Ulcerative colitis is a superficial inflammation of the large intestine, not caused by bacteria, which results in ulceration and bleeding. The patient typically experiences alternating periods with no or few symptoms, and periods with frequent stomach pains and diarrhoea that is mixed with pus, blood, and mucus.

The exact cause of ulcerative colitis is unknown. Hereditary, infectious and immunological factors have been proposed as possible causes.

The symptoms of ulcerative colitis can vary considerably. The disease is characterized by periods with diarrhoea, mixed with pus, blood, and mucus, which alternate with periods of few or no symptoms. When the colitis is active, the patient often has mild stomach pains, and sometimes a fever. The symptoms vary according to the extent of the disease. A quarter of patients only have the disease in the rectum, which means that the symptoms are fairly mild. In one third of patients, the disease also affects the lower part of the large intestine. In the remaining patients, ulcerative colitis affects all of the large intestine.

Flare-ups cannot be prevented, but the severity and extent of the attacks can be reduced. It is important that affected people follow preventive treatments carefully, watch out for symptoms, and consult their doctor if there is blood in their stool.

Diagnosis:
Stool specimens are collected for cultivation and microscopy to exclude infection caused by bacteria and parasites. The diagnosis is confirmed by means of an endoscopy in the large intestine and the rectum. Small tissue samples from the mucosa are usually obtained during the procedure, which can in many cases confirm the diagnosis. An endoscopic examination of the entire intestine (colonoscopy), or a barium enema X-ray examination can help determine the extent of the disease. Blood samples can help determine the severity of the inflammation, and show whether the patient suffers from anaemia (low haemoglobin count).

In rare cases, life-threatening bleeding, perforation of the intestine, and inflammation of the abdominal cavity may occur. Malnutrition and inflammation of joints, eyes, and skin. The risk of colon cancer and rectal cancer begins to rise after 10 years of ulcerative colitis.

When the disease is active, it is often treated with tablets. When the disease is in remission, the treatment often continues in order to suppress the inflammation. Medical treatment is usually sufficient. If the disease cannot be controlled by medical treatment, it can be cured by surgical removal of the large intestine. In having the removal of the large intestine you may be required to use a pouch or bag.

Which medicines can be used?

Corticosteroids to reduce inflammation. Enemas and suppositories are used for mild to moderate symptoms in the rectum. Tablets are used for moderate to severe symptoms and more extensive disease. Hospital admission and injections of corticosteorids are required for very severe symptoms and extensive disease.

Aminosalicylates, as tablets, enemas or suppositories. These are anti-inflammatory medicines for the treatment of mild to moderate symptoms. They can also be used continuously to prevent attacks.

Immunosuppressants, such as azathioprine (eg Imuran) are used for very severe symptoms that cannot be controlled by corticosteroids (unlicensed indication).

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Heart disease is a number of abnormal conditions affecting the heart and the blood vessels in the heart. Types of heart disease include:

Coronary artery disease (CAD) is the most common type and is the leading cause of heart attacks. When you have CAD, your arteries become hard and narrow. Blood has a hard time getting to the heart, so the heart does not get all the blood it needs. CAD can lead to angina and/or a heart attack.

• Angina is chest pain or discomfort that happens when the heart does not get enough blood. It may feel like a pressing or squeezing pain, often in the chest, but sometimes the pain is in the shoulders, arms, neck, jaw, or back. It can also feel like indigestion (upset stomach). Angina is not a heart attack, but having angina means you are more likely to have a heart attack.
• A heart attack occurs when an artery is severely or completely blocked, and the heart does not get the blood it needs for more than 20 minutes.

Heart failure occurs when the heart is not able to pump blood through the body as well as it should. This means that other organs, which normally get blood from the heart, do not get enough blood. It does NOT mean that the heart stops.

Signs of heart failure include:

• Shortness of breath (feeling like you can’t get enough air)
• Swelling in feet, ankles, and legs
• Extreme tiredness

Heart arrhythmias are changes in the beat of the heart. Most people have felt dizzy, faint, out of breath or had chest pains at one time. These changes in heartbeat are, for most people, harmless. As you get older, you are more likely to have arrhythmias. Don’t panic if you have a few flutters or if your heart races once in a while. If you have flutters AND other symptoms such as dizziness or shortness of breath (feeling like you can’t get enough air), call 911 right away.

One in three American women dies of heart disease. In 2003, almost twice as many women died of cardiovascular disease (both heart disease and stroke) than from all cancers combined. The older a woman gets, the more likely she is to get heart disease. But women of all ages should be concerned about heart disease. All women should take steps to prevent heart disease.

Both men and women have heart attacks, but more women who have heart attacks die from them. Treatments can limit heart damage but they must be given as soon as possible after a heart attack starts. Ideally, treatment should start within one hour of the first symptoms.

One of the most useful tools for a healthcare provider is to have a great deal of information about the symptoms and general habits of the child. Consider keeping a symptom diary of daily habits and routines for a two week period prior to a medical appointment. You should take care to note when your child voids during the day and night, when accidents occur (time of day or night), the amount of urine voided, drinking patterns (does your child drink a lot of fluids in the later afternoon/evening? Does your child get up to drink something during the night?), what your child drinks (sugary fluids, caffeinated, etc.), when constipation occurs, if fecal soiling occurs, the nature of the urinary stream (is the urinary stream is strong and constant? Is there continuous dribbling?), if there are recurrent infections, and the number of wet versus dry nights. Any and all of this information can help a healthcare provider determine the cause of the problem and the appropriate treatment.

At the time of the appointment, you should be prepared to supply such information as well as questions related to medical history, medication, and family medical history. In addition to helping you find options to help cure bedwetting it is also important that you see a healthcare provider to rule out any other more serious problems that may cause bed wetting as a side effect.

Treatment Options

A variety of options are available to end bedwetting. Effective treatment for bed wetting has also been show to greatly improve the self-esteem of the child. Treatment options may vary based on the severity of the problem, the age of the child, the impact on the family. Both pharmacological and behavioral treatment options exist. To better combat the problem a combination of treatments may be used if necessary.

The most important aspect of all treatment options is the child’s involvement in treatment and motivation to dedicate the time and energy necessary. For this reason, some younger children may not be motivated and ready for treatment. This should be considered and if necessary treatment postponed until the child is ready.
It is also important for parents to be motivated and supportive of the child.

Behavioral Treatments Include:

Withholding Fluids: Limiting a child’s intake of fluids in the late afternoon and evening before bedtime, thereby causing a decreased amount of urine at night, may be a helpful first step to reduce wet nights.

Urotherapy : This behavioral treatment option implements a regular schedule of voiding during the day with voiding occurring every 2-3 hours.

Wakening: This treatment option involves the parent either randomly waking the child during the night or at schedule times once the child is asleep in order to urinate. If choosing this option, it is very important that the child be fully awake and aware. Otherwise the process encourages urinating while sleeping. This option also requires a high level of parental involvement to wake the child in the middle of the night and put them back to bed.

Reward System: While the child cannot control nocturnal enuresis, this option involves positive reinforcement of behavior the child can control, such as voiding before bed and at regular times during the day, as well as helping clean sheets and strip the bed. Rewards in some cases have consisted of sticker charts for positive behavior with a prize when a certain number of stickers have been won. Punishments for wet nights or rewards for dry nights are NOT appropriate as the child has no control over these.

In any case, until they are able to overcome this it is best to use underpads in bed in order to keep the urine from getting to the mattress.