Ulcerative colitis

Ulcerative colitis is a chronic (long-term) condition which inflames the lining of the large intestine (colon or large bowel). Your bowel inflammation may be in the rectum, at the end of the large bowel, or spread throughout the bowel.

Symptoms include 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. However, it’s most commonly diagnosed between the age of 15 and 25.

There’s no cure for ulcerative colitis but it can usually be managed, with medical advice and changes to your diet.

Symptoms of ulcerative colitis are:

• Frequent diarrhoea, which may contain blood or mucus
• Abdominal pain
• Increased urge to open your bowels
• Tiredness and fatigue
• Feeling unwell, sometimes accompanied by a loss of appetite and unexplained weight loss

In some cases, ulcerative colitis can also cause:

• Anaemia (low iron in your blood)
• Sore, swollen joints
• Painful red eyes (episcleritis)
• Irritability and low mood
• Anal fissures

Ulcerative colitis can usually be controlled, so make an appointment to see your GP. If needed, your GP will refer you to a gastroenterologist – a consultant specialising in the digestive system.

Following an abdominal examination, your consultant may recommend a biopsy. This involves removing a small sample of tissue from your bowel to check for bowel inflammation.

The exact cause of ulcerative colitis isn’t known. However, it’s thought to be a combination of:

• Genetics - if a close relative has ulcerative colitis, you’re 10 times more likely to develop it
• Your immune system reacting abnormally to bacteria in your bowel
• An unknown trigger - perhaps diet, stress or a virus

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.

Diet

Making small changes to your daily diet may relieve your symptoms. Try:

• Changing from three daily main meals to five or six small meals every day
• Drinking lots of water
• Avoiding caffeine, alcohol and fizzy drinks

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.

Medication

To prevent symptoms recurring or relieve symptoms during a flare-up, your consultant may prescribe:

• Immunosuppressants
• Aminosalicylates or steroids - to reduce inflammation
• Monoclonal antibodies - drugs which target specific cells

Surgery

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:

• An ileostomy – an opening in your abdomen for your small intestine to drain into an external pouch
• An ileo-anal pouch – where a pouch is made inside and connected to your anus to pass waste as normal