What is ulcerative colitis?
Ulcerative colitis (UC) is a type of inflammatory bowel disease (IBD). IBD comprises a group of diseases that affect the gastrointestinal tract.
UC occurs when the lining of your large intestine (also called the colon), rectum, or both becomes inflamed.
This inflammation produces tiny sores called ulcers on the lining of your colon. It usually begins in the rectum and spreads upward. It can involve your entire colon.
The inflammation causes your bowel to move its contents rapidly and empty frequently. As cells on the surface of the lining of your bowel die, ulcers form. The ulcers may cause bleeding and discharge of mucus and pus.
While this disease affects people of all ages, most people are diagnosed between the ages of 15 and 35. After age 50, another small increase in diagnosis for this disease is seen, usually in men.
The seriousness of UC symptoms varies among affected people. The symptoms can also change over time.
People diagnosed with UC may experience periods of mild symptoms or no symptoms at all. This is called remission. However, symptoms can return and be severe. This is called a flare-up.
Common symptoms of UC include:
- abdominal pain
- increased abdominal sounds
- bloody stools
- rectal pain
- weight loss
UC may cause additional conditions, such as:
Researchers believe that UC may be the result of an overactive immune system. However, it’s unclear why some immune systems respond by attacking the large intestines and not others.
Factors that may play a role in who develops UC include:
- Genes. You may inherit a gene from a parent that increases your chance.
- Other immune disorders. If you have one type of immune disorder, your chance for developing a second is higher.
- Environmental factors. Bacteria, viruses, and antigens may trigger your immune system.
Different tests can help your doctor diagnose UC. This disorder mimics other bowel diseases such as Crohn’s disease. Your doctor will run multiple tests to rule out other conditions.
Tests to diagnose UC often include:
- Stool test. A doctor examines your stool for certain inflammatory markers, blood, bacteria, and parasites.
- Endoscopy. A doctor uses a flexible tube to examine your stomach, esophagus, and small intestine.
- Colonoscopy. This diagnostic test involves insertion of a long, flexible tube into your rectum to examine the inside of your colon.
- Biopsy. A surgeon removes a tissue sample from your colon for analysis.
- CT scan. This is a specialized X-ray of your abdomen and pelvis.
Blood tests are often useful in the diagnosis of UC. A complete blood count looks for signs of anemia (low blood count). Other tests indicate inflammation, such as a high level of C-reactive protein and a high sedimentation rate. Your doctor may also order specialized antibody tests.
Were you recently diagnosed? Here’s what you need to know about treating and living with UC.
UC is a chronic condition. The goal of treatment is to reduce the inflammation that causes your symptoms so you can prevent flare-ups and have longer periods of remission.
Which medication you’ll take will depend on you and how severe your symptoms are.
For mild symptoms, your doctor may prescribe a medication to reduce inflammation and swelling. This will help alleviate many symptoms.
These types of medications include:
- mesalamine (Asacol and Lialda)
- sulfasalazine (Azulfidine)
- balsalazide (Colazal)
- olsalazine (Dipentum)
- 5-aminosalicylates (5-ASA)
Some people may need corticosteroids to help reduce inflammation, but these can have adverse effects, and doctors try to limit their use. If an infection is present, you may need antibiotics.
If you have moderate to severe symptoms, a doctor may prescribe a type of drug known as a biologic. Biologics are antibody medications that help block inflammation. Taking these can help prevent a symptom flare.
Effective options for most people include:
- infliximab (Remicade)
- vedolizumab (Entyvio)
- ustekinumab (Stelara)
- tofacitinib (Xeljanz)
A doctor may also prescribe an immunomodulator. These change the way the immune system works. Examples include methotrexate, 5-ASA, and thiopurine. However, current guidelines don’t recommend these as a standalone treatment.
In 2018, the Food and Drug Administration (FDA) approved the use of tofacitinib (Xeljanz) as a treatment for UC. Initially used to treat rheumatoid arthritis, this drug targets cells responsible for inflammation. It’s the first oral medication approved for the long-term treatment of UC.
If your symptoms are severe, you’ll need to be hospitalized to correct the effects of dehydration and loss of electrolytes that diarrhea causes. You may also need to replace blood and to treat any other complications.
Researchers continue to look for new treatments each year. Learn more about the newest UC treatments.
Surgery is necessary if you experience large blood loss, chronic and debilitating symptoms, perforation of your colon, or a severe blockage. A CT scan or colonoscopy can detect these serious problems.
Surgery involves removing your entire colon with the creation of a new pathway for waste. This pathway can be out through a small opening in your abdominal wall or redirected back through the end of your rectum.
To redirect waste through your abdominal wall, your surgeon will make a small opening in the wall. The tip of your lower small intestine, or the ileum, is then brought to the skin’s surface. Waste will drain through the opening into a bag.
If waste is able to be redirected through your rectum, your surgeon removes the diseased part of your colon and rectum but retains the outer muscles of your rectum. The surgeon then attaches your small intestine to the rectum to form a small pouch.
After this surgery, you’re able to pass stool through your rectum. Bowel movements will be more frequent and watery than normal.
One in five people with UC will require surgery in their lifetime. Read more about each of the surgical options and their long-term effects.
Some of the medications prescribed to treat UC can have serious side effects. When traditional treatments aren’t well tolerated, some people turn to natural remedies to manage UC.
Natural remedies that may help treat UC include:
- Boswellia. This herb is found in the resin underneath Boswellia serrata tree bark, and research suggests it stops some of the chemical reactions in the body that can cause inflammation.
- Bromelain. These enzymes are found naturally in pineapples, but they’re also sold as supplements. They may ease symptoms of UC and reduce flares.
- Probiotics. Your intestines and stomach are home to billions of bacteria. When the bacteria are healthy, your body is better able to ward off inflammation and symptoms of UC. Eating foods with probiotics or taking probiotic supplements can help boost the health of the microbial flora in your gut.
- Psyllium. This fiber supplement can help keep bowel movements regular. This may alleviate symptoms, prevent constipation, and make eliminating waste easier. However, many people with IBD can experience worsening abdominal cramping, gas, and bloating when they consume fiber during a flare-up.
- Turmeric. This golden yellow spice is chock-full of curcumin, an antioxidant that has been shown to reduce inflammation.
Many natural remedies can be used in conjunction with other UC treatments. Discover which ones might be safe for you and what questions you should ask your doctor.
There’s no specific diet for UC. Each person reacts to food and drink differently. However, a few general rules may be helpful for people trying to avoid a flare-up:
- Eat a low fat diet. It’s not clear why a low fat diet is beneficial, but it’s known that foods high in fat commonly cause diarrhea, especially in those with IBD. Eating more low fat foods may delay flares. When you do eat fat, pick healthier options like olive oil and omega-3 fatty acids.
- Take in more vitamin C. This vitamin may have a protective effect on your intestines and help them heal or recover faster after a flare. People who eat diets rich in vitamin C have prolonged periods of UC remission. Vitamin C-rich foods include parsley, bell peppers, spinach, and berries.
- Eat more fiber. During a flare, bulky, slow-moving fiber is the last thing you want in your intestines. During remission, however, fiber can help you stay regular. It may also improve how easily you can void during bowel movements.
Make a food diary
Creating a food diary is a smart way to begin to understand which foods affect you. For several weeks, closely track what you eat and how you feel in the hours after. Record details of bowel movements or any symptoms you might experience.
In that span of time, you can likely detect trends between discomfort or stomach pain and certain problematic foods. Try eliminating those foods to see if symptoms improve.
You may be able to manage mild symptoms of UC by avoiding foods that upset your gastrointestinal tract.
UC and Crohn’s disease are the most common forms of inflammatory bowel disease (IBD). Both diseases are thought to be the result of an overactive immune system.
They also share many similar symptoms, including:
- abdominal pain
However, UC and Crohn’s disease do have distinct differences.
These two diseases impact different portions of the gastrointestinal (GI) tract.
Crohn’s disease may affect any part of the GI tract, from the mouth to the anus. It’s most often found in the small intestine. UC impacts only the colon and the rectum.
Response to treatment
Similar medications are prescribed to treat both conditions. Surgery is also a treatment option. It’s a last resort for both conditions, but it can actually be a cure for UC, whereas it’s it only a temporary therapy for Crohn’s.
The two conditions are similar. Understanding the key differences between UC and Crohn’s disease can help you obtain a proper diagnosis.
Currently, there’s no nonsurgical cure for UC. Treatments for the inflammatory disease aim to extend periods of remission and make flare-ups less severe.
For people with severe UC, curative surgery is a possible treatment. Removing the entire large intestine (total colectomy) will end the symptoms of the disease.
This procedure requires your doctor to create a pouch on the outside of your body where waste can empty. This pouch can become inflamed and cause side effects.
For that reason, some people choose to have only a partial colectomy. In this surgery, doctors remove only parts of the colon that are affected by the disease.
While these surgeries can help ease or end symptoms of UC, they have adverse effects and possible long-term complications.
A colonoscopy is a test that doctors can use to diagnose UC. They can also use the test to determine the severity of the disease and screen for colorectal cancer.
Before the procedure, your doctor will likely instruct you to reduce solid foods and switch to a liquid-only diet then fast for a period of time before the procedure.
Typical colonoscopy prep involves taking a laxative the evening before the test, too. This helps eliminate any waste still in the colon and rectum. Doctors can examine a clean colon more easily.
During the procedure, you will lie on your side. Your doctor will give you a sedative to help you relax and prevent any discomfort.
Once the medication takes effect, the doctor will insert a lighted scope called a colonoscope into your anus. This device is long and flexible so it can move easily through your GI tract. The colonoscope also has a camera attached so your doctor can see inside the colon.
During the exam, your doctor will look for signs of inflammation. They will check for precancerous growth called polyps. Your doctor may also remove a small piece of tissue, a procedure called a biopsy. The tissue can be sent to a laboratory for further examination.
If you’ve been diagnosed with UC, your doctor may do periodic colonoscopies to monitor inflammation, damage to your intestines, and healing progress.
A colonoscopy is an important tool in detecting colorectal cancer as well. Find out why that’s so important for people who’ve been diagnosed with UC.
Colitis refers to inflammation of the inner lining of the large intestine (colon). Colitis causes symptoms such as abdominal pain and cramping, bloating, and diarrhea.
An inflamed colon can be caused by several conditions. UC is one possible cause. Other possible causes of colitis include infection, reaction to certain medications, Crohn’s disease, or an allergic reaction.
To diagnose the cause of colitis, your doctor will conduct a series of tests. These tests will help them understand what other symptoms you’re experience and rule out conditions based on what you’re not experiencing.
Treatment for colitis will depend on the underlying cause and other symptoms you have.
No, UC isn’t contagious.
Some causes of colitis or inflammation in the large intestine can be contagious though. That includes inflammation caused by bacteria and viruses.
However, UC isn’t caused by anything that can be shared with another person.
According to the Crohn’s and Colitis Foundation, 1 in 10 people under the age of 18 are diagnosed with IBD. Indeed, most people diagnosed with the disease will be under age 30. For children with UC, a diagnosis is more likely after age 10.
Symptoms in children are similar to symptoms in older individuals. Children may experience diarrhea with blood, stomach pain, abdominal cramping, and fatigue.
In addition, they may experience issues compounded by the condition. These symptoms include:
- anemia due to blood loss
- malnutrition from poor eating
- unexplained weight loss
UC can significantly impact a child’s life, especially if the condition isn’t treated and managed properly. Treatments for children are more limited because of possible complications. For example, medicated enemas are rarely used with children.
However, children with UC may be prescribed medications that reduce inflammation and prevent immune system attacks on the colon. For some children, surgery may be necessary to manage symptoms.
If your child has been diagnosed with UC, it’s important you work closely with their doctor to find treatments and lifestyle changes that can help your child. Read these tips for parents and children dealing with UC.
UC increases your risk for developing colon cancer. The longer you have the disease, the higher your risk for this cancer.
Because of this increased risk, your doctor will perform a colonoscopy and check for cancer when you receive your diagnosis.
Regular screenings help lower your risk for colon cancer. Repeat screenings every one to three years are recommended thereafter. Follow-up screenings can detect precancerous cells early.
Other complications of UC include:
- thickening of the intestinal wall
- sepsis, or blood infection
- severe dehydration
- toxic megacolon, or a rapidly swelling colon
- liver disease (rare)
- intestinal bleeding
- kidney stones
- inflammation of your skin, joints, and eyes
- rupture of your colon
- ankylosing spondylitis, which involves inflammation of joints between your spinal bones
Complications of UC are worse if the condition isn’t properly treated. Read about these six common complications of unmanaged UC.
Most people with UC don’t have a family history of the condition. However, about 12 percent with the disease do have a family member with the disease.
UC can develop in a person of any race, but it’s more common in white people. If you’re an Ashkenazi Jew, you have a greater chance of developing the condition than most other groups.
If you decide not to treat UC, you increase your risk for some serious complications.
There’s no solid evidence that indicates that what you eat affects UC. You may find that certain foods aggravate your symptoms when you have a flare-up.
Practices that may help include:
- drinking small amounts of water throughout the day
- eating smaller meals throughout the day
- limiting your intake of high fiber foods
- avoiding fatty foods
- lowering your intake of milk if you’re lactose intolerant
Also, ask your doctor if you should take a multivitamin.
The only cure for UC is removal of the entire colon and rectum. Your doctor will usually begin with medical therapy unless you have a severe complication initially that requires surgery. Some may do well with nonsurgical therapy, but many will eventually require surgery.
If you have this condition, your doctor will need to monitor it, and you’ll need to carefully follow your treatment plan throughout your life.