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

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New Member

Date Joined Dec 2008
Total Posts : 14
   Posted 1/18/2009 1:46 AM (GMT -6)   
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?

Elite Member

Date Joined Feb 2004
Total Posts : 20577
   Posted 1/18/2009 2:13 AM (GMT -6)   
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.

My bum is broken....there's a big crack down the middle of it! LOL :)

Regular Member

Date Joined Apr 2008
Total Posts : 191
   Posted 1/18/2009 2:53 AM (GMT -6)   
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

Veteran Member

Date Joined Dec 2008
Total Posts : 511
   Posted 1/18/2009 8:40 AM (GMT -6)   
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
Dx-May 2007  Asacol-2400mg bid  Prednisone-20mg  Remicade-5 Tx
Paxil-40mg  Prilosec-bid  Multivitamin  Moderate/Severe Pancolitis
28 year old Mommy of a 1 year old and a Wife for almost 2 years!
Life has never been so sweet!  I appreciate the small things in life...the little joys that occur every second of every day.  Though we struggle and have crazy complications, nothing can over ride our love and happiness.
Meeting with a surgeon next week...and hopefully scheduling the surgery by the end of the month!

Regular Member

Date Joined Jul 2008
Total Posts : 298
   Posted 1/18/2009 10:04 AM (GMT -6)   
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...
Diagnosed w/ Ulcerative Colitis in 1995
32 years old
Living med free  
mini flare 

Old Hat
Veteran Member

Date Joined Feb 2007
Total Posts : 5154
   Posted 1/18/2009 6:26 PM (GMT -6)   
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.])

Veteran Member

Date Joined Dec 2008
Total Posts : 3231
   Posted 1/20/2009 5:23 PM (GMT -6)   
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).
Joy - 47 yrs and counting
Diagnosed w/ UC Dec 06 (also have IBS)
Currently in remission

Lexapro (for stress)
Vitamins (a whole bunch of them)
Anti-inflammatory foods: turmeric, seaweed, garlic...
Avoid: anything with high-fructose corn syrup, foods high in fructose, artificial sweeteners

New Member

Date Joined Dec 2008
Total Posts : 14
   Posted 1/22/2009 12:58 AM (GMT -6)   
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.

Veteran Member

Date Joined Aug 2008
Total Posts : 5951
   Posted 1/23/2009 2:35 PM (GMT -6)   
     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.
62 yr old granny. South Jersey
Diagnosed with ulcerative proctitis in 1998 in hospital
Hospitalized (2nd time) in May 2008
Update 11/03/08...finally in remission!!  Hope I don't jinx myself.  Off the prednisone since 11/01/08...now see if I can stay off for longer than two weeks.  Other meds: 6MP (75 mgm), colazal (6 per day), Benicar and Toprol (high blood pressure meds), Probiotic (2 per day), fish oil capsule and multi-vitamin and calcium with vitamin D.

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