Ulcerative colitis (UC) is a type of inflammatory bowel disease (IBD) in which the lining of the large intestine (colon) becomes inflamed and may produce mucus, blood, or pus. Inflammation of the colon also causes abdominal discomfort, frequent bowel movements, and bloody stools.
UC is divided into several subtypes, according to the part of the colon it affects:
Ulcerative proctitis affects only the rectum.
Left-sided colitis affects the rectum, sigmoid colon, and descending colon up to the sharp bend near the spleen.
Extensive colitis or pancolitis affects the entire colon.
The most common symptoms of UC are urgency, bleeding, and diarrhea, which often contains mucus. Symptoms may develop gradually or suddenly and come and go.
People with UC can experience inactive periods, or remission, which may last months or years.
Over time, UC can progress to other areas of the colon and become more severe. This typically leads to increased symptoms.
The exact cause of UC is not fully understood, but it is believed to be an abnormal immune system response. There is no known way of preventing UC.
Normally, your immune system defends against harmful invasive bacteria and viruses. But in some people, the immune system mistakenly attacks the body’s own tissue.
While they don’t cause UC, stress and diet can trigger UC symptoms.
Risk factors for UC include:
Age: UC can occur at any age, but it is more likely in people younger than 15 or older than 60.
Family history: Having a close family member with UC or another autoimmune disease increases your risk.
Race and ethnicity: White people and people of Ashkenazi Jewish descent have a greater risk of developing UC.
A colonoscopy to examine your entire colon, along with a tissue biopsy, is the best way to diagnose UC.
Other tests can help confirm a diagnosis and rule out other possible conditions. These include:
Blood tests: Blood tests, including a complete blood count and C-reactive protein test, can help check for signs of anemia, inflammation, or infection, which can indicate UC.
Stool sample: A stool sample can check for signs of inflammation and help rule out other causes, such as an infection from bacteria or parasites.
Imaging tests: A magnetic resonance imaging or computed tomography scan examines your small intestine to help rule out other conditions, such as Crohn’s disease.
Endoscopic procedures: Like a colonoscopy, these involve a camera on a flexible tube or capsule to examine parts of your digestive system.
Drugs for UC work by reducing inflammation in your colon.
Some drugs for UC are commonly used for maintenance, to help you stay in remission, while others help reduce activity during flare-ups. You may need a combination of these drugs for optimal treatment.
Surgery may be necessary if your body isn’t responding well to medication or if you have severe complications that require urgent treatment.
Medication Options
There are a few types of drugs that are used to treat ulcerative colitis:
5-aminosalicylates: These are typically the first-line of treatment for mild ulcerative colitis. They work by reducing inflammation directly in your digestive tract and can be taken on an ongoing basis.
Corticosteroids: These are also known simply as steroids, and they are used to treat UC flare-ups. Most drugs of this type work by suppressing the entire immune system. Because of this, they can have severe side effects and shouldn’t be taken for long periods.
Biologics and small molecules: Biologics are made of antibodies that are grown in a lab and work by stopping certain proteins in the body from causing inflammation. Small molecules are oral medications that also work on the immune system but act differently from biologics.
Immunomodulators: These drugs reduce inflammation by suppressing the activity of your immune system. They are sometimes used in combination with biologics for severe cases of UC.
Acetaminophen (Tylenol): Tylenol may be used to help relieve pain symptoms of ulcerative colitis. However, certain drugs, including ibuprofen (Advil, Motrin) and naproxen (Aleve, Naprosyn), may make symptoms worse.
Surgery
Surgery to cure UC is called a proctocolectomy and usually involves removing your entire colon and rectum.
Proctocolectomy with ileal pouch (J-pouch): After the colon and rectum are removed, the surgeon then creates a pouch from the end of the small intestine and attaches this to the anus. This is an alternative to a long-term ostomy.
Proctocolectomy with ileostomy: In some cases, an ileal pouch may not be possible. Instead, the surgeon will fix an opening from the intestine to your skin, which allows for emptying of waste.
There is no known way of preventing UC. However, treatment with medication or surgery and lifestyle changes, such as avoiding dietary triggers, can help you manage the condition and reduce your risk of flares.
Along with medical treatment, it can help to make certain lifestyle changes to manage UC symptoms. These may include:
Limit or avoid dietary triggers: If certain foods trigger UC symptoms for you, it can help to eat less of them or avoid them altogether. Triggers vary from person to person. If you’re not sure how to identify your triggers, it can help to keep a food diary to track how certain foods make you feel. Or you may want to meet with a registered dietitian for professional help.
Stay hydrated: Drink plenty of water each day. Try to limit or avoid caffeine, alcohol, and carbonated beverages, which can irritate the gut.
Eat smaller, more frequent meals: Eating five to six small meals a day may be gentler on your gut than three large meals a day.
Do your best to manage stress: Although stress doesn’t cause UC, it may make your symptoms worse. Activities such as exercise, meditation, and deep breathing exercises can help ease stress.
The only definitive long-term treatment option for UC is surgery to completely remove the large intestine. However 50 percent of people with UC only experience mild to moderate symptoms, and many have only occasional flare-ups with longer periods of remission.
In up to one-third of people, the condition worsens and the symptoms become more frequent, eventually requiring surgery.
Along with medications to manage symptoms, avoiding triggers can help reduce flare-ups, which includes reducing stress.
During more active periods of the disease, making the following dietary changes can help reduce symptoms:
Eat smaller amounts of food throughout the day.
Drink plenty of water.
Limit insoluble fiber, a type of fiber that the body doesn’t digest and is more irritating to the gut than soluble fiber, a type of fiber that the body does digest.
Avoid greasy or fatty foods.
Limit dairy products, if you’re lactose intolerant.
Without treatment, UC can lead to the following complications:
UC affects up to 900,000 people in the United States.
Symptoms of the condition typically start between ages 15 and 30, and most people receive a diagnosis in their mid-thirties. There’s also a peak in UC diagnoses between ages of 50 and 70.
White people and people of Ashkenazi Jewish descent have a higher risk of developing ulcerative colitis.
Ulcerative colitis affects men and women equally, and people with a family history are more likely to develop the condition.
UC is a type of IBD, but it differs from another digestive condition called irritable bowel syndrome (IBS). Although the disorders share symptoms, such as abdominal pain and diarrhea, inflammation and ulcers do not occur with IBS.
Crohn’s disease is another type of IBD that differs from UC. While UC affects the colon, Crohn’s disease can affect any part of the digestive tract. Common symptoms include nausea, weight loss, abdominal pain, and vomiting.
The Crohn’s & Colitis Foundation is the leading nonprofit organization focused on research and support for people with IBD. Their mission is to cure Crohn’s disease and ulcerative colitis and improve the quality of life of Americans living with IBD.
Ulcerative colitis is a chronic inflammatory condition that affects the colon.
Symptoms include urgency, frequent bowel movements, and bloody stools.
While surgery to remove the colon is the only definitive long-term treatment, most people can manage the condition with medications and lifestyle adjustments.
