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What do you think is the reason that ulcerative colitis (always) starts from the rectum?

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Ulcerative Colitis
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Posted 1/18/2009 7:46 AM (GMT 0)
What I have understood UC always stars in the rectum and then spreads upwards. Also the healing starts from the opposite direction. And it seems that rectum is the most difficult part to get to remission. I think it should be valuable to know to understand this disease better. What is your theory behind that, is it maybe because

1. Bacteria is needed for inflammation and there is more bacteria present in that part?

2. It is more fragile type of tissue and under the condition of strain during the bowel movements?

3. It's more closer to the "outside world" and the body finds (believes) that some agent comes from outside and starts fighting it by inflammation to get rid of that substance

I think the crap is most of the time stored elsewhere than in the rectum and only passes it so I find it a little strange that rectum reacts (first) so strongly

Your opinions?

Posted 1/18/2009 8:13 AM (GMT 0)
The same reason why CD can affect the entire GI tract from mouth to anus...it's all about the encoded genetic factor, for UC that's the genetic encoding for the behavior of UC just as it is for CD and that's why although they are both an IBD they are 2 seperate entities/diseases.

:)
Posted 1/18/2009 8:53 AM (GMT 0)
My UC started in the rectum and sig spread upwards as you say,but now my GI says all my tail end as he calls it is completly clear but It is still severely now inflamed down my left side so I dont fit with the theory,
also it seems very difficult to treat as the rectal meds dont make any difference,the oral meds dont reach it
Pred makes no difference,the only thing that has done the trick so far is cyclosporin,and after azathrioprine
which it is making it just about livable with,but by know means satisfactory,I'm waiting hopefully for these knew intelligent pills that release exactly at the spot,or hoping for a new breakthrough, so I dont have to stay on aza for years
Posted 1/18/2009 2:40 PM (GMT 0)
I do feel that it is very interesting the start site for flares and irritation. I'm sure it does have something to do with the exposure to the outside world, but I'm not sure how proven that theory is. In my case I am very pleased that it starts there and spreads throughout from that point, as with pancolitis I feel the 'end' and left side is more maintainable (pain-wise) than when my entire colon is upset...I also experience the craziest burning and pain in the middle behind my belly button.

Anyway, you bring up a very good point...why is it that this is where it all begins? It could also be that because UC is an immune disease that we have a little more sensitivity to certain things and once something enters our body we go into a flare.

I don't know. Just thinking about continued struggle and future flares (like I've ever been out of my initial flare from two years ago) is stressful! I just don't know how you all do it...in and out of flares and continued attempts with different kinds and levels of medication. Goodness.

: ) Robin
Posted 1/18/2009 4:04 PM (GMT 0)
UC symptoms are thought to be inflammation brought on by the breakdown in the mucosal layer that protects against bacteria (good and bad) and other undesirables. Thanks to the immune system's activation inflammation occurs.
What causes this is not certain but perhaps the protective intenstinal lining is thinner in the anus and rectal tissue for whatever reason.
Maybe it degrades more rapidly than the rest of the colon thus creating a start point from which inflammation spreads. When healing, it could be the last to heal because of this too.

Just a thought...
Posted 1/19/2009 12:26 AM (GMT 0)
Also it gets a lot of continuous pressure from moving waste & gas, being essentially bulb-shaped & positioned near the end of a person's alimentary canal. / Old Hat (nearly 30 yrs with left-sided UC ... [etc.])
Posted 1/20/2009 11:23 PM (GMT 0)
This is a very good question.

I guess it's like the common cold. It usually starts closer to the opening and works its way internally. I don't know why. Perhaps some microscopic germs get inside.

I agree that poo doesn't sit in the rectum. I knew exactly where I was flaring during my last flare, because as soon as the poo hit that spot in the rectum, I had to go. Thus, the urgency feelings and the five-second rule (five seconds to get to the bathroom or else).
Posted 1/22/2009 6:58 AM (GMT 0)
Thanks for your comments. I know that rectum may be almost perfect while the inflammation is bad in other parts of the colon. I myself had severe pancolitis some time ago where the colonoscopy revealed that the rectum was almost good. However, it wasn't perfect and with the help of medicines and other support I was able almost get a complete remission. However, I didn't get it because I am sure the last short bit of bowel didn't response to meds as other parts. This makes it difficult for me to maintain remission when there is a little inflammation in the rectum and it has a tendency to spread. If only I could tackle that last remaining part of inflammation I am sure maintaining the remission would be so much easier.

Posted 1/23/2009 8:35 PM (GMT 0)
     Just thought I would throw this out there for any of you who suffer from ulcerative proctitis as I do.  My last flare (and my worse) started the day after I took a bath with cheapo bubble bath which I purchased at a dollar store.  Basically, I noticed a small sore outside my vaginal area and boom..by nightfall I started with the mucus and you all know the drill....diarrhea, bleeding and all that comes with it, within a few days time.  My GI doctor explained that it could very well have been triggered by the cheap bubble bath.  It may have harbored a bacterium and been perfectly harmless in a "normal" person.  But, with my compromised immune system that is all it took for my body to send out signals that something was awry.  Needless to say, I no longer even take a bath, just showers.
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