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Over the past seven-plus years, Prime Minister Shinzo Abe has survived headline-dominating political scandals, relentless questioning by opposition lawmakers and plummeting approval ratings. But in the end, it was his illness that felled his administration for a second time.

Abe’s surprise decision to end his record-breaking tenure was triggered by a chronic inflammatory bowel disease known as ulcerative colitis — an ailment he has battled since adolescence. It’s the same illness that compelled him to end his first, one-year stint in disgrace in 2007.

Ulcerative colitis is essentially an incurable condition and is designated as an “intractable disease” by the health ministry. It causes ulcers and sores in the large intestine, leading to symptoms such as bloody stool, diarrhea and acute stomach aches and potentially extending to complications such as fever, weight loss and anemia, according to the Japan Intractable Diseases Information Center. It can also increase the risk of bowel cancer.

The potentially debilitating illness is said to affect an estimated 160,000 to 220,000 patients in Japan and most commonly strikes those in their 20s to 30s, although children and older people can develop it as well. The cause remains a mystery, but irregularities in the immune system, changes in dietary habits and hereditary factors are often cited as possible reasons.

Although incurable, the disease can be suppressed by medicine. Abe himself swept back into power in December 2012 thanks to what was then hailed as an innovative drug known as Asacol that became available in Japan in 2009.

Medicine works in most cases, allowing patients to recover to the point where they can go about their daily lives with no major issues. But depending on the severity, patients may need to undergo surgery that involves removing the large intestine in its entirety, the Japan Intractable Diseases Information Center says.

On Friday, Abe, 65, said at a news conference that he had been able to “thoroughly control” his underlying condition during the nearly eight years he has been in office.

Prime Minister Shinzo Abe arrives at the Prime Minister's Office in Tokyo on Friday. | REUTERS
Prime Minister Shinzo Abe arrives at the Prime Minister’s Office in Tokyo on Friday. | REUTERS

But a regular checkup in June found signs of its return, he said. Last month saw his health deteriorate further to the point that he felt “severely exhausted.” A visit to a hospital earlier this month confirmed that the disease had recurred.

Abe said at the news conference that he planned to add another medicine to his current regimen. The new one, he said, has so far proven effective, but since treatment is likely to remain a long-haul battle, he decided staying on as leader of the world’s third-largest economy was too risky. Even after stepping down, he said he would continue to support the incoming administration as a member of the ruling Liberal Democratic Party.

For Abe, ulcerative colitis has been the most taxing nemesis of his life.

In a medical publication issued by the Japanese Society of Gastroenterology in August 2012, Abe candidly reflected on the first time he, as a junior high school student, experienced an episode of the disease, describing the horror he felt at the sight of a “toilet drenched in red” due to bouts of bloody feces and diarrhea.

It wasn’t until 10 years later, as a young Kobe Steel employee, that he was officially diagnosed with ulcerative colitis, setting off what would become decades of treatment, he said in an interview with the publication.

According to the story, his first major battle with the illness as a politician occurred when he was running for the Lower House for the second time in 1996. On the campaign trail, “I would be frequently assailed by strong urges to defecate, but there was no way I could just get off the campaign van so I had to hold tight while perspiring severely. It was one hell of an ordeal.”

Two years later, the condition worsened so much he had to rely on an intravenous drip and lost more than 10 kg, resulting in three months of hospitalization. After finding a medicine that suited him, however, he was able to regain his strength and forge ahead with his political career.

But his first stint as prime minister from 2006 to 2007 was “tens of times more exhausting” than he had anticipated, which exacerbated the ailment and made it nearly uncontrollable, he said.

“It was in its worst condition ever, and there was no sign of recovery,” he recalled. “So I expressed my intention to quit.”

Five years later, a reinvigorated Abe once again found himself in the limelight as head of the then-opposition LDP.

On a Facebook post from October that year, Abe launched a tirade against TV commentators who appeared to have made light of his illness, noting how they said it had been “childish” of him to quit as prime minister in 2007 just because he had a “weak stomach.”

“I want them to know such excessively derisive comments are hurting the feelings of many who suffer from the same illness,” he wrote. “Fortunately, I’ve made a full recovery, but there are lots of others struggling.”

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