WebMD The Magazine - Feature
Brunilda Nazario, MD
Ulcerative colitis can begin very early. At the age of 12, for instance, Amanda Sina Griffith found herself the object of a custody battle -- and was besieged by painful stomach cramps and bloody diarrhea. “I’d had very mild stomach symptoms before; my doctor thought it was a bacterial infection. But now, it was worse,” she recalls. The diagnosis was ulcerative colitis.
Now 31, the Norton, Mass., public relations consultant and mother of a 7-month-old still finds that when she’s under stress her symptoms flare up. “My system is very sensitive. If I’m under stress, I feel tired, run-down, and crampy in the belly,” says Griffith, who worked full time until recently, but reduced her hours when she found job pressures worsened her stomach problems.
Griffith’s story sounds familiar to Gerard E. Mullin, MD, director of integrative GI nutrition services at Johns Hopkins Hospital in Baltimore. While stress doesn’t cause ulcerative colitis, research shows it can increase the risk of flare-ups, says Mullin.
Ulcerative colitis is a disease that affects the large intestine (also known as the colon) and the rectum. Although the causes of ulcerative colitis are unknown, some researchers believe that an autoimmune process may be a factor in the disease. When the body’s immune system is oversensitive and attacks its own healthy organs and tissues, disease can occur. Other factors that may contribute to the development of ulcerative colitis include genetics, environmental factors, smoking, and psychological stress.
Symptoms include abdominal pain or cramping, mild fever, rectal bleeding and diarrhea, and, less commonly, fatigue, loss of appetite, weight loss, and anemia. Some people may have joint pain, with redness and swelling, and liver problems.
Treatment of mild to moderate ulcerative colitis usually begins with drugs to relieve inflammation and help prevent flare-ups. If these drugs do not work, doctors can prescribe stronger medications. And while dealing with stress is not a substitute for medication, doing so can help ease the emotional anxiety that often comes with the disease, Mullin says.
“People with these diseases are often more vulnerable to stress. They have an immune system that is overactive to begin with. Their immune system needs to be calmed down,” Mullin says.
When someone is under stress, the body gears up for a fight-or-flight response by secreting certain hormones, including adrenalin, as well as molecules called cytokines. They stimulate the immune system, which triggers inflammation. In people whose ulcerative colitis is in remission, this sets the stage for the return of their symptoms, known as a flare-up. (Other factors linked to flare-ups include antibiotics, oral contraceptives, and nonsteroidal anti-inflammatory drugs, like aspirin, ibuprofen, and naproxen. Also, while what you eat doesn’t cause ulcerative colitis, some people may find certain foods worsen their bowel symptoms.)
It isn’t only the outside stress of life events, such as losing a job or going through a divorce, that can make people more vulnerable to flare-ups; living with ulcerative colitis also takes a toll. For instance, for most people, going out to eat or visiting a friend’s house is a pleasurable activity. But for those with ulcerative colitis, the need to learn ahead of time where the bathrooms are located, or the fear of not reaching one in time, can turn simple pleasures into anxiety-filled events.
“Because they have special needs, people with ulcerative colitis can start thinking of themselves as outcasts. All this causes stress,” notes Mullin.
There are many ways to ease such stress. First, try to find a supportive physician who listens. “More doctors need to be aware of the emotional factors involved in this disease so patients can get the help they need,” says Mullin. For instance, cognitive therapy, a relatively short-term form of psychotherapy based on the belief that people can change how they feel by changing the way they think about things, is often effective. Stress reduction techniques, such as yoga and meditation, can help.
In addition, disease-specific support groups can be emotional lifesavers. “People develop a feeling of community, and this breaks down social isolation,” Mullin notes.
Laura Wingate, who manages outpatient/professional programs at the Crohn’s & Colitis Foundation of America (which has about 300 support groups) offers these tips for finding one that’s right for you:
Wingate likes in-person groups because members often become friends. If you don’t live near a local group, give an online group a try.
Griffith makes dealing with stress a priority. “When I feel stressed, I withdraw from the situation. I take lots of deep breaths. I try to either read or go for a walk, or do some cooking. I do anything I can to get my mind off the situation, and it usually works.”
SOURCES:Gerard E. Mullin, MD, director of integrative GI nutrition services, co-director of gastroenterology & hepatology nurse practitioner fellowship program, Johns Hopkins Hospital, Baltimore.Laura Wingate, manager of outpatient/professional programs for the Crohn’s & Colitis Foundation, New York. Bitton, A. American Journal of Gastroenterology, October 2003, vol 98: pp 2112-2115.Levenstein, S. American Journal of Gastroenterology, May 2000, vol 95: pp 1213-1220.Maunder, R.G. Inflammatory Bowel Disease, June 2005, vol 11: pp 600-608.Mawdsley, J.E. Gastroenterology, August 2006, vol 131: pp 410-419."Q&A: Crohn’s Disease and Ulcerative Colitis: Emotional Factors,"Crohn's & Colitis Foundation of America.WebMD Medical Reference: "Ulcerative Colitis: Symptoms and Treatments."
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