Researchers have established a connection between primary sclerosing cholangitis (PSC) and ulcerative colitis (UC). PSC is a rare condition that causes scarring in the bile ducts of the liver.

The scarring can ultimately lead to liver damage and potentially failure in some severe instances. Most people who have PSC also have UC.

While doctors don’t know exactly what causes PSC, they have established UC as a risk factor. Keep reading to learn more about the potential connections between these two conditions.

An estimated 60 to 80 percent of those with PSC have UC, while PSC affects about 5 percent of people with UC. Like PSC, UC doesn’t have a known cause or causes. But both conditions are the result of inflammation.

Doctors do know that people assigned male at birth tend to experience PSC at higher rates. They also think there’s a strong genetic component to both diseases, so having a family history of them may then increase the risk of both conditions.

In addition to these risk factors, there are some theories that UC could increase a person’s likelihood for experiencing PSC. Researchers think UC may allow bacteria to leak into the liver’s circulation, which can lead to inflammation, but. research hasn’t revealed the definite effects of UC on the liver.

There are several treatment approaches that may change when you have both UC and PSC. These include the following.


The results of several studies suggest those with PSC and UC typically have milder UC symptoms compared with those who don’t. However, the risk of colon cancer is higher in those with both conditions. As a result, this may change the recommended frequency of undergoing colonoscopies.


Those with UC and PSC are less likely to require medications doctors usually prescribe to treat more severe cases of UC. Examples include anti-tumor necrosis factor alpha (anti-TNFα) therapy and corticosteroids. But some people with both conditions may require treatment with these medications.


If UC worsens and causes significant damage, a doctor may recommend surgery to remove the diseased portion of the colon. This surgical approach may require an ileostomy, a procedure in which a surgeon will route a portion of the intestine to the abdominal wall. This gives the body time to heal and recover from significant inflammation.

After the healing time, a doctor may perform a restorative surgery. This is a procedure in which they reverse the ileostomy so your stool will exit via the rectum again. Studies of restorative surgeries for UC and PSC indicate no higher risk of failure compared with surgeries for people who don’t have PSC.

One smaller study found those with PSC and UC were more likely to experience abnormal colon tissue cells, such as precancerous and cancerous cells. Those with both UC and PSC are also at greater risk of the following:

Another review related to children with UC and PSC found children typically experienced less severe bowel disease and fewer hospital admissions related to their condition than those who didn’t. But the study’s authors also found that children with both conditions were more likely to experience colorectal cancer and growth impairment than children with UC alone.

Living with PSC and UC

Currently, there are no treatments for PSC, and the only cure for UC requires major surgery. But there are support groups and resources that can help you live better with both conditions. Examples of these resources include:

  • Crohn’s & Colitis Foundation. The Crohn’s & Colitis Foundation offers support programs, discussion boards, and the opportunity to ask experts questions.
  • United Ostomy Associates of America Inc. If you require an ostomy for treatment of your UC, this organization offers more than 300 support groups across the United States.
  • National Ulcerative Colitis Alliance. This organization offers a Facebook page that provides updates on the latest treatments for UC as well as ways to find support.
  • PSC Partners Seeking a Cure. This organization offers a patient registry that allows you to create a profile that will notify you of new research studies and treatments you may qualify for.
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Those with UC are at greater risk of PSC than of Crohn’s disease, another inflammatory bowel disease type. Researchers have theories about why people experience these two conditions together more commonly, but they haven’t established a specific link.

If you’ve had both conditions diagnosed, it’s important to seek support. From participating in research studies to talking with others, support is available to help you have a better quality of life.