What Is Ulcerative Colitis?

Ulcerative colitis (UC) is the most common type of inflammatory bowel disease (IBD). It causes inflammation and sores (ulcers) in the inner lining of the large intestine (the colon and rectum).

The cause of ulcerative colitis is unknown. Potential causes for the chronic inflammation seen in UC include genes, the immune system and environmental factors. Any of those factors could trigger the immune system to overreact and attack the cells that line the colon or rectum.

People with this condition have issues with their immune systems. It is not known if the immune system causes the disease. Ulcerative colitis flares can be triggered by stress or certain foods (ultra processed foods and sugar-sweetened beverages). However, the triggers do not cause UC.

The disease develops over time. Although people of any age may be affected by ulcerative colitis. It is most likely to develop in people 15 to 30 years old. Ulcerative colitis begins in the rectum and may spread to other areas of the large intestine. This leads to damage in the lining of the large intestine.

Medical treatment can put the disease into remission and maintain the remission. Most people with ulcerative colitis can manage their symptoms and lead active lives.

Signs and Symptoms

Ulcerative colitis symptoms vary depending on where the inflammation is located and how inflamed it is. Symptoms may start slowly or suddenly. Half of the people with UC only have mild symptoms. Some people may have severe attacks that happen more often.

Symptoms include:

Abdominal cramps and pain
Blood in stool or rectal bleeding
Constant urge to have a bowel movement
Diarrhea
Mucus or pus in stool

Ulcerative colitis severity depends on the person. Mild symptoms may include having up to four bowel movements a day and occasionally bloody stools. Severe UC symptoms may include having more than six bowel movements a day and passing bloody stools most of the time.

When ulcerative colitis is more severe or affects more of the large intestine, symptoms can include:

Anemia
Delayed growth and development in children
Fatigue
Fever
Loss of appetite
Nausea or vomiting
Weight loss

Ulcerative colitis also can put people at higher risk for other health conditions or life-threatening complications. See a doctor if you notice a lasting change in your bowel habits.

Risk Factors

Abnormal immune reactions: The immune system misidentifies harmless substances as threats. These could be friendly bacteria in the colon that help with digestion. This causes the immune system to attack the cells that line the colon.
Age: Most people with UC develop the condition before age 30. The risk increases again from age 50 to 70.
Environmental triggers: If you have genetic risk, air pollution, diet, infections, medications, smoking and stress can trigger or worsen UC.
Ethnicity: People of Ashkenazi Jewish descent have a higher risk of developing ulcerative colitis.
Family history: If you have a family member with ulcerative colitis or Crohn’s disease, you are more likely to develop the disease.
Genes: Variation in immune cell function and regulation genes can increase the risk of disease.

Diagnosis

A gastroenterologist is a specialist who can diagnose ulcerative colitis. This doctor will ask about your symptoms and your medical history. The doctor will also want to know if any family members have a history of UC. A physical exam will be done. Tests may be ordered to diagnose ulcerative colitis.

Diagnostic Procedures

Colonoscopy and/or Sigmoidoscopy with biopsy: This procedure is the best way to diagnose ulcerative colitis. It examines the inside of your colon and rectum with a camera on a flexible tube. It can show the extent of inflammation. Your doctor also may take a tissue sample (biopsy) during the procedure.

Imaging Tests

CT scan: A CT or CAT scan is a shortened name for computerized tomography. A CT scan is a special type of X-ray that produces detailed 3D images. This test can show signs of inflammation. It can help your doctor differentiate ulcerative colitis from Crohn’s disease (another form of IBD). A CT scan also can help your doctor determine whether a colonoscopy is necessary.

MRI: Magnetic resonance imaging, or MRI, creates detailed images that can reveal the extent of damage from UC. It is like a CT scan but does not use radiation. It uses strong magnets and radio waves.

Lab Tests

Blood tests: There are a variety of blood tests that can check for signs of infection, anemia, inflammation, electrolyte levels and more. These tests can indicate bleeding in the colon or rectum.

Stool tests: Your doctor may order a stool test. This test looks for signs of inflammation, infection, elevated protein levels. It can also detect bleeding in the colon that could be causing your symptoms.

Treatment

Treating ulcerative colitis depends on your symptoms. Treatment will depend on how much of your large intestine has been affected. Your treatment plan may include diet changes, medications or surgery. It may also include participating in a clinical trial.

Goals of ulcerative colitis treatment include managing your immune system, preventing repeat attacks and living a full life. Most people can reach remission with medical treatment. The only cure for UC is removing the colon, which is a last resort.

Medications

Aminosalicylates: Treats mild to moderate ulcerative colitis and can help people stay in remission.
Biologics (immunosuppressants): Treats moderate to severe UC and can help people stay in remission. These are usually administered as shots or intravenous infusions.
Corticosteroids: These drugs can be used to treat UC in people who don’t respond to aminosalicylates. Corticosteroids are typically prescribed for a short period. They cannot be used to maintain remission.
Other Immunosuppressants: Some medications can change the immune system to work more effectively. They are useful for treating some patients with UC.

Surgical Procedures

If your condition has not responded to treatment, you may need surgery for ulcerative colitis. Surgery is also considered if you have widespread damage through the colon. Surgery is also done to reduce your risk of developing colon cancer.

In most cases, the entire colon and rectum are removed. After surgery, you may have an opening in your belly called stoma. Stool will drain through the opening into a pouch. Another surgical procedure to treat UC connects the small intestine to the anus to gain more normal bowel function.

Lifestyle Management

Certain foods may make ulcerative colitis symptoms worse, like diarrhea and gas. You can prevent triggering symptoms by avoiding highly processed foods and sweetened beverages. A Mediterranean diet has been considered the best diet to reduce the frequency of UC flares. Eating small amounts of food throughout the day and drinking lots of water are recommended during flare ups.

Stress can make digestive problems worse. Managing stress can help prevent ulcerative colitis from worsening.

Clinical Trials

Clinical trials help determine new treatment options for diseases and conditions. Patients with ulcerative colitis have access to clinical trials and should speak with their doctor to determine what trials might work best for them.

Clinical Trials