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Ulcerative Colitis in Children

What is ulcerative colitis?

Ulcerative colitis is an inflammatory bowel disease (IBD). In this condition, the inner lining of your child’s large intestine (colon or bowel) and rectum gets inflamed. This inflammation often starts in the rectum and lower (sigmoid) intestine. Then it spreads to the whole colon.

This causes diarrhea or frequent emptying of the colon. As cells on the surface of the lining of the colon die and fall off, open sores (ulcers) form. This causes pus, mucus, and bleeding.

What causes ulcerative colitis?

Healthcare providers don't know what causes this condition. It may be triggered by a virus or bacteria. This interacts with your child’s immune system and causes an inflammatory reaction in the intestinal wall.

Children with ulcerative colitis often have problems with their immune system. But healthcare providers don't know if these issues are a cause or a result of the disease.

There’s no cure for this condition, except to take out your child’s colon with surgery. However, the symptoms can be managed medically.

Who is at risk for ulcerative colitis?

People between the ages of 15 and 30 are at greatest risk of developing this condition. This issue can also start in children and older adults. It affects males and females equally. It also seems to run in some families.

What are the symptoms of ulcerative colitis?

Symptoms can happen a bit differently in each child. They can include:

  • Stomach pain
  • Bloody diarrhea
  • Fatigue
  • Weight loss
  • Loss of appetite
  • Rectal bleeding
  • Loss of body fluids and nutrients
  • Anemia caused by severe bleeding

Some children also have the following symptoms:

  • Skin sores (lesions)
  • Joint pain
  • Inflammation of the eyes
  • Liver problems
  • Osteoporosis
  • Rashes
  • Kidney stones

The symptoms of ulcerative colitis may look like symptoms of other health problems. Make sure your child sees his or her healthcare provider for a diagnosis.

How is ulcerative colitis diagnosed?

Your child's healthcare provider will ask about your child's health history. He or she will also give your child an exam.

Your child will have blood tests. These tests can tell if your child has anemia. They can also tell if your child has a high white blood cell count. This can be a sign of inflammation. Your child’s healthcare provider may also do other tests.

Stool sample

This test checks for bacteria in your child’s digestive tract. A small sample of stool is collected from your child and sent to a lab.

Upper endoscopy

In this test, a small, flexible tube (endoscope) is used to look at the inside of your child’s digestive tract. This tube has a light and a camera lens at the end of it. During the test, the healthcare provider may take tissue samples from your child's digestive tract. The provider will test these samples.

Colonoscopy

This test lets your child’s healthcare provider look at the length of your child’s colon. This can spot abnormal growths, inflamed tissue, ulcers, and bleeding. In this test, your child’s healthcare provider puts a special instrument (colonoscope) in through the rectum up into the colon. This instrument is a long, flexible, and lighted tube. During the test, your child’s healthcare provider may take out tissue to look at it more closely. He or she may also treat some problems.

Biopsy

Your child’s healthcare provider may take out a sample of tissue from the lining of the colon. Then he or she may look at it closely under a microscope.

Barium enema (lower GI series)

This test looks at the large intestine. Your child will get barium in his or her rectum as an enema. This is a metallic liquid that coats the inside of his or her organs. This helps them show up on an X-ray better. Your child’s healthcare provider will take X-rays of his or her belly. This can show narrowed areas (strictures), blockages (obstructions), and other issues.

How is ulcerative colitis treated?

Treatment will depend on your child’s symptoms, age, and general health. It will also depend on how severe the condition is.

Diet

No diet can help this condition. But if certain foods upset your child’s stomach, avoiding those foods may help ease your child’s symptoms.

Medicine

Your child’s healthcare provider may prescribe medicines that reduce colon inflammation. These can include aminosalicylates, corticosteroids, and immunomodulators. If your child’s condition is severe, he or she may also need steroids, antibiotics, or medicines that affect the body's immune system.

Hospital stay

If your child’s symptoms are severe, he or she may need to stay in the hospital. This can help make sure your child is getting the nutrition he or she needs. It can also stop diarrhea and the loss of blood, fluids, and minerals. Your child may need a special diet, feeding through a vein, or medicines. Some children may also need surgery.

Surgery

About 1 in 4 to 2 in 50 children with this condition eventually need surgery. This is done because of heavy bleeding, tear (perforation) of the colon, cancer risk, or severe illness. In surgery, your child’s colon is removed. This may also be done if other treatments don’t work or if your child has side effects.

Your child may have one of the following surgeries:

  • Proctocolectomy with ileostomy. This is the most common surgery. In a proctocolectomy, the whole colon and rectum are taken out. In an ileostomy, your child’s surgeon makes a small opening of the abdominal wall. The tip of the lower small intestine (ileum) is brought to the surface of your child’s skin. This allows waste to drain.
  • Ileoanal anastomosis. In this surgery, just the affected part of your child’s colon is taken out. The outer muscles of the rectum aren’t removed. Your child’s surgeon attaches the ileum to the inside the rectum. This forms a pouch to hold the waste. This allows your child to pass stool through his or her anus in a normal way. But your child’s bowel movements may happen more often and be more watery than normal.

What are the complications of ulcerative colitis?

In rare cases, this condition can cause death. If your child’s condition affects more than just his or her rectum and lower colon, your child has a higher risk for colon cancer.

Living with ulcerative colitis

Children with this condition need long-term care. Your child may have times when symptoms go away (remission). This can sometimes last for months or years. But symptoms usually come back.

Your child should learn what foods trigger his or her symptoms and avoid these foods. You and your child’s healthcare provider should make sure your child gets enough nutrients to grow and develop well. Support groups can help you and your child. Work with your child’s healthcare provider to create a care plan for your child.

When should I call my child's healthcare provider?

If your child has any symptoms of ulcerative colitis, call his or her healthcare provider.

If your child is being treated for ulcerative colitis and has new symptoms, call his or her healthcare provider. You should also call if you’re worried about your child’s growth.

Key points about ulcerative colitis

  • Ulcerative colitis is an inflammatory bowel disease. In this condition, the inner lining of your child’s large intestine and rectum gets inflamed.
  • This inflammation causes diarrhea or frequent emptying of the colon. Your child may also have stomach pain and diarrhea.
  • Treatment may include avoiding foods that cause symptoms, taking medicine, and having surgery.
  • Children with this condition need long-term care. Your child may have times when symptoms go away. But symptoms usually come back.

Next steps

Tips to help you get the most from a visit to your child’s healthcare provider:

  • Know the reason for the visit and what you want to happen.
  • Before your visit, write down questions you want answered.
  • At the visit, write down the name of a new diagnosis, and any new medicines, treatments, or tests. Also write down any new instructions your provider gives you for your child.
  • Know why a new medicine or treatment is prescribed and how it will help your child. Also know what the side effects are.
  • Ask if your child’s condition can be treated in other ways.
  • Know why a test or procedure is recommended and what the results could mean.
  • Know what to expect if your child does not take the medicine or have the test or procedure.
  • If your child has a follow-up appointment, write down the date, time, and purpose for that visit.
  • Know how you can contact your child’s provider after office hours. This is important if your child becomes ill and you have questions or need advice.
Online Medical Reviewer: Adler, Liora C., MD
Online Medical Reviewer: Freeborn, Donna, PhD, CNM, FNP
Date Last Reviewed: 9/1/2016
© 2000-2016 The StayWell Company, LLC. 780 Township Line Road, Yardley, PA 19067. All rights reserved. This information is not intended as a substitute for professional medical care. Always follow your healthcare professional's instructions.
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