Ulcerative Colitis

Ulcerative colitis (UC) is a chronic inflammatory disease of the colon. Granulomatous colitis is another name for this disease. It is one of two disorders listed under the category of inflammatory bowel disease. The other disorder is Crohn's disease. Ulcerative colitis causes tiny ulcers and small abscesses to form in the inner lining of the colon. The cause of UC is not known. It affects men and women equally and appears to run in some families. About 250,000 Americans have UC. The most commonly affected individuals are between the ages of 15 and 35 years.

Detection of UC is by a flexible sigmoidoscopy, a procedure where a lighted flexible instrument is inserted into the rectum to view the rectum and the lower portion of colon. Tissue samples are taken from the colon and sent for microscopic examination. Alternative detection methods are colonoscopy, a procedure similar to a flexible sigmoidoscopy but with a longer instrument, or barium enema x-ray. Ulcerative colitis is a lifelong condition in most individuals. About half of the patients will have only mild symptoms. Others experience more frequent and severe attacks. Medications can control the symptoms. This condition is sometimes curable with surgery.

Living With Your Diagnosis
Abdominal pain and bloody diarrhea with mucus are the most common symptoms of UC. The abdominal pain is usually on the left side. A bowel movement may help relieve the pain. As the condition worsens, the diarrhea increases in frequency, Up to 20 stools a day is common. Symptoms of UC may alternate with periods of remission. Over 75% of patients will have relapses.

Other symptoms include fatigue, weight loss, loss of appetite, and fever. Symptoms are not limited to the colon. About 15% to 20% of individuals will have joint pains. The most commonly affected joints are the knees, ankles, and wrists. Eye problems occur in up to 10% of individuals. Complications of UC include severe hemorrhage (blood loss), perforation of the bowel, megacolon (dilatation of the colon), and peritonitis (infection of the abdomen). Individuals with UC are at greater risk for having colon cancer.

The goal of treatment is to relieve the symptoms, control the inflammation, and prevent complications. Anti-inflammatory drugs are the main medications used; these include sulfasalazine, mesalamine, olzalazine, and corticosteroids. Sulfasalazine is used to maintain remissions and control minor-to-moderate symptom flares. Corticosteroids are used for major flares and to maintain remissions. This drug can be given as an enema if needed. If symptoms are severe, hospitalization is necessary. The bowel is put at rest (no food orally) and intravenous nutrition given.

About 20% to 25% of UC patients require surgery at some time. Patients who do not respond to medications or have severe disease are good candidates for surgery. The surgery involves removing the affected portion of the colon and joining the two ends of bowel.

The DOs

  • Maintain normal physical activity except when symptoms require bed rest.
  • Take medications as prescribed.
  • A heating pad or hot water bottle placed on the abdomen may help with pain and cramping.
  • See your physician regularly. Evaluation of the bowel by colonoscopy to monitor for cancerous changes is important.

The DON'Ts

  • Avoid aspirin. This medication can cause bleeding.
  • Avoid antidiarrheal medications except for minimal symptoms. These medications can cause megacolon.
  • Avoid raw fruits and vegetables. They can cause the symptoms to worsen.
  • Avoid spicy foods, coffee, and alcohol. They can cause diarrhea symptoms to worsen.

When to Call Your Doctor

  • If you have symptoms of UC.
  • If fever or chills develop.
  • If the number of bowel movements increase or if bleeding increased.
  • If the abdomen becomes distended, the pain increases, or vomiting starts.


Ulcerative Colitis FAQs

1. What is ulcerative colitis?

Ulcerative colitis is a disease of the large intestine (also known as the colon). It’s a chronic condition where the lining of the colon becomes inflamed and ulcers form. These produce discharge which causes discomfort and a frequent urge to empty the colon.  

2. Are there different types of colitis?

There are different types of colitis, usually classified by where in the body it occurs:

  • Ulcerative proctitis. Inflammation occurs WITHIN the rectum; it’s the mildest form of ulcerative colitis. Rectal bleeding is often the main symptom of the disease. 
  • Proctosigmoiditis. Inflammation occurs in the rectum and lower end of the colon. Symptoms of this include bloody diarrhea, abdominal pain, and an inability to move the bowels.
  • Left-sided colitis. Inflammation extends from the rectum through a larger portion of the colon. Symptoms include bloody diarrhea, abdominal cramping and pain on the left side, and unintended weight loss.
  • Pancolitis.This affects the entire colon and causes bouts of bloody diarrhea that may be severe, abdominal cramps, fatigue, and significant weight loss.
  • Acute severe ulcerative colitis. This is a rare form of colitis that affects the entire colon causing severe pain, profuse diarrhea, bleeding, fever, and inability to eat. 

3. Are Crohn’s disease and ulcerative colitis the same?

No they are not. Crohn's disease is a chronic inflammatory condition of the gastrointestinal tract and may affect any part of it. Ulcerative colitis is limited to the colon.

4. Are IBD and ulcerative colitis the same?

Crohn’s Disease and ulcerative colitis are types of IBD (inflammatory bowel disease). 

5. What are the symptoms of ulcerative colitis? 

Common symptoms of ulcerative colitis include:

  • abdominal pain
  • increased abdominal noise 
  • bloody stools
  • diarrhea
  • fever
  • rectal pain
  • weight loss
  • malnutrition

6. What causes ulcerative colitis?

Health experts are not entirely sure. We do know that it’s the result of your immune system responding abnormally to your colon. Additionally, genes and environment are factors. 

7. How is ulcerative colitis diagnosed?

Colonoscopy is the gold standard for diagnosis through biopsy and tissue diagnosis. Other tests that can be used to assess the activity of already established disease would be stool tests and imaging

8. What are the treatment options for ulcerative colitis?

Treatment options for ulcerative colitis include medication and/or surgery. There are many medication options for UC. Your gastroenterologist can help make the best tailored plan for you.

9. Is ulcerative colitis considered a chronic disease?

Yes, although a person’s symptoms may subside, the condition is chronic and does require active management to control the chronic in inflammation.  Untreated individuals, or those relying on home remedies are at increased risk of colorectal cancer and other complications.

10. Can ulcerative colitis be cured?

The only cure for ulcerative colitis is removal of the rectum and colon. However, even with removal of the colon some folks can still have issues with their GI tract. Like any chronic disease, most times it can be managed through medication which should be prescribed by a gastroenterologist.  

11. Does ulcerative colitis require surgery?

Surgery is only necessary when the disease is not responding to medical management. Patients will in this situation develop chronic and debilitating symptoms, including bleeding, pain, weight loss.   Your doctor will use endoscopy and imaging among other things to decide if surgery might be the right option.

12. Can a person die from ulcerative colitis?

Death from ulcerative colitis is very rare and occurs as a result untreated disease. Ulcerative colitis can increase the possibility for colon cancer. Patients with ulcerative colitis 

13. What should you eat if you have ulcerative colitis?

If your disease process is well controlled, you should not have any restrictions on your diet. A well balanced and nutrient rich diet is what is recommended. 


For More Information

National Foundation for Ileitis and Colitis
444 Park Avenue S, 11th Floor
New York, NY 10016-7374

Crohn's and Colitis Foundation of America
386 Park Avenue South, 17th Floor
New York, NY 10016-7374

National Digestive Diseases Information Clearinghouse
2 Information Way
Bethesda, MD 20892-3570