer very effective treatment for Ulcerative colitis based on the classical principle of Ayurveda and our research. Our treatment of Ulcerative colitis is focused in healing the ulcers and restoring the normal function of colon and maintaining the overall health of the digestive system.
Treatment involves Shodana chikitsa (Panchakarma therapy), Shamana chikitsa (internal medicines), life style modifications and very strict diet regime.
In more severe case Panchakarma therapy plays a vital role as it quickly detoxifies & rejuvenates the digestive system, controls the inflammation, rectal bleeding and heals the ulcerations.
Usually results are very good with Ayurvedic line of treatment. Early cases tend to respond quickly than chronic. If patient can stick to all the guidelines as advised, even complete cure can also be achieved.
Shodana chikitsa (Panchakarma therapy):
Basti Therapy
” There is no causative factor greater than Vata in the manifestation of diseases in the peripheral tissues (sakha), viscera of the thorax and abdomen (kostha), marma (vital points), upper region of the body (urdhva), travelling throughout the entire body (sarvavayava), and those effecting individual parts (anga).
Basti (enema therapy) according to all the ancient vaidyas is the most important panchakarma procedure. The reason in part is that basti promotes the elimination of excess Vata dosha from the body, and Vata dosha is the root of the majority of diseases which afflicts mankind. It is the moving force in the physiology which governs the formation, interaction, spread, and elimination of all biological substances and waste products. It is also the force which propels the other doshas out of their normal seats and shrotas into the peripheral tissues. Being the principal treatment of this most influential of biological energies, basti Karma is of paramount importance in any regimen of panchakarma.
Two types of vastis are always used:
Anuvasana (oil or fat based)
Niruha (decoction-based), especially piccha basti
Normally, Basti therapy is administered first and followed by oral medications. Panchakarma Therapies of varying duration are also strongly advised.

Ayurvedic Management of Ulcerative Colitis :

Treatment involves internal research medicines, strict diet regime and life style modifications. In more severe and chronic cases, Panchakarma therapy is selectively done along with these.
Ayurvedic Treatment: – Ayurvedic treatment provided relief to patients with severe disease and those patients who never had a remission with mainline allopathic drugs were saved from surgery with the help of this treatment.
Ayurveda management
Ayurveda, the holistic science, places a lot of emphasis of the care of the digestive system. Ayurvedic concepts particularly focus on the significance of healthy digestive system with regard to the overall balanced functioning and healthiness of the human body and mind. Healthy digestion ensures that the nutrients taken in through food are able to produce healthy tissues (Saptha Dhathus). When digestion is weak, the tissues of your body – including muscle, blood, bone and nerves – become weak and susceptible to disease.
According to Ayurveda, ulcerative colitis can be compared to rakataja aatisara or adhogata raktapitta disease. Any vitiation or inflammation to this particular part by imbalanced Doshas (Vata, Pitta, Kapha) can cause a wide variety of symptom similar to that of ulcerative colitis, especially in the colon or in the rectal part. Degree and nature of symptoms may vary as per the doshic predominance & involvement.
As per Ayurveda, primary causes of the disease is Mandagi (poor appetite and poor digestion), irregular, improper, irrelevant or incompatible diet habits and junk food. Non-following of the healthy diet habits (Pathya) in certain digestive disorders, especially the conditions of post diarrhea and irritable bowels, are also one of the important causes of this disease.
In our clinic, we are providing very effective treatment for ulcerative colitis disease based on the classical principle of Ayurveda and our research.
Usually results are very good with Ayurvedic line of treatment. Early cases tend to respond quickly than chronic. If patient can stick to all the guidelines as advised, even complete cure can also be achieved.

Commonly used drugs in raktaja atisara or adhogata raktapitta:
Holarrehna antidysentrica
Bombax malbaricum
Cyperus rotundus
Woodfordia floribunda
Aegle marmelos
Cryophyllus aromaticus
Withania somnifera
Azadirachta indica
Myristica officinalis
Boswellia serrata

These herbs help to stop the bleeding, repair the damage and block the leakage of intestine wall. Reduces mucosal inflammation of intestines. Protect and rebuilds the intestinal inner lining. Enhances proper immune function through improved digestion.
Some commonly used Herbal formulations :
• Kutajaghan vati
• Bilwadi mishran
• Karpoora rasa
• Jatiphaladi mishran
• Kutajarista
• Kumaryasava
• Sankh bhasma
• Kapardak bhasma
• Panchamrit parpati
• Kehrava pisti
• Bol parpati
• Dadimaastak choorna
• Takrarista

With the complete ayurvedic sodhana and shamana treatment, also with proper diet and life style regimen the condition of the disease improves with:
• Consistency of stool improves, however frequency remains same, which improves later on with time.
• Quantity of blood in stool reduces.
• Quantity of mucus in stool reduces.
• Slowly steadily the urgency to go to toilet reduces.
• Hemoglobin improves and energy level goes up. After 6 to 8 months we advise the patients to go through colonoscopic examination which usually shows improved vascular pattern.

Ayurveda – Ulcerative Colitis Diet
Diet control is crucial in the success of Ayurveda Ulcerative colitis treatment. Food that are hard to digest, that cause increase in bowel motility, that cause increase in Pitta and fiber rich diet are best avoided in Ulcerative coloitis. As per the principles of Ayurveda, the following are to avoid in Ulcerative colitis.
Apathya:
• Ayurvedic procedures like body massage, sweating therapy, herbal smoking, nasal instillation of drops (Nasya), etc are best avoided.
• Watch your food – During Ulcerative colitis, the patient needs to make a list of food that trigger the disease and has to avoid such foods.
• Wheat, barley, – rich in fiber, initiates bowel movement.
• Black gram – Takes a long time for digestion.
• Black night shade – fruit and leaves are used as food in some parts of India.
• Peas – Causes Vata imbalance in intestines and bloating
• Jaggery, Ash gourd, jujube – Heavy to digest
• sugar cane – causes increased intestinal motility and may trigger symptoms
• Grapes, coconut water, Spinach and green leafy vegetables – May cause increased bowel motility
• Betel leaf, garlic – may cause increase in Pitta.
• Ayurvedic medicines containing Kshara as an ingredient – causes Pitta imbalance.
• Avoid milk intak, in those who are having lactose intolerance

Pathya: The following specific foods are generally recommended in Ayurveda for patients of ulcerative colitis. However, not all patients will tolerate all of these food items. Your physician can provide a more individualized nutritional plan.
Old basmati rice (>3 months), barley, mung dal, urad dal, saffron, coriander, cumin, fennel, navy beans, kidney beans, green lentils, cow’s milk and butter, goat’s milk and butter, almonds, water chestnut, pomegranate, banana, mango, limes, and kiwi fruit, Drum stick, Mango, – Both may improve intestinal motility
.

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Lifestyle Guide & Recommended Diet
• It is recommended to have celery seeds and cumin seeds in our daily meal
• It is also recommended to have foods properly and not while doing another work simultaneously like watching TV, talking, or walking. It is important to chew food properly.
• Consuming soups made with the skimmed milk, goat’s milk, yoghurt, and buttermilk and by boiling split gram is good for treating this condition.
• Consumption of whole peas, broccoli, potatoes, jaggery, sweet potatoes, rich junk foods, should be avoided.
• Coffee, tea and alcohol consumption should be avoided completely

Homemade Therapies
• In a glass of buttermilk, add a quarter spoon of turmeric powder, rock salt to taste and roasted cumin seeds. This needs to be had with breakfast and with lunch and not with dinner.
• Take equal measures of dried ginger roots, long pepper, black pepper in powdered forms and mixed and a quarter spoonful of this mixture is to be added to water two times a day.
• Powder cinnamon, cloves, asafetida and green cardamom and have a teaspoon of this with water two times a day.
• Half teaspoon of powdered Indian gooseberry fruit, with quarter of a spoon of nutmeg powder, with half spoon of celery seeds when mixed should be had with water before going to bed at night.

Points to Remember
• Ulcerative colitis is a chronic, or long lasting, disease that causes inflammation—irritation or swelling—and sores called ulcers on the inner lining of the large intestine.
• The exact cause of ulcerative colitis is unknown. Researchers believe that factors such as an overactive intestinal immune system, genes, and environment may play a role in causing ulcerative colitis.
• Ulcerative colitis can occur in people of any age. However, it is more likely to develop in people
o between the ages of 15 and 30
o older than 60
o who have a family member with inflammatory bowel disease (IBD)
o of Jewish descent
• The most common signs and symptoms of ulcerative colitis are diarrhea with blood or pus and abdominal discomfort.
• A health care provider diagnoses ulcerative colitis with the following:
o medical and family history
o physical exam
o lab tests
o endoscopies of the large intestine
• Which treatment a person needs depends on the severity of the disease and symptoms.
• Good nutrition is important in the management of ulcerative colitis. A health care provider may recommend that a person make dietary changes.
• People with ulcerative colitis should talk with their health care provider about how often they should get screened for colon cancer.

How Can Prevent Ulcerative Colitis?

There is no solid evidence that what you eat can affect your condition. Certain foods aggravate the symptoms when have a flare-up.
• drinking small amounts of water throughout the day
• eating smaller meals throughout the day
• limiting your intake of high-fiber foods
• avoiding fatty foods
• lowering your intake of milk if you’re lactose intolerant (unable to digest lactose.