Is it possible to be misdiagnosed with ulcerative colitis (UC)? How will I know if it’s a misdiagnosis or that I need a different treatment?

People often confuse UC with Crohn’s disease. Crohn’s is also a common inflammatory bowel disease (IBD). A few of the symptoms are similar, such as remissions and flare-ups.

To determine if you have UC or Crohn’s, visit your doctor and get tested. You may have to get repeating colonoscopy, or the doctor may order an X-ray of the small bowel to check if it has been affected. If it has, you may have Crohn’s disease. UC only impacts the colon. In contrast, Crohn’s could affect any part of your gastrointestinal (GI) tract.

What are the complications of untreated or improperly treated UC?

Improperly treated or untreated UC may cause abdominal pain, diarrhea, and rectal bleeding. Severe bleeding can trigger extreme fatigue, marked anemia, and shortness of breath. If your UC is so severe that it doesn’t respond to medical treatment, the doctor may recommend having your colon (also known as the large intestine) removed.

What are the available treatment options for UC? Are there some that work better than others?

You have the following treatment options for UC:

Anti-inflammatories

These drugs are usually the first course of action for treating UC. They include corticosteroids and 5-aminosalicylates (5-ASAs). Depending on which part of the colon is affected, you may take these drugs orally, as a suppository, or as an enema.

Antibiotics

Doctors prescribe antibiotics if they suspect there's an infection in your colon. However, people with UC are often advised not to take antibiotics because they can cause diarrhea.

Immunosuppressors

These medications can control inflammation. They include mercaptopurine, azathioprine, and cyclosporine. Stay in touch with your doctor if you take these. Side effects may impact your liver as well as your pancreas.

Biologic therapies

Biologic therapies include Humira (adalimumab), Remicade (infliximab), and Simponi (golimumab). They are also known as tumor necrosis factor (TNF) inhibitors. They control your abnormal immune response. Entyvio (vedolizumab) is used for the treatment of UC in individuals who do not respond to or cannot tolerate various other treatments.

Are there side effects of medication I should be aware of?

The following is a list of some common UC drugs with their typical side effects:

Anti-inflammatory drugs

Common side effects of 5-ASAs include vomiting, nausea, and loss of appetite.

In the long-term, corticosteroids can lead to side effects such as high blood pressure, increased risk of infection, high blood sugar levels, acne, weight gain, mood swings, cataracts, insomnia, and impaired bones.

Antibiotics

Cipro and Flagyl are usually prescribed to people with UC. Their common side effects include upset stomach, diarrhea, loss of appetite, and vomiting.

Immunosuppressors

6-mercaptopurine (6-MP) and azathioprine (AZA) can trigger side effects like reduced resistance to infection, skin cancer, liver inflammation, and lymphoma.

Biologic therapies

Biologic therapies include Humira (adalimumab), Remicade (infliximab), Entyvio (vedolizumab), Certolizumab (Cimzia), and Simponi (golimumab).

Common side effects include itching, redness, pain or mild swelling near the injection site, fever, headache, chills, and rashes.

How will I know if my treatment isn’t working properly?

If your medication isn’t working, you will experience persistent diarrhea, rectal bleeding, and abdominal pain — even after three to four weeks of being on the drug.

What are common triggers of UC?

Common triggers of UC include dairy, beans, coffee, seeds, broccoli, corn, and alcohol.

How common is UC? IBDs? Is it hereditary?

According to current estimates, about 1 to 1.3 million Americans are living with an IBD. If you have a family member who has an IBD, it can increase your risk of developing one.

  • The prevalence of UC is 238 for every 100,000 adults.
  • The prevalence of Crohn’s is about 201 for every 100,000 adults.

Are there natural remedies for UC? Alternative therapies? Do they work?

For individuals who can’t tolerate medication, there are a couple of other options.

Dietary remedies

Diets low in fiber and fat seem to be very useful in lowering the frequency of typical UC flare-ups. Eliminating certain foods from your diet can have the same effect. For example, dairy, alcohol, meat, and high-carb foods.

Herbal remedies

Various herbal remedies can be suitable for the treatment of UC. They include Boswellia, psyllium seed/husk, and turmeric.

Stress management

You can prevent relapses of UC with stress-relieving therapies, such as yoga or meditation.

Exercise

Adding regular physical activity to your routine can help to manage your UC.

Should I consider surgery?

About 25 to 40 percent of people with UC need surgery to remove the colon.

Surgery becomes necessary because of the following:

  • failure of medical treatment
  • extensive bleeding
  • severe side effects of certain medications

Where can find more information on UC or find support from people also living with the condition?

An incredible and evidence-based resource is the Crohn's and Colitis Foundation of America. It’s a nonprofit organization with tons of useful information on UC management.

You can also find more information by joining various UC social media communities. You will benefit from meeting and connecting with other people who are dealing with the exact same issues.

You can also help advocate by organizing meetings, events, and activities. These provide a chance for people affected by the disease to exchange tips, stories, and resources.


Dr. Saurabh Sethi is a board-certified physician specializing in gastroenterology, hepatology, and advanced interventional endoscopy. In 2014, Dr. Sethi completed his gastroenterology and hepatology fellowship at Beth Israel Deaconess Medical Center at Harvard Medical School. Soon after, he completed his advanced endoscopy fellowship at Stanford University in 2015. Dr. Sethi has been involved with multiple books and research publications, including over 30 peer-reviewed publications. Dr. Sethi’s interests include reading, blogging, traveling, and public health advocacy.