Ulcerative colitis (UC) is a type of inflammatory bowel disease (IBD). Symptoms can range from mild to severe. In some cases, you may not have any symptoms. Treatment focuses on managing or reducing symptoms.
Ulcerative colitis (UC) is a type of inflammatory bowel disease (IBD). IBD comprises a group of diseases that affect the gastrointestinal (GI) tract.
UC occurs when the lining of your large intestine (also called the colon), rectum, or both become inflamed.
This inflammation produces tiny sores called ulcers on the lining of your colon. Inflammation 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 condition affects people of all ages, most people develop UC between ages 15 and 30 years old, according to the American Gastroenterological Association. After 50 years old, there’s another small increase in diagnosis of IBD, usually in men.
The seriousness of UC symptoms varies among people who have the condition. 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 become 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 symptoms, 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 others don’t.
Factors that may play a role in who develops UC include:
- Genes. You may inherit a gene from a parent that increases your chance of having UC.
- Other immune disorders. If you have one type of immune disorder, your chance of developing a second is higher.
- Environmental factors. Bacteria, viruses, and antigens may trigger your immune system.
UC can be categorized according to the parts of the GI tract that it affects.
- Ulcerative proctitis. In ulcerative proctitis, only the rectum is inflamed. It’s considered a mild form of UC.
- Left-sided colitis. Left-sided colitis causes inflammation in the area between the splenic flexure (near the upper part of the colon, where it bends) and the last section of the colon. The last section of the colon, known as the distal colon, includes the descending colon and sigmoid colon. Left-sided colitis is also known as distal ulcerative colitis.
- Proctosigmoiditis. Proctosigmoiditis is a form of left-sided colitis. It causes inflammation in the rectum and sigmoid colon.
- Extensive colitis. Extensive colitis, also known as pancolitis, causes inflammation throughout the entire colon. It’s considered a severe form of UC.
Different tests can help a doctor diagnose UC. UC mimics other bowel diseases such as Crohn’s disease. A doctor will order multiple tests to rule out other conditions.
Tests to diagnose UC often include:
- Blood tests. Blood tests are often useful in the diagnosis of UC. A complete blood count looks for signs of anemia (a low red blood cell count). Other tests indicate inflammation, such as a high level of C-reactive protein and a high sedimentation rate. A doctor may also order specialized antibody tests.
- Stool test. A doctor examines your stool for certain inflammatory markers, blood, bacteria, and parasites.
- CT scan. This is a specialized X-ray of your abdomen and pelvis.
- Endoscopy. A doctor uses a flexible tube to examine your stomach, esophagus, and small intestine.
- Biopsy. A surgeon removes a tissue sample from your colon for analysis.
- Flexible sigmoidoscopy. Flexible sigmoidoscopy is a type of endoscopy. During this test, a doctor inserts a long, flexible tube into your rectum so that they can examine it, the sigmoid colon, and part of the descending colon. Flexible sigmoidoscopy is also known as sigmoidoscopy.
- Colonoscopy. During a colonoscopy, a doctor inserts a lighted scope called a colonoscope into your rectum to examine the inside of your colon. It’s also a type of endoscopy.
Were you recently diagnosed? Here’s what you need to know about treating and living with UC.
Doctors can use a colonoscopy to diagnose UC or determine the severity of the condition.
Before the procedure, a doctor will likely instruct you to reduce solid foods and switch to a liquid-only diet. Then you’ll fast for a period of time before the procedure.
Typical colonoscopy prep involves taking a laxative the evening before the procedure, too. This helps eliminate any waste still in the colon and rectum. Doctors can examine a clean colon more easily.
During the procedure, you’ll 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 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, the doctor will look for signs of inflammation and check for precancerous growth called polyps. The doctor may also perform a biopsy. The tissue can be sent to a laboratory for further examination.
If you’ve been diagnosed with UC, a doctor may conduct 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.
If you’ve been diagnosed with UC, see a doctor if you experience symptoms such as:
- severe abdominal pain or cramping
- severe rectal bleeding
- chronic diarrhea that’s difficult to treat
- high fever
- swelling of areas such as the skin or joints
These symptoms are sometimes associated with UC complications.
If you haven’t been diagnosed with UC, see a doctor if you experience multiple symptoms of the condition. They can help determine whether you may have UC or another bowel disease.
UC is a chronic condition. The goal of treatment is to reduce the inflammation that causes your symptoms to prevent flare-ups and have longer periods of remission.
Which medication you’ll take will depend on your specific situation, including 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 5-aminosalicylates (5-ASA drugs) such as:
- mesalamine (Asacol HD, Lialda)
- sulfasalazine (Azulfidine)
- balsalazide (Colazal)
- olsalazine (Dipentum)
Some people may need corticosteroids to help reduce inflammation, but these can have adverse effects, so 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 medication known as a biologic. Biologics are made from antibodies and help block inflammation. Taking these can help prevent a symptom flare-up.
Effective options for most people include:
- adalimumab (Humira)
- golimumab (Simponi)
- infliximab (Remicade)
- tofacitinib (Xeljanz)
- ustekinumab (Stelara)
- vedolizumab (Entyvio)
A doctor may also prescribe an immunomodulator. These change the way the immune system works. Examples include methotrexate, 5-ASA drugs, and thiopurine drugs. However, current guidelines don’t recommend these as standalone treatments.
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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.
Ulcerative colitis surgery
Surgery is necessary if you experience:
- substantial blood loss
- chronic and debilitating symptoms
- perforation of your colon
- a severe blockage
A CT scan or colonoscopy can detect these serious problems.
Surgery typically involves removing your entire colon and rectum as well as creating a new pathway for waste. This pathway can be out through a small opening in your abdominal wall.
To redirect waste through your abdominal wall, the 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.
In other types of surgery, the 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.
In certain procedures, the anus is also removed. 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 are not well tolerated, some people turn to natural remedies to manage UC.
Natural remedies that may help relieve UC symptoms include:
- Boswellia. This herb is found in the resin underneath Boswellia serrata tree bark. Research suggests it stops some of the chemical reactions in the body that can cause inflammation.
- Bromelain. This enzyme mixture is found naturally in pineapples, but it’s also sold as a supplement. It may help 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’s been shown to reduce inflammation.
Keep in mind that these natural remedies have not undergone clinical trials and are not necessarily endorsed by professional organizations or their clinical guidelines.
Many of these 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 useful 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 people with IBD. Eating more low fat foods may delay flare-ups. 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-up. 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-up, 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 eliminate waste products during bowel movements.
Making 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 removing those foods from your diet to see if your symptoms improve.
You may be able to manage mild symptoms of UC by avoiding foods that upset your GI tract. Discover the foods that are most likely to cause issues if you have UC.
Below are some frequently asked questions people have about UC.
What’s the difference between ulcerative colitis and Crohn’s disease?
UC and Crohn’s disease are the most common forms of IBD. Both conditions are thought to be the result of an overactive immune system.
They also share many symptoms, including:
- abdominal pain
However, UC and Crohn’s disease do have distinct differences. Understanding the key differences between them can help you obtain a proper diagnosis.
These two conditions affect different portions of the 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 only affects the large intestine (colon) and 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 be a cure for UC, whereas it’s only a temporary therapy for Crohn’s.
What’s the difference between ulcerative colitis and colitis?
Colitis refers to inflammation of the inner lining of the 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:
- reaction to certain medications
- Crohn’s disease
- an allergic reaction
To diagnose the cause of colitis, a doctor will order 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.
Is ulcerative colitis curable?
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 treatment option. Removing the entire large intestine (as in a total colectomy) will end the symptoms of UC.
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, your doctor only removes the parts of the colon that are affected by UC.
While these surgeries can help ease or end symptoms of UC, they can have adverse effects and possible long-term complications. Read more about these issues to determine if surgery is an option for you.
Is ulcerative colitis contagious?
UC is not contagious.
Some causes of colitis or inflammation in the colon can be contagious, though. That includes inflammation caused by bacteria and viruses.
However, UC is not caused by anything that can be transmitted to another person.
According to one study of IBD in the United States, 1 in 1,299 children between ages 2 and 17 years old were affected by the condition in 2016. Crohn’s disease was twice as common as UC, and boys were more likely to have IBD than girls.
For children with IBD, a diagnosis is more likely after 10 years old.
UC symptoms in children are similar to symptoms in older individuals. Children may experience bloody diarrhea, abdominal pain and cramping, and fatigue.
In addition, they may experience issues compounded by the condition, such as:
- anemia due to blood loss
- malnutrition from poor eating
- unexplained weight loss
UC can have a significant effect on 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 as a treatment method in 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 that you work closely with their doctor to find treatments and lifestyle changes that can help. Check out these tips for parents and children dealing with UC.
UC increases your risk of developing colon cancer. The longer you have the disease, the higher your risk of this cancer.
Because of this increased risk, your doctor will perform a colonoscopy and check for cancer when you receive your diagnosis.
Other complications of UC include:
- thickening of the intestinal wall
- intestinal bleeding
- sepsis, or blood infection
- severe dehydration
- toxic megacolon, or a rapidly swelling colon
- rupture of your colon
- inflammation of your skin, joints, and eyes
- ankylosing spondylitis, which involves inflammation of joints between your spinal bones
- kidney stones
- liver disease, which is rare
Complications of UC are worse if the condition isn’t properly treated. Learn more about the complications of unmanaged UC.
Most people with UC don’t have a family history of the condition. However, about 12 percent of people with UC do have a family member with IBD, according to research from 2014.
UC can develop in a person of any race, but it’s more common in white people. If you’re of Ashkenazi Jewish descent, you have a greater chance of developing the condition than most other groups.
Young people with IBD may also be dealing with acne at the same time. Some older studies have suggested a possible link between the use of the cystic acne medication isotretinoin (Absorbica, Amnesteem, Claravis) and UC. However, newer research has yet to find a definitive causal relationship.
There’s no solid evidence indicating that your diet affects whether you develop UC. You may find that certain foods and drinks aggravate your symptoms when you have a flare-up, though.
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 a doctor if you should take a multivitamin.
If you have UC, a doctor will need to monitor your condition, and you’ll need to carefully follow your treatment plan throughout your life.
The only true 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 that requires surgery. Some people will eventually require surgery, but most do well with nonsurgical therapy and care.