My sister has ulcerative colitis. She gets a little better in the hospital, but once she goes home (she lives alone) she gets sick again. Do you know if emotions play a role in this disorder? If so, what can be done to help her?

C.S.

Ulcerative colitis (UC) is a chronic, inflammatory disorder of the rectum and colon that causes abdominal cramping and bloody diarrhea associated with fever. The cause of this disorder is not yet known. However, the disease runs varying courses in different patients. About 80 percent of patients with UC have intermittent flare-ups of the disease, while the others have symptoms all the time.

Certain factors seem to be associated with flare-ups of the disease, including gastrointestinal infections and certain medications (such as nonsteroidal anti-inflammatory drugs). Interestingly, cigarette smoking seems to prevent relapses.

In the past, it was thought that UC might be caused by emotional problems or psychological disorders. This theory was linked to the observation that many UC patients suffer from anxiety and/or depression. However, it's now thought that UC patients' psychological and emotional problems do not cause UC, but are rather brought on by the stress of dealing with this very disruptive and painful digestive disorder. Some of these factors may be playing a role in your sister's case. Her symptoms likely improve while she is in the hospital because she gets more intensive treatment there and does not have the worries of everyday life. Once she is discharged, she has to take more responsibility for her own care and this may lead to a certain amount of anxiety on her part. Although the anxiety is not likely to worsen her colitis, it probably makes it difficult for her to take care of herself and, thus, makes a flare-up of the disease more likely to happen.

There is much that you can do to help your sister. For example, try talking to her about her disease and how it affects her life on a daily basis. Also, it may help for her to live with someone else (a roommate, perhaps). In addition, showing her that there is strong family emotional support may help ease her fears. You should also make sure that she follows-up closely with her gastroenterologist to ensure that her colitis is well controlled.