Are you having back pain with any of the following?

  • Severe pain, weakness or tingling in your leg(s).
  • Difficulty stopping urination or loss of control of bladder or bowels.
  • Unexplained fever, nausea or vomiting.
  • A history of cancer or unexplained weight loss.

We understand that you are experiencing one or more of the health issues that might be impacting your back pain.

We recommend that you discuss these health issues with your doctor before proceeding with this program.

Once you are cleared by your doctor to do this program, we hope it helps you find relief from your back pain.

Provider photo for Jeremy Swartzberg

Jeremy Swartzberg, MD

Hospital Medicine

Welcome to My Doctor Online, a web site that my colleagues and I developed to make it easier for you to take care of your healthcare needs. On this site you will find answers to many of your questions about my clinical practice. Also included are several online features that will allow you to e-mail me, check your laboratory results and refill prescriptions. I hope you find its content informative and useful.

My Offices

Oakland Medical Center
Appt/Advice: 510-752-1190

See all office information »

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Overview

Ulcerative colitis (UC) is an inflammatory bowel disease. It causes inflammation in the lining of the colon only. It usually starts at the rectum and over time can affect the entire colon. This condition can affect people of any age. Most people are diagnosed before the age of 40. Although there is no cure, treatment can ease symptoms. Most people continue to lead healthy and active lives.

Symptoms

Symptoms of ulcerative colitis include:

  • Abdominal cramps, pain, and tenderness.
  • Diarrhea. You may feel an urgent need to use the bathroom. Diarrhea may be bloody and contain mucus.
  • Anemia. This can happen as a result of persistent bleeding from your colon. You may experience fatigue, weakness, and pale skin.
  • Weight loss.
  • Fever. This may be sign of infection.
  • Other related health issues: Joint pain, liver disease, eye problems, or skin rash.

Diagnosis

Some tests can be used to determine if you have ulcerative colitis (UC).

Flexible sigmoidoscopy or colonoscopy. These camera procedures examine the inside of your colon. Biopsies (tissue samples) can be obtained during these procedures to help us confirm your diagnosis and determine the severity of the inflammation

Stool analysis. This test can detect several substances including:

  • Blood
  • Bacterial infection
  • Parasites
  • Inflammation

The results can help confirm that you have ulcerative colitis rather than irritable bowel syndrome (IBS). IBS is a chronic noninflammatory condition with similar symptoms. 

Other tests that will help us diagnose and monitor UC include:

  • Computed tomography (CT) scan (radiology test).
  • Blood and urine tests. These tests check for anemia, inflammation, liver/kidney abnormalities, or malnutrition.

Causes and Risk Factors

We don’t know the exact cause of ulcerative colitis (UC). Research suggests that it may be related to an abnormal immune response to certain intestinal bacteria.

Certain known risk factors for developing UC (others are being studied) include:

  • Family history. Your risk increases if an immediate family member has the disease. Your immediate family includes your parents and brothers and sisters.
  • Ethnicity. People with Ashkenazi Jewish ancestry are at higher risk.

Treatment

The main goals of treatment are to:

  • Improve your symptoms
  • Heal colon inflammation completely
  • Reduce your risk of colon cancer 

Treatment may include medications or surgery. This will depend on how severe your disease is. Most people learn how to manage their symptoms and lead active, healthy lives.

Additional References:

Medications

For mild symptoms we may recommend:

  • Aminosalicylates. These medications reduce inflammation. They can be used both to treat an acute flare-up and to prevent symptoms from coming back. They can be taken as a tablet, enema, or suppository.
  • Corticosteroids. These medications also reduce inflammation, and are more potent than aminosalicylates. Because side effects can develop with long-term use, these medications are used for short-term treatment.

If your symptoms are moderate to severe, we may recommend:

  • Immunomodulators. These medicines prevent inflammation by suppressing the immune system. They are useful for preventing symptoms from coming back, but are not helpful for acute flare-ups.
  • Biologic therapies. These medications block your body’s inflammatory response. They are helpful for treating acute flare-ups that do not respond to corticosteroids, and also prevent symptoms from recurring when taken long-term. Some biologic therapies are given as intravenous infusions, while others are given as skin injections.
Additional References:

Surgery

Most people don’t require surgery. However, if symptoms are severe and medications aren’t working, surgery may be needed.

Proctocolectomy and ileostomy. We remove the colon and rectum. We make a small opening in the skin of the lower abdomen and connect the end of the small intestine to it. Stool empties into a small plastic bag worn outside the body.

Ileoanal anastomosis. This surgery is usually performed several months after the removal of the colon/rectum and ileostomy. It enables stool to pass normally through the anus.

Lifestyle Changes

Ulcerative colitis symptoms can last for years. However, symptoms usually get better with treatment. Some lifestyle changes can reduce the severity of the disease. We recommend:

  • Taking your medication(s) and staying in contact with your doctor regularly. This prevents flare-ups and keeps the disease in remission.
  • Avoiding nonsteroidal anti-inflammatory drugs (NSAIDS) for pain relief. Examples include ibuperofen or naproxen. NSAIDS have been linked to flare-ups. Take acetaminophen (Tylenol) instead.
  • Avoiding trigger foods. Be aware of foods that cause symptoms. These may be different for each person. There is no single UC diet, but some diets may be more beneficial than others.
  • Avoiding antibiotics unless prescribed by a doctor. They can make symptoms worse and should be used only when necessary.
  • Having screening tests for colorectal cancer. We recommend regular colonoscopies if you have had colitis for 8 to 10 years. Ulcerative colitis slightly increases your risk of developing colorectal cancer. Screening can find cancer early when it is easier to treat. Speak to your GI doctor to determine your colonoscopy schedule.
Additional References:

Complementary and Alternative Medicines

Because there is no cure for ulcerative colitis, many people consider complementary and alternative medicine (CAM) to help ease symptoms. While not all of these therapies have been proven to be effective, many may improve your overall well-being. 

If you are interested in trying CAM, we strongly recommend that you consult with us first. Some CAM therapies such as herbs, vitamins, and other nutritional supplements can have negative side effects when taken with prescription or over-the-counter medicines. We can work together to manage your medications. 

Some common CAM therapies include:

  • Nutritional supplements (probiotics, curcumin, and fish oils)
  • Vitamin supplements (vitamins D and B12)

Scientists are just beginning to document the benefits of mind-body and herbal approaches for chronic health issues like ulcerative colitis. You can try some CAM approaches to see if they help reduce your symptoms. 

We recommend that CAM approaches be combined with a healthy diet and a regular exercise routine.

Your Care with Me

Ulcerative colitis is a chronic long-term condition. Either I, or another gastroenterologist in our department, will manage your ongoing care.  I will work closely with your personal physician, who will continue to oversee your care for non-Ulcerative colitis health issues. 

Mild symptoms of Ulcerative colitis can be treated at home.

If you are having symptoms that concern you, your first contact will typically be with your personal physician, who will evaluate your health and symptoms.

If specialty care is needed, your personal physician will facilitate the process of scheduling an appointment in my department. If appropriate, she or he might call me or one of my colleagues while you are in the office so we can all discuss your care together. If we decide you need an appointment with me after that discussion, we can often schedule it the same day or soon thereafter.

During your office visit, we will discuss your medical and family history and I will perform a physical exam. I will explain the findings of your exam and answer any questions or concerns you may have. We will discuss treatment options and develop a treatment plan that is right for you.

If you need to talk with me after your visit or procedure, please call my office. You can also e-mail me with nonurgent issues from this website whenever it is convenient for you.

If you have urgent concerns or issues while my office is closed, or need general medical advice, you can call the Appointment and Advice line, available 24 hours a day, 7 days a week. You will be connected with a nurse who can give you immediate advice.

If you are experiencing a serious problem or an emergency, call 911 or go to the nearest Emergency Room when the clinic is not open.

Coordinating Your Care

Having all of our Kaiser Permanente departments located together or nearby, including pharmacy, laboratory, radiology, and health education, makes getting your care easier for you.

Another major benefit is our comprehensive electronic medical record system, which allows all of the doctors and clinicians involved in your care to stay connected on your health status and collaborate with each other as appropriate.

When every member of the health care team is aware of all aspects of your condition, care is safer and more effective.

If you come to an office visit
  • At the beginning of your visit, you will receive information about when you are due for your next test, screening, or immunization. We can discuss and schedule any preventive tests that you need. 
  • At the end of your visit, you may receive a document called the “After Visit Summary” that will summarize the issues we discussed during your visit. You can refer to it if you forget what we discussed, or if you just want to recheck your vital signs and weight. You can also view it online under Past Visits.
  • To help you prepare for your visit, please see additional details under Office Visit. 
If I prescribe medications

We will work together to monitor and assess how your medications are working and make adjustments over time. Prescriptions can be filled at any Kaiser Permanente pharmacy. Just let me know which pharmacy works best for you, and I will send the prescription electronically in advance of your arrival at the pharmacy.

If refills are needed in the future, you can:

  • Order them online or by phone. Order future refills from my home page or by phone using the pharmacy refill number on your prescription label.
  • Have them delivered to you by mail at no extra cost. Or you can pick up your medications at the pharmacy. If no refills remain when you place your order, the pharmacy will contact me regarding your prescription.
If lab testing or imaging is needed

For lab tests, I will use our electronic medical record system to send the requisition to the Kaiser Permanente laboratory of your choice. For imaging procedures, we will schedule an appointment with the Radiology department. When the results are ready, I will contact you with your results by letter, secure e-mail message, or phone. In addition, you can view most of your laboratory results online, along with any comments that I have attached to explain them.

If I refer you to another specialty colleague

If we decide together that your condition would also benefit from the care of other types of specialists, our staff will help arrange the appointment(s) with one or more of my specialty colleagues.

If surgery or a procedure is a treatment option

I will recommend that you review educational information and tools to help you prepare for your procedure or surgery. The information will often help you decide whether surgery is right for you. If you decide to have a surgery or procedure, the information will provide details about how to prepare and what to expect.

If we proceed with surgery, I will have my Surgery Scheduler contact you to determine a surgery date and provide you with additional instructions regarding your procedure. Once your surgery is scheduled, a medical colleague of mine will contact you to conduct a preoperative medical evaluation that will assure that you are properly prepared for your surgery.

Convenient Resources for You

As your specialist, I have a goal to provide high-quality care and to offer you choices that make your health care convenient. I recommend that you become familiar with the many resources we offer so that you can choose the services that work best for you.

My Doctor Online is available at any time that is most convenient for you. From my home page you can:

Manage your care securely

• View and compose secure e-mail messages.
• Manage your prescriptions.
• View your past visits and test results.
• View your Preventive Services to see whether you are due for a routine screening or updated immunization.

Learn more about your condition

• Read about causes, symptoms, treatments, and procedures.
• Find interactive health tools, videos, and podcasts to help you manage your condition.
• View programs to help you decide on or prepare for a surgery or procedure.

Stay healthy

• Locate health education classes and support groups offered at every medical center.
• Explore interactive programs, videos, and podcasts that focus on helping you stay healthy.
• View your Preventive Services to see whether you are due for a routine screening or updated immunization.

Related Health Tools:

Classes and Coaching
Interactive Programs
Podcasts
Prepare for Your Procedure
Videos

See more Health Tools »

If you have an emergency medical condition, call 911 or go to the nearest hospital. An emergency medical condition is any of the following: (1) a medical condition that manifests itself by acute symptoms of sufficient severity (including severe pain) such that you could reasonably expect the absence of immediate medical attention to result in serious jeopardy to your health or body functions or organs; (2) active labor when there isn't enough time for safe transfer to a Plan hospital (or designated hospital) before delivery, or if transfer poses a threat to your (or your unborn child's) health and safety, or (3) a mental disorder that manifests itself by acute symptoms of sufficient severity such that either you are an immediate danger to yourself or others, or you are not immediately able to provide for, or use, food, shelter, or clothing, due to the mental disorder.

This information is not intended to diagnose health problems or to take the place of specific medical advice or care you receive from your physician or other health care professional. If you have persistent health problems, or if you have additional questions, please consult with your doctor. If you have questions or need more information about your medication, please speak to your pharmacist. Kaiser Permanente does not endorse the medications or products mentioned. Any trade names listed are for easy identification only.

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