10351 Ulcerative Colitis

Overview

Ulcerative colitis is a long-term condition that causes inflammation and sores (ulcers) in the lining of the large intestine (colon) and rectum. It is a type of inflammatory bowel disease (IBD). The inflammation can lead to belly pain, frequent diarrhea, and other digestive symptoms.

In the UK, about 1 in every 400 people has ulcerative colitis. It is one of the most common types of inflammatory bowel disease.

Ulcerative colitis can start at any age, but it is most often diagnosed between ages 15 and 30. It affects men and women equally. It can also run in families.

Symptoms

Common symptoms

• Frequent diarrhea, often with blood or mucus
• Belly pain and cramping
• A sudden urge to go to the toilet (urgency)
• Feeling tired or fatigued
• Weight loss or loss of appetite
• A feeling of not having emptied your bowel completely

Symptoms in children

• Diarrhea, sometimes with blood
• Belly pain and cramping
• Delayed growth or poor weight gain
• Fatigue and low energy

Symptoms in older adults

• Symptoms can be similar to younger adults, but sometimes less typical
• May have more frequent complications, such as severe inflammation
• Symptoms can be mistaken for other bowel conditions like diverticulitis

Causes

Main causes

• The exact cause is unknown. It likely happens when the immune system mistakenly attacks the lining of the large intestine.
• Genes may play a role – ulcerative colitis can run in families.
• Something in the environment, such as an infection, may trigger the condition in people who are already at risk.

Risk factors

• Having a family history of ulcerative colitis or Crohn's disease
• Being between 15 and 30 years old
• Being of white or Ashkenazi Jewish descent
• Long-term stress or certain medicines may trigger flare-ups, but they do not cause the disease itself

When to see a doctor

See a doctor urgently if:

• You have blood or mucus in your stool
• You have frequent diarrhea that lasts more than a few days
• You have severe belly pain or ongoing cramping
• You are losing weight without trying

Book a routine appointment if:

• You have persistent digestive symptoms that worry you
• You feel tired all the time and are not sure why
• You have a family history of inflammatory bowel disease and want to discuss your risk

Diagnosis

Your doctor will ask about your symptoms, examine you, and may order some basic tests. If ulcerative colitis is suspected, you will usually be referred to a specialist (gastroenterologist) for a camera test of your large bowel, called a colonoscopy.

Tests that may be done

• Blood tests – to check for inflammation or anemia
• Stool samples – to look for infection or blood
• Colonoscopy – a test using a flexible tube with a camera to look at the lining of your large intestine
• Biopsy – tiny tissue samples taken during colonoscopy to check under a microscope
• Imaging tests – such as an MRI or CT scan, in some cases

What to expect at your appointment

During a colonoscopy, you will be given medicine to help you relax. The doctor will gently pass a thin, flexible tube through your back passage into your large intestine. The test usually takes about 30 minutes and you can go home the same day. You may feel some bloating or cramping afterwards, but this normally settles quickly.

Treatment

The main goals of treatment are to reduce inflammation, control symptoms, and help you stay in remission (feel well with little or no symptoms). The right plan depends on how severe your condition is and how it affects your daily life.

Self-care at home

• Drink plenty of fluids to avoid dehydration, especially if you have diarrhea
• Keep a food diary to spot foods that make your symptoms worse
• Eat small, frequent meals rather than large meals
• Take gentle regular exercise, like walking or swimming
• Ask your healthcare team about stress management or relaxation techniques

Medical treatments

Your doctor may prescribe medicines that reduce inflammation in your bowel. These can be given as tablets, suppositories, enemas, or injections. Some medicines help calm the immune system. You may also be given short courses of steroid medicine to control a flare-up. Always take your medicines as prescribed, and talk to your doctor before stopping anything. Do not take over-the-counter anti-diarrhea medicines without checking with your doctor first.

When is surgery considered?

Surgery may be needed if medicines do not control the condition or if serious complications develop. The most common operation removes the colon and rectum (proctocolectomy). Afterwards, the surgeon creates either an internal pouch or an opening on the belly (a stoma) to pass waste. This is a major decision, and your surgeon will explain what to expect and help you weigh the pros and cons.

Living with this condition

Living with ulcerative colitis can be challenging, but many people manage it well with the right treatment and self-care. Learning your personal triggers and planning ahead (for example, knowing where toilets are) can help you feel more in control.

Lifestyle tips

• Get enough rest and sleep – fatigue is common
• Try to reduce stress with mindfulness, deep breathing, or talking to someone you trust
• Stay physically active – it helps your mood and overall health
• Avoid smoking – it is harmful for your general health and can complicate your condition
• Stay in touch with your healthcare team for regular reviews

Diet and exercise

There is no single diet that works for everyone with ulcerative colitis. A balanced diet with plenty of fruit, vegetables, and whole grains is generally best, but during a flare-up you may need to choose softer, lower-fibre foods. Regular exercise, such as walking or yoga, can support your wellbeing and help manage symptoms.

Mental health and emotional wellbeing

Living with a chronic bowel condition can be stressful and may affect your mood or confidence. It is normal to feel frustrated, anxious, or low at times. Talk to your healthcare team if you are struggling – they can offer support or refer you to a counsellor. If you ever have thoughts of harming yourself, call your local emergency number or a crisis line immediately.

Prevention

There is no proven way to prevent ulcerative colitis, because the exact cause is not yet known. However, you can take steps to manage the condition and reduce the frequency and severity of flare-ups by following your treatment plan, eating well, and managing stress.

Vaccines

Some treatments for ulcerative colitis can weaken the immune system. It is important to stay up to date with routine vaccines, such as flu and pneumonia vaccines. Ask your doctor or pharmacist which vaccines are right for you.

Screening programmes

People who have had ulcerative colitis for many years have a higher risk of bowel cancer. Regular colonoscopy checks are recommended every 1 to 5 years, depending on your age and risk. Your doctor will advise you on the right schedule.

Complications

If left untreated

• Severe bleeding from the bowel
• Dehydration and low levels of important minerals called electrolytes
• A tear (perforation) in the large intestine
• Severe swelling of the colon, known as toxic megacolon
• A higher risk of bowel cancer over time

Long-term outlook

Ulcerative colitis is a lifelong condition, but most people can achieve long periods without symptoms (remission) with the right treatment. Many people with ulcerative colitis live active, full, and rewarding lives. Working closely with your healthcare team and looking after your overall wellbeing can make a big difference.

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