Ulcerative Colitis

Overview

Ulcerative colitis is a long-term condition that causes inflammation (swelling) and sores (ulcers) in the lining of the large intestine (colon) and rectum. It is a type of inflammatory bowel disease (IBD).

Ulcerative colitis affects about 1 in every 400 people in the UK. It can occur at any age, but is most often diagnosed between ages 15 and 30.

It affects people of all ages, but it usually starts in young adulthood. Both men and women can get it. It is more common in people of white European and Ashkenazi Jewish descent.

Symptoms

Common symptoms

• Diarrhea, often with blood or mucus
• Abdominal pain and cramping
• Urgent need to pass stools (feeling like you can't wait)
• Feeling tired all the time (fatigue)
• Weight loss without trying
• Fever during flare-ups

Symptoms in children

• Diarrhea with blood is common
• Poor growth or delayed puberty
• Abdominal pain and tiredness
• Joint pain or skin rashes

Symptoms in older adults

• Diarrhea and urgency that may be more severe
• More likely to develop complications like dehydration or severe inflammation
• May have other health conditions that complicate management

Causes

Main causes

• The exact cause is not fully understood. It is thought to be an overactive immune response in the gut.
• Genetics may play a role—some people have a family history of ulcerative colitis.
• Environmental factors (like certain infections or changes in gut bacteria) may trigger the condition in people who are already at risk.

Risk factors

• Having a close family member (parent, sibling, child) with ulcerative colitis or Crohn's disease
• Age: most often diagnosed between 15 and 30
• Ethnicity: more common in white people of European descent and Ashkenazi Jewish heritage
• Taking certain medications (like nonsteroidal anti-inflammatory drugs, NSAIDs) may increase risk of flare-ups

When to see a doctor

See a doctor urgently if:

• If you see blood in your stool for the first time
• If you have persistent diarrhea (more than a few days) with abdominal pain
• If you have a fever along with stomach cramps
• If you are losing weight without trying

Book a routine appointment if:

• If you have mild symptoms that come and go but affect your quality of life
• If you need help managing your condition or want to discuss treatment options
• If you are due for regular monitoring (e.g., colonoscopy)

Diagnosis

Doctors diagnose ulcerative colitis based on symptoms, a physical exam, and tests that look at the colon and rectum. They may also rule out other causes of similar symptoms.

Tests that may be done

• Stool tests to check for infection or blood
• Blood tests to check for anemia (low red blood cells) or inflammation
• Sigmoidoscopy or colonoscopy – a thin, flexible tube with a camera is used to see the inside of the colon and take small tissue samples (biopsy)
• Imaging tests (like CT scan or MRI) if needed

What to expect at your appointment

A colonoscopy or sigmoidoscopy is usually done with sedation so you are comfortable. The procedure takes about 30 minutes. You will need to follow a special diet and take laxatives to clean out your bowel beforehand. Your doctor will discuss the results with you.

Treatment

Treatment aims to reduce inflammation, manage symptoms, and keep the disease in remission (no symptoms). It depends on how severe your condition is and how much of the colon is affected.

Self-care at home

• Keep a diary of symptoms, food, and stress to identify triggers
• Eat small, frequent meals and avoid foods that worsen symptoms (like spicy or high-fiber foods during flare-ups)
• Stay hydrated, especially if you have diarrhea
• Manage stress with relaxation techniques, meditation, or counselling

Medical treatments

Medications are often used to control inflammation. These include aminosalicylates (5-ASAs), corticosteroids for short-term flare-ups, immunomodulators, and biologic therapies. Your doctor will choose the best option based on your needs. It's important to take medication regularly even when you feel well.

When is surgery considered?

Surgery may be an option if medications do not control symptoms or if complications develop. The most common surgery is removal of the colon and rectum (proctocolectomy) with creation of a new reservoir (ileo-anal pouch) or a permanent stoma. This can often eliminate the disease and its symptoms.

Living with this condition

Living with ulcerative colitis means learning to manage flare-ups and remission. You may need to plan bathroom breaks, carry a change of clothes, and talk to your employer or school about your condition. Many people find that support groups and open communication help.

Lifestyle tips

• Avoid smoking – smoking can make symptoms worse (unlike in Crohn's disease)
• Limit alcohol and caffeine, which can irritate the bowel
• Get regular exercise to reduce stress and improve overall health
• Consider stress management techniques like yoga or mindfulness

Diet and exercise

There is no one-size-fits-all diet, but keeping a food diary can help identify trigger foods. During flare-ups, a low-fibre diet may be easier to tolerate. Exercise helps reduce stress and improve energy levels, but listen to your body and rest when needed.

Mental health and emotional wellbeing

Living with a chronic condition can be stressful and may lead to anxiety or depression. It is normal to feel frustrated, sad, or worried. These feelings are important to discuss with your healthcare team. Talking to a mental health professional can help.

Prevention

There is no known way to prevent ulcerative colitis because the exact cause is unknown. However, you may be able to reduce flare-ups by sticking to your treatment plan, avoiding known triggers, and keeping regular follow-up with your doctor.

Vaccines

People with ulcerative colitis should stay up to date on routine vaccinations, including the flu and pneumonia vaccines. Talk to your doctor about live vaccines if you are on immunosuppressive medications.

Screening programmes

If you have ulcerative colitis, you will need regular colonoscopy screenings to check for changes in the lining of the colon that could lead to cancer, especially if you have had the condition for more than 8-10 years.

Complications

If left untreated

• Severe inflammation that can lead to a hole in the colon (perforation)
• Massive bleeding from ulcers
• Increased risk of colon cancer, especially if the entire colon is affected for many years
• Toxic megacolon (a serious condition where the colon widens and becomes paralyzed)

Long-term outlook

With proper treatment, most people with ulcerative colitis can manage their symptoms and have a good quality of life. Many achieve long periods of remission. Although it is a lifelong condition, new treatments and a proactive approach offer hope. Regular follow-up and a healthy lifestyle can help reduce the risk of complications.

Find support

International organisations

• Crohn's & Colitis Foundation (US) ↗
• Crohn's and Colitis Canada ↗
• European Crohn's and Colitis Organisation (ECCO) ↗

Local organisations

• Crohn's & Colitis UK ↗ · UK
• Crohn's and Colitis Australia ↗ · Australia
• Crohn's and Colitis New Zealand ↗ · New Zealand

Helplines

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