Ulcerative Colitis

Ulcerative Colitis

Causes, Symptoms and Treatments

Learn more about the symptoms, causes, diagnosis, and drugs used to treat Ulcerative Colitis.

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This content is intended for US audiences only

Navin Khosla NowPatientGreen tick
Updated on 7 Jun 2024

Ulcerative colitis is a chronic inflammatory bowel disease (IBD) that affects the large intestine and causes inflammation and ulcers in the inner lining of the colon. It is estimated that around 1 million Americans are currently living with ulcerative colitis, making it the most common type of inflammatory bowel disease. This condition can have a significant impact on a person’s quality of life, with symptoms ranging from mild to severe. In this comprehensive guide, we will explore the symptoms, causes, diagnosis, treatment options, and complications associated with ulcerative colitis.

Introduction to Ulcerative Colitis

The digestive system is made up of the gastrointestinal tract (digestive tract), liver, pancreas, and gallbladder. The GI tract is essentially a long, twisting tube that leads from the mouth to the anus. Ulcerative colitis is a chronic inflammatory bowel disease characterized by inflammation and ulcers in the large intestine, specifically the colon and rectum. It is one of the two main types of IBD, the other being Crohn’s disease. While the exact cause of ulcerative colitis is unknown, it is believed to involve a combination of genetic, immune system, microbiome, and environmental factors.

The disease typically develops during adolescence or early adulthood, but it can occur at any age. It affects men and women equally and is more prevalent in certain ethnic groups, such as individuals of Ashkenazi Jewish descent. Ulcerative colitis is a relapsing and remitting condition, meaning that symptoms can flare up and then subside periodically.

Symptoms of Ulcerative Colitis

The symptoms of ulcerative colitis can vary from person to person and may range from mild to severe. Common symptoms include:

  • Rectal pain
  • Rectal bleeding
  • Bloody diarrhea, often with blood or mucus
  • Abdominal pain and cramping
  • Urgency to have bowel movements
  • Fatigue and weakness
  • Weight loss
  • Loss of appetite
  • Fever
  • Inability to defecate despite urgency (tenesmus)
  • Failure to grow in children

In some cases, ulcerative colitis can also present with extra-intestinal symptoms, affecting other parts of the body. These may include joint pain, skin rashes, eye inflammation, and mouth ulcers. The severity and frequency of symptoms can fluctuate, with periods of remission and flare-ups.

Causes and Risk Factors

The exact cause of ulcerative colitis is not fully understood, but it is believed to involve a combination of genetic, immune system, microbiome, and environmental factors. Individuals with a family history of ulcerative colitis or other autoimmune diseases are at a higher risk of developing the condition. Certain ethnic groups, such as individuals of Ashkenazi Jewish descent, also have an increased risk.

The immune system plays a significant role in ulcerative colitis. It is thought that an abnormal immune response leads to inflammation and damage to the colon’s lining. The microbiome, which consists of the bacteria, viruses, and fungi in the digestive system, may also contribute to the development of ulcerative colitis. Environmental factors, such as stress and certain dietary factors, may trigger flare-ups but are not considered direct causes.

Diagnosing Ulcerative Colitis

Diagnosing ulcerative colitis involves a thorough evaluation of symptoms, medical history, and various diagnostic tests. A healthcare provider will assess the patient’s symptoms, perform a physical examination, and order specific tests to confirm the diagnosis. These tests may include:

  • Blood tests: These can help determine if there are signs of inflammation or anemia (a low red blood cell count
  • Stool tests: These assess for the presence of blood, infections, or other abnormalities
  • Endoscopy: Common endoscopic tests to diagnose ulcerative colitis include a colonoscopy or a flexible sigmoidoscopy. Your doctor will insert the endoscope through your rectum to take tissue samples (biopsies) and see inside your colon
  • Imaging scans: Specialized X-rays (called a barium enema) to show signs of inflammation in the colon, CT scans (computed tomography scans), or MRI scans may be used to assess the extent of inflammation or detect complications, especially with moderate and severe ulcerative colitis

A definitive diagnosis of ulcerative colitis is made based on the combination of clinical symptoms, physical examination findings, and the results of these diagnostic tests.

Types of ulcerative colitis

The type of ulcerative colitis you have depends on where the inflammation is in your colon. Inflammation normally starts in your rectum (close to your anus). Inflammation then spreads and affects part or all of your colon. The different types of ulcerative colitis include:

  • Ulcerative proctitis: Inflammation affecting your rectum
  • Left-sided colitis: Inflammation from the rectum through the sigmoid and descending colon. Symptoms include bloody diarrhea, abdominal pain and cramping on the left side, and the urgency to defecate, but the inability to do so (tenesmus)
  • Pancolitis: Inflammation affecting the entire colon causing bloody diarrhea that may be severe, abdominal pain and cramps, tiredness, and weight loss
  • Ulcerative proctitis: Inflammation is confined to the rectum area. Rectal bleeding may be the only sign of this type of ulcerative colitis
  • Proctosigmoiditis: Inflammation of the rectum and sigmoid colon. Symptoms may include bloody diarrhea, abdominal pain and cramps, and the inability to defecate despite wanting to (tenesmus)

Ulcerative colitis may range from mild to severe, depending on your symptoms. Fulminant ulcerative colitis, the most serious form of ulcerative colitis, is rare. It can, however, cause life-threatening complications that will require urgent medical treatment.

Treatment Options for Ulcerative Colitis

The primary goals of ulcerative colitis treatment are to reduce inflammation, manage symptoms, achieve and maintain remission, and improve quality of life. The treatment approach may vary depending on the severity of the disease and the individual’s response to therapy. Treatment options for ulcerative colitis include medication therapy and, in some cases, surgical interventions.

Medications for Managing Symptoms

Medications are often the first line of treatment for ulcerative colitis and aim to reduce inflammation and control symptoms. Several types of medications may be used, including:

  • Aminosalicylates: These anti-inflammatory drugs, such as mesalamine or sulfasalazine, are commonly used to manage mild to moderate symptoms
  • Corticosteroids: These powerful anti-inflammatory drugs (such as prednisone), suppress the immune system and are primarily used for short-term symptom control during flare-ups, where inflammation has not responded to other treatments. Corticosteroids are not used long-term due to their side effects
  • Immunomodulators: Medications like azathioprine or methotrexate work by suppressing the immune system to reduce inflammation
  • Biologic therapies: These newer medications, such as infliximab or adalimumab, target specific molecules involved in the immune response and are reserved for more severe cases or when other treatments have been ineffective

In a number of studies, probiotics have been shown to be useful in the treatment of ulcerative colitis. Certain types of probiotics such as E. coli Nissle show the ability to induce remission in some patients for up to 1 year.

Surgical Interventions

Surgery may be necessary in cases where medications fail to control symptoms or if complications arise. Surgical options for ulcerative colitis include:

  • Colectomy: This procedure involves the removal of the entire colon and rectum, but leaves your anus intact. It may be done in one or two stages. The surgeon may create an ileostomy or an ileal pouch (a section of the small intestine attached to your anus) to restore normal bowel function
  • Proctocolectomy: This procedure involves the removal of the colon and rectum, including the anus. An ileostomy or ileoanal pouch is created to divert stools

Surgery can provide long-term remission and may be curative for ulcerative colitis, but it is typically reserved for cases where medical management has been unsuccessful or in the presence of complications such as severe bleeding, perforation, or the development of colon cancer.

Diet and Nutrition Recommendations

Diet and nutrition play an essential role in managing ulcerative colitis symptoms and supporting overall health. While diet alone cannot cure the condition, certain dietary modifications may help alleviate symptoms and improve well-being. It is important for individuals with ulcerative colitis to work with a registered dietitian or healthcare provider to develop a personalized diet plan. Some general recommendations include:

  • Eating a well-balanced diet rich in fruits, vegetables, lean proteins, and whole grains
  • Avoiding trigger foods that may worsen symptoms, such as spicy foods, high-fiber foods, and dairy products for those who are lactose intolerant
  • Staying hydrated by drinking plenty of fluids throughout the day
  • Considering nutritional supplements or vitamins if nutrient deficiencies are present

It is important to note that dietary recommendations may vary from person to person, and what works for one individual may not work for another. Consulting with a healthcare professional is crucial to ensure appropriate dietary management.

Complications of Ulcerative Colitis

Ulcerative colitis can lead to various complications that may require additional monitoring and treatment. These complications include:

  • Colon cancer: Individuals with ulcerative colitis have an increased risk of developing colorectal cancer, particularly if the disease affects a larger portion of the colon and if the condition has been present for a long duration
  • Perforation: In rare cases, severe inflammation can lead to a hole or perforation in the colon, requiring immediate medical attention
  • Toxic megacolon: This life-threatening condition occurs when the colon becomes severely inflamed and dilated, leading to potential rupture and infection
  • Malnutrition and nutrient deficiencies: Chronic inflammation and poor absorption of nutrients can result in malnutrition and deficiencies in vitamins and minerals
  • Osteoporosis: Prolonged steroid use and chronic inflammation can lead to weakened bones and an increased risk of osteoporosis as a side effect
  • Poor development and growth in young people and children. Puberty may be delayed in kids with ulcerative colitis

Ulcerative colitis may also cause other problems, such as eye problems, rashes, arthritis, joint pain, and liver disease. It is important for individuals with ulcerative colitis to be aware of these potential complications and undergo regular monitoring and surveillance as recommended by their healthcare provider.

Ulcerative Colitis vs. Crohn’s Disease vs. Irritable Bowel

Other diseases of the gut can have some of the same symptoms:

  • Ulcerative colitis only affects the large intestine and its lining
  • Crohn’s disease will cause inflammation, but will also affect other parts of your digestive tract
  • Irritable bowel syndrome has some similar symptoms to ulcerative colitis but does not cause ulcers or inflammation. Irritable bowel syndrome is actually a problem with the muscles in the intestines

Lifestyle Management and Coping Strategies

Living with ulcerative colitis can be challenging, but there are strategies and lifestyle modifications that can help manage symptoms and improve overall well-being. Some tips for managing ulcerative colitis include:

  • Stress management: Stress can trigger flare-ups, so finding effective stress management techniques such as exercise, relaxation exercises, and therapy can be beneficial
  • Regular exercise: Engaging in regular physical activity can help reduce inflammation, promote overall health, and manage stress
  • Support network: Building a support network of friends, family members, or support groups can provide emotional support and a safe space for sharing experiences and coping strategies
  • Open communication with healthcare providers: Regular communication with healthcare providers is crucial for monitoring symptoms, adjusting treatment plans, and addressing any concerns or questions

Each individual may have unique coping strategies that work best for them, and it is important to find a personalized approach to managing the physical and emotional aspects of living with ulcerative colitis.

Research and Clinical Trials

Ongoing research and clinical trials are essential for advancing our understanding of ulcerative colitis and exploring new treatment options. The National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK) and other organizations conduct and support research into ulcerative colitis and related conditions. Participation in clinical trials may provide individuals with access to innovative treatments and contribute to the broader scientific knowledge base.

Individuals interested in participating in clinical trials should discuss this option with their healthcare provider and explore reputable research institutions and organizations for opportunities.


Ulcerative colitis is a chronic inflammatory bowel disease that can significantly impact a person’s daily life. Understanding the symptoms, causes, diagnosis, treatment options, and potential complications is crucial for effectively managing the condition. With proper medical care, lifestyle modifications, and support, individuals with ulcerative colitis can lead fulfilling lives and achieve long-term remission. If you suspect you may have ulcerative colitis or have been diagnosed with the condition, it is important to work closely with healthcare providers to develop a personalized treatment plan that addresses your specific needs.


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