Left-Sided Ulcerative Colitis Explained: Symptoms, Causes & 2025 Treatment Options

Left-sided ulcerative colitis (UC) is a chronic inflammatory condition affecting the left portion of the colon, often resulting in abdominal or rectal discomfort. Managing this condition generally involves targeted medications to reduce inflammation and improve quality of life.

Ulcerative colitis is a form of inflammatory bowel disease (IBD) characterized by inflammation and ulcers in the colon's lining. Specifically, left-sided UC involves inflammation extending from the rectum up to the splenic flexure—the bend near the spleen on the left side of the abdomen.

Other UC types include:

• Proctitis: inflammation limited to the rectum
• Pancolitis: widespread inflammation throughout the entire colon

The severity of symptoms often correlates with the extent of colon involvement.

Recognizing Symptoms

Diarrhea, often accompanied by blood streaks, is the hallmark symptom of UC. Persistent irritation in the rectum can create an urgent sensation to have bowel movements, though the stool volume may be minimal.

Additional symptoms include:

• Abdominal or rectal pain
• Fever
• Unintended weight loss
• Constipation
• Rectal spasms

Blood in stool, whether bright or dark red, signals potential colon damage and warrants prompt medical evaluation. Excessive bleeding requires urgent care.

Understanding Causes and Risk Factors

Ulcerative colitis is an autoimmune disorder where the immune system mistakenly attacks the colon, causing inflammation. Although exact triggers remain unclear, 2024 studies highlight factors such as:

• Genetic predisposition
• Immune system irregularities
• Gut microbiome imbalances
• Environmental influences

Accurate Diagnosis

Doctors diagnose left-sided UC through colonoscopy, which allows direct visualization of the colon’s inner lining using a lighted camera. Key inflammation indicators include redness, swelling, ulcers, tissue atrophy, and bleeding.

In left-sided UC, inflammation is confined up to the splenic flexure, beyond which the colon lining appears normal.

Effective Treatment Options in 2024

Treatment depends on the inflammation’s extent and symptom severity. Common approaches include:

5-ASA Medications

5-aminosalicylic acid (5-ASA) drugs reduce bowel inflammation and can be administered orally, topically, or via enemas. For left-sided UC, enemas are preferred to target the affected area effectively.

Oral Corticosteroids

If 5-ASA alone is insufficient, corticosteroids may be prescribed to quickly diminish inflammation, often in combination with 5-ASA.

Biologics and Immunomodulators

For moderate to severe cases, biologic therapies such as infliximab (Remicade), vedolizumab (Entyvio), and ustekinumab (Stelara) are recommended. These target specific immune pathways to prevent flare-ups.

Immunomodulators like methotrexate and thiopurines may also support long-term disease control and reduce steroid dependency.

JAK Inhibitors

Janus kinase (JAK) inhibitors, including tofacitinib (Xelianz) and upadacitinib (Rinvoq), provide rapid inflammation relief by blocking inflammatory pathways. These oral medications are FDA-approved for moderate to severe UC, especially after other treatments fail.

Hospital Care

Severe flare-ups might require hospitalization for intravenous steroids or other medications. In rare cases, surgery to remove damaged colon sections may be necessary.

Complementary Natural Therapies

While research continues, some natural remedies may aid symptom management, such as probiotics, acupuncture, and herbal supplements like turmeric and ginseng. Always consult your healthcare provider before starting these.

Common Questions Answered

How does left-sided colitis differ from extensive colitis?

Left-sided colitis affects only the left colon, whereas extensive colitis (pancolitis) involves inflammation throughout the entire colon.

What distinguishes left-sided UC from proctitis?

Proctitis is inflammation confined to the rectum near the anus, while left-sided UC extends further along the colon.

What else can cause inflammation or pain in the left colon?

Besides left-sided colitis, ischemic colitis (reduced blood flow) and infections can also cause left colon pain.

For more information, read this article in Spanish.

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