Ulcerative colitis is a type of inflammatory bowel disease which can trigger irregular, often troublesome, symptoms.
Ulcerative colitis is a chronic (long-term) condition — colitis means inflammation of the colon, also known as the large intestine or large bowel, and ulcerative refers to the formation of ulcers.
Ulcerative colitis, therefore, causes the lining of the colon to become inflamed, as well as small ulcers to develop that bleed and produce pus. Ulcers usually occur in areas of inflammation, which damages the lining of the colon, exposing the underlying tissue. Ulcers look like small, red craters in your gut lining.
Inflammation can occur in your rectum ie at the end of the large bowel where your stools are stored, or spread throughout your bowel.
Symptoms include passing blood and mucus, diarrhoea, abdominal pain and a frequent urge to open your bowels (poo). Depending on the extent of your bowel inflammation, ulcerative colitis may cause difficulties in your daily life. You may have periods of time with no symptoms (remission), followed by flare-ups, where your symptoms are worse.
Ulcerative colitis can develop at any age and occurs in around one in 420 people in the UK, affecting men and women equally. It is most commonly diagnosed between the ages of 15 and 25. However, around one in seven cases are diagnosed in the over 60s. It is more common in black people and white people of European descent, particularly in Ashkenazi Jewish communities. It is less common in people of Asian descent.
There is no cure for ulcerative colitis but it can usually be managed with medical advice and changes to your diet.
Symptoms of ulcerative colitis vary in severity depending on how much of your colon is inflamed and the severity of the inflammation. While some people experience mild symptoms, for others symptoms significantly reduce their quality of life. Symptoms include:
In some cases, ulcerative colitis can make you feel irritable and low. It can also cause:
In severe ulcerative colitis, where you have to empty your bowels at least six times a day, you may also develop:
Signs of a flare-up
You can go without symptoms of ulcerative colitis for weeks or months (remission) or only have very mild symptoms. Your symptoms may then worsen — this is called a flare-up or relapse. A flare-up doesn't always just cause gut symptoms, you may also develop:
If your ulcerative colitis only causes inflammation of your rectum (proctitis), signs of a flare-up may be different. Instead of diarrhoea, your stools may be normal but you may notice bleeding from your rectum, or you may become constipated but frequently feel that you want to have a bowel movement.
Ulcerative colitis is a chronic condition that goes through periods of remission and flare-ups. The severity of your symptoms will depend on how inflamed your colon is and how often you have flare-ups. The first time you develop symptoms ie the first flare-up is usually the most severe.
Ulcerative colitis usually starts with inflammation in your rectum — this is called proctitis. For some people, ulcerative colitis remains limited to the rectum, while for others it spreads to the other parts or all of the colon.
In between flare-ups, the inflamed parts of your colon will heal and your symptoms will reduce or go away altogether. Flare-ups are classed as:
In a given year, around half of people with ulcerative colitis will have mild or no symptoms (remission) and the other half will have a flare-up. Flare-ups can occur gradually over weeks or suddenly over several days.
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Ulcerative colitis can usually be controlled, so make an appointment to see your GP. If your GP thinks you may have an inflammatory bowel disease ie ulcerative colitis or Crohn’s disease, they will refer you to a gastroenterologist (a doctor specialising in the digestive system).
Your doctor will carry out a physical examination of your abdomen to check for tenderness, which is caused by inflammation. They will also check if you are pale, which can be a sign of anaemia. You may need an X-ray or CT scan to rule out other more serious complications.
They may ask you to collect a stool sample for testing to rule out gastroenteritis (infection of the stomach and bowel), which has similar symptoms to ulcerative colitis. In some cases, an infection can trigger a flare-up of ulcerative colitis and treating the infection can ease your symptoms.
Your doctor may also recommend blood tests to check for anaemia and inflammation anywhere in your body and/or a biopsy where a small sample of tissue from your bowel is collected to check for bowel inflammation.
A biopsy can be collected during one of two different procedures:
A thin, flexible tube with a camera on the end (sigmoidoscope) is inserted into your rectum to examine it and your lower colon, and if needed, collect a tissue sample. This is an outpatient procedure, so you can go home the same day, and it takes around 15 minutes. You will be awake, however, you can have a sedative to relax you.
If after your sigmoidoscopy your doctor thinks your ulcerative colitis has spread further than your lower colon, a different thin, flexible tube with a camera on the end (colonoscope) will be inserted into your rectum and passed further along your colon to examine all of it and if needed, collect a tissue sample.
This is an outpatient procedure, so you can go home on the same day, and it takes around 30 minutes. You will be awake, however, you can have a sedative to relax you and pain medication to make you more comfortable.
Your colon needs to be completely empty before you have a colonoscopy, so you will be given strong laxatives beforehand.
The exact cause of ulcerative colitis isn’t known. However, it’s thought to be a combination of unknown environmental triggers, genetics and your immune system reacting abnormally.
Over a quarter of people with ulcerative colitis have a family history of it — if a close relative has it, you are 10 times more likely to develop it. Certain gene changes have been identified that increase your risk of developing ulcerative colitis if exposed to a trigger for the condition. Some of these genes are thought to be involved in your immune system.
Ulcerative colitis is also more common in black people and white people of European descent, particularly in Ashkenazi Jewish communities. It is less common in people of Asian descent.
Ulcerative colitis may be caused by an autoimmune response. This is when your immune system mistakenly attacks healthy tissue. There are several theories as to what happens in ulcerative colitis:
Another theory suggests that ulcerative colitis is caused by an imbalance between 'good' and 'bad' bacteria in your colon.
Ulcerative colitis is more common in urban areas of North America and northwestern Europe. It is also more common in countries with better sanitation, suggesting that reduced exposure to bacteria may affect your risk of developing ulcerative colitis.
Ulcerative colitis can't be cured, but you can usually manage the symptoms through diet, medication and/or surgery. Your consultant will discuss options with you, based on your symptoms and the extent of your bowel inflammation.
During a very severe flare-up, you may require hospital treatment as an in-patient.
Making small changes to your daily diet may relieve your symptoms. Try:
Also, your consultant may recommend taking food supplements to replace nutrients lost as a result of frequent diarrhoea. You may also be referred to a dietitian, who’ll help you follow an ulcerative colitis diet plan.
To prevent symptoms recurring or relieve symptoms during a flare-up, your consultant may prescribe:
If ulcerative colitis is affecting your daily life and other treatments are unsuccessful, your consultant may suggest surgery. In most cases, this involves removing your large bowel so that waste is passed out of your small intestine instead. This requires either:
Ulcerative colitis can't be cured but you can usually manage the symptoms through diet, medication and/or surgery. Treatment aims to reduce your symptoms (inducing remission) and ensure you remain without symptoms for as long as possible (maintaining remission).
Your doctor will discuss your options with you, based on your symptoms and the extent of your bowel inflammation. If you have just developed ulcerative colitis, you will usually be prescribed medication for several weeks to help clear your symptoms. You will then be prescribed medication every time you have a flare-up. The medication you receive will depend on the severity of your symptoms and where your bowel inflammation is mainly located.
Making small changes to your daily diet may relieve your symptoms. Try:
Your consultant may recommend taking food supplements to replace nutrients lost as a result of frequent diarrhoea. You may also be referred to a dietitian, who’ll help you follow an ulcerative colitis diet plan.
To prevent symptoms from recurring or relieve symptoms during a flare-up, your consultant may prescribe:
Also called 5-ASAs, aminosalicylates help reduce inflammation, which gives damaged tissue a chance to heal. If you have mild to moderate ulcerative colitis, aminosalicylates are usually the first treatment given. They can be used to treat flare-ups (short-term use) or to maintain your remission (lifelong or long-term use).
They can be taken orally as tablets or capsules, as a suppository ie inserted into your rectum where it dissolves or as an enema ie where a fluid version of the drug is pumped into your colon. The severity of your condition will determine how your medication is given. Mild to moderate ulcerative colitis is usually treated with a suppository or enema and if after four weeks your symptoms are not better, you will be given tablets or capsules.
Aminosalicylates do not usually cause side effects. However, rare side effects include:
Corticosteroids (eg prednisolone) help reduce inflammation. They are stronger than aminosalicylates and can be used alongside them or instead of them to treat a flare-up. They can be taken orally as tablets or capsules, as a suppository ie inserted into your rectum where it dissolves or as an enema ie where a fluid version of the drug is pumped into your colon.
They can't be used for long-term treatment as they have serious side effects when used for a long time, including osteoporosis and cataracts. Short-term side effects include:
Immunosuppressants (eg tacrolimus and azathioprine) reduce the activity of your immune system and are used to treat mild to moderate flare-ups or to maintain remission when other treatments are ineffective. They are given as tablets orally and take two to three months before they start to be effective.
Immunosuppressants put you at greater risk of catching infections, so if you notice signs of an infection (eg fever or sickness), tell your GP as soon as possible. They also increase your risk of anaemia as they can reduce your production of red blood cells. You will therefore need regular blood tests to check your red blood cell numbers.
This treatment uses antibodies to target cells that cause inflammation. Monoclonal antibodies are usually only recommended when other treatments have been ineffective.
During a very severe flare-up, you may need hospital treatment as an inpatient to prevent you from becoming dehydrated or developing life-threatening complications, such as your colon rupturing. You will be given medications, usually ciclosporin or infliximab, and if needed, you will also be given fluids directly into a vein (intravenously).
This is a strong immunosuppressant that takes just a few days to work. It is given intravenously and continuously for around seven days. Side effects include:
It can also cause high blood pressure and reduced kidney and liver function. However, you will be closely monitored to check for signs of these conditions.
Infliximab belongs to a group of medications called biologicals. It is a monoclonal antibody and reduces inflammation by targeting cells that cause inflammation. It is used to treat moderate to severe ulcerative colitis in adults as well as children and adolescents aged six to 17 if other treatments are ineffective.
It is given for a year unless it is shown to not be effective. It is given intravenously over one to two hours. The usual course of treatment is to have your first dose and then another dose two weeks and then six weeks later, and then every eight weeks thereafter if it’s still needed.
Side effects of infliximab include:
Most adverse reactions to infliximab occur within two hours of your first dose of the drug, which is why you will be closely monitored after your first dose. However, some people have delayed reactions, several days or weeks later. You should therefore stay alert to any of the above side effects. If you notice any signs of an allergic reaction, get urgent medical assistance; you may need to be given a strong anti-allergy medication called epinephrine.
Infliximab is not suitable for people who have had tuberculosis (TB) or hepatitis B and must be used with caution in people with HIV or hepatitis C. This is because infliximab has been shown to trigger dormant infections. Infliximab is also not suitable for people with heart disease or multiple sclerosis.
Tofacitinib is a newer treatment for moderate to severe ulcerative colitis, which is used when other treatments, including biologicals, are not suitable or ineffective. It blocks the activity of an enzyme that is involved in the immune system. It is not suitable for pregnant women. Women in their reproductive years who take tofacitinib should always use reliable contraception and continue to do so for at least four weeks after they stop taking the drug.
If ulcerative colitis is affecting your daily life and other treatments are unsuccessful in managing your symptoms, your doctor may suggest surgery. About a quarter of people with ulcerative colitis need surgery at some point.
Surgery is usually recommended if:
In most cases, surgery involves removing your large bowel so that waste is passed out of your small intestine instead. This requires either:
Surgery cures ulcerative colitis as it removes the colon. However, as with any surgery, there are risks and you will have to adjust to permanently living with an ileostomy or an ileoanal pouch.
You do not need to follow a special diet but your doctor will recommend following a healthy, well-balanced diet. If you have proctitis, they may recommend a high-fibre diet to reduce your risk of constipation.
If you develop anaemia as a result of your ulcerative colitis, you may be prescribed iron tablets, intravenous iron, vitamin B or folic acid tablets.
Your doctor may recommend getting vaccinations against hepatitis, human papillomavirus (HPV) and pneumonia, particularly if you are on medication that reduces the activity of your immune system.
During a flare-up, you may need to take painkillers.
Changes to your diet
You do not need to follow a special diet, however, some changes to your diet may help manage your condition. This includes:
During a flare-up, you may want to try temporarily eating a low-residue or low-fibre diet to reduce how often you have a bowel movement and reduce the volume of your stools. Always speak to your care team before starting on a low-residue or low-fibre diet.
Foods that form part of a low-residue diet include:
Keeping a food diary
Keeping a record of the foods you eat and your symptoms may reveal foods that aggravate your symptoms and foods that you tolerate well. You can then make changes to your diet accordingly. However, you should never exclude entire food groups from your diet without first speaking to your care team as you could end up lacking in certain vitamins or minerals.
If you’re trying new foods, stick to one type of new food each day so you can easily identify anything that aggravates your symptoms.
Reducing stress and anxiety
Reducing your stress levels can help reduce how often you have flare-ups. Exercise, relaxation techniques and talking to others about your condition can all help reduce your stress levels.
Also, be aware of signs of depression as it can be challenging to live with ulcerative colitis, especially if you have more severe symptoms. Signs of depression include feeling very low and hopeless and no longer enjoying activities that you used to find fun. Speak to your GP if you are concerned that you are depressed.
Fertility and pregnancy
Ulcerative colitis doesn't affect a woman's fertility. However, surgery to create an ileoanal pouch can lead to complications that cause infertility — the risks of infertility are much lower with surgery to create an ileostomy.
Pregnancy in women with ulcerative colitis is usually not affected by the condition. However, if you are pregnant or are planning to get pregnant you should still let your care team know that you have ulcerative colitis. This is because if you have a flare-up during your pregnancy or become pregnant during a flare-up, there is a risk of premature birth or having a baby with a low birth weight. It is therefore recommended that you try to get your ulcerative colitis under control before getting pregnant.
Most medications for ulcerative colitis can be taken while pregnant. However, there are some exceptions, so you will need to discuss this with your care team and change your medications if needed.
Corticosteroid treatments for ulcerative colitis increase the risk of osteoporosis (weakened bones that are more prone to fracture). Your bone health will therefore be regularly monitored and your doctor may recommend taking vitamin D and calcium supplements to strengthen your bones.
Poor growth and development
In children, ulcerative colitis and certain treatments for the condition can slow down growth and delay puberty. Children and adolescents with ulcerative colitis will therefore have their height and weight closely monitored and checked against averages for their age. If any problems are detected, your child may be referred to a paediatrician (a doctor specialising in treating children and young people).
Primary sclerosing cholangitis
Primary sclerosing cholangitis is a rare complication of ulcerative colitis. It occurs when the bile ducts become inflamed and damaged over time. It is usually without symptoms until it reaches an advanced stage. Symptoms include fever, chills, diarrhoea, fatigue, itchy skin, jaundice and unintentional weight loss. Medications can help relieve symptoms but in severe cases, a liver transplant may be needed.
Toxic megacolon is a rare complication of ulcerative colitis, which is life-threatening if left untreated. It occurs when the colon swells due to trapped gas, which can lead to a rupture (split) and cause your blood to become infected (septicaemia). Symptoms include a fever, a rapid heart rate and tummy pain. Treatment includes intravenous fluids, antibiotics and steroids, and if those are not effective, then surgery to remove the colon.
Ulcerative colitis increases your risk of bowel cancer over time, particularly if your whole colon is affected by the condition, you have frequent flare-ups and a family history of bowel cancer.
Symptoms of bowel cancer are often similar to symptoms of ulcerative colitis and include blood in your stools, diarrhoea and tummy pain. You will therefore need regular check-ups for bowel cancer after about 10 years from your initial diagnosis of ulcerative colitis.
Bowel cancer check-ups include having a colonoscopy, where a thin, flexible tube with a camera on the end is inserted into your rectum. The longer you live with ulcerative colitis, the more often you will need to have colonoscopies, varying from every one to every five years.
You can reduce your risk of bowel cancer by:
With treatment, the life expectancy for people with ulcerative colitis is roughly the same as the general population. However, a severe flare-up can still be life-threatening and needs urgent medical treatment.
Without medication, half of all people with ulcerative colitis have a flare-up on average once a year. Taking medication improves your chances of avoiding frequent flare-ups, although in a quarter of people with the condition, regular flare-ups will continue and surgery will become necessary.
A year after getting a diagnosis of ulcerative colitis and starting treatment, most people can work as normal and live a full life. However around one in 10 people will struggle to work with their condition.
How serious is ulcerative colitis?
When treated, ulcerative colitis can be well-managed and you can continue to live a full life. However, severe flare-ups can cause life-threatening complications and need urgent treatment. Left untreated, ulcerative colitis can also lead to short-term and long-term health problems, such as anaemia, dehydration, fatigue, osteoporosis, and in children, poor growth and development. It is therefore important to seek medical treatment if you’re concerned that you have the condition.
What is the life expectancy of someone with ulcerative colitis?
With treatment, the life expectancy for someone with ulcerative colitis is roughly the same as for someone without the condition. However, severe flare-ups can be life-threatening and should be treated urgently.
What foods trigger ulcerative colitis?
Ulcerative colitis is not triggered by food. However, your diet can worsen or ease your symptoms. In general, during a flare-up, foods that are high in insoluble fibre can worsen your symptoms. This is because insoluble fibre speeds up your bowel movements and can irritate your colon. Some people find that dairy, spicy or fried foods also worsen their symptoms. Keeping a food diary, where you record your symptoms and what food you’ve eaten, can help you identify which foods, in particular, affect your ulcerative colitis flare-ups.
What is the main cause of ulcerative colitis?
The exact cause of ulcerative colitis is unknown. It is thought to be a combination of your genetics, your immune system reacting abnormally and environmental factors.
Which is worse, Crohn's or ulcerative colitis?
Both Crohn’s disease and ulcerative colitis cause chronic (long-term) inflammation of the colon. However, one is not worse than the other. It all depends on the severity of your condition — both can be mild, moderate or severe.
Is there a difference between colitis and ulcerative colitis?
Colitis means inflammation of the lining of the colon. It can be short-term or long-term depending on the underlying cause, of which there are several eg food poisoning, an infection, allergies or inflammatory bowel disease. Ulcerative colitis is a type of colitis and an inflammatory bowel disease, which is a chronic (long-term) condition.
How do you calm down an ulcerative colitis flare-up?
Make sure you avoid caffeine, alcohol and fizzy drinks, which can all worsen your symptoms. Additionally, try to eat five or six small meals every day instead of three large meals and drink lots of water so that you stay hydrated. There are also a range of medications you can take to ease your symptoms — your GP will prescribe the medication most appropriate for your particular case and dependent on how severe your symptoms are.
Are bananas good for ulcerative colitis?
Bananas are generally well-tolerated during an ulcerative colitis flare-up. This is because they contain soluble fibre, which is already partially broken down and forms a glue-like substance in your colon to produce soft stools without triggering inflammation.
Can I drink coffee with colitis?
Caffeine can aggravate diarrhoea, which is one of the main symptoms of colitis. It is, therefore, best to avoid caffeine, especially during a flare-up.
Does stress cause ulcerative colitis?
Stress doesn’t cause ulcerative colitis. However, stress can increase the frequency of your flare-ups.
Is ulcerative colitis a disability?
Ulcerative colitis is not considered a disability, and with treatment, you can lead a full and active life.
What are the symptoms of an ulcerative colitis flare-up?
Symptoms of a flare-up include frequent diarrhoea that may contain blood or mucus, tummy pain, feeling unwell and a loss of appetite. You may also feel extremely tired and frequently have the urge to open your bowels.
Can you have both Crohn's disease and ulcerative colitis?
Crohn's disease and ulcerative colitis are both types of inflammatory bowel disease and based on your symptoms it may be hard to initially tell the difference between the two. However, further investigations (ie a sigmoidoscopy or colonoscopy) will help identify which condition you have. It is not possible to have both at the same time. However, around one in 10 people with inflammatory bowel disease may not get a clear diagnosis as they have some but not all features of both diseases — this is called indeterminate colitis.