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Ulcerative colitis and
Crohn's disease are the most common types of
inflammatory bowel disease. Ulcerative colitis affects
only the colon and rectum. Crohn's can affect any part of the digestive tract.
To learn more about Crohn's disease, see the topic
Ulcerative colitis is
a disease that causes
inflammation and sores (ulcers) in the lining of the
large intestine (colon). It usually affects the lower section (sigmoid colon)
and the rectum. But it can affect the entire colon. In general, the more of the
colon that's affected, the worse the symptoms will be.
The disease can affect
people of any age. But most people who have it are diagnosed before the age of
sure what causes it. They think it might be caused by the
immune system overreacting to normal bacteria in the
digestive tract. Or other kinds of bacteria and viruses may cause it.
You are more likely to get ulcerative colitis if other people in your
family have it.
The main symptoms
Some people also may have a fever, may not feel hungry,
and may lose weight. In severe cases, people may have diarrhea 10 to 20 times a
The disease can also cause other problems, such as
joint pain, eye problems, or liver disease.
In most people, the
symptoms come and go. Some people go for months or years without symptoms
(remission). Then they will have a flare-up. About 5 to 10 out of 100 people
with ulcerative colitis have symptoms all the time.1
Doctors ask about the symptoms, do a physical exam, and do
a number of tests. Testing can help the doctor rule out other problems that can
cause similar symptoms, such as Crohn's disease,
irritable bowel syndrome, and
Tests that may be done
Ulcerative colitis affects
everyone differently. Your doctor will help you find treatments that reduce
your symptoms and help you avoid new flare-ups.
If your symptoms
are mild, you may only need to use
over-the-counter medicines for diarrhea (such as
Imodium). Talk to your doctor before you take these medicines.
Many people need prescription medicines, such as aminosalicylates, steroid medicines, or other medicines that reduce the body's immune response. These medicines can stop or reduce symptoms and prevent flare-ups.
Some people find that certain foods make their symptoms
worse. If this happens to you, it makes sense to not eat those foods. But be
sure to eat a healthy, varied diet to keep your weight up and to stay
If you have severe symptoms and medicines don't help, you
may need surgery to remove your colon. Removing the colon
cures ulcerative colitis. It also prevents colon cancer.
People who have ulcerative colitis
for 8 years or longer also have a greater chance of getting
colon cancer. The longer you have had ulcerative colitis, the greater your risk.2 Talk to your
doctor about your need for cancer screening. These tests help find cancer
early, when it is easier to treat.3
Ulcerative colitis can be hard to live with. During a flare-up, it may
seem like you are always running to the bathroom. This can be embarrassing. And it
can take a toll on how you feel about yourself. Not knowing when the disease
will strike next can be stressful.
If you are having a hard time, seek support from family,
friends, or a counselor. Or look for a support group. It
can be a big help to talk to others who are coping with this disease.
Learning about ulcerative colitis:
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The cause of
ulcerative colitis is unknown. It may be caused by an
abnormal response by the body's
immune system to normal intestinal bacteria. Disease-causing bacteria and viruses also may play a role.
Ulcerative colitis can run in families.
The symptoms of
ulcerative colitis may include:
Other conditions with symptoms similar to ulcerative colitis include Crohn's disease,
irritable bowel syndrome (IBS),
and colon cancer.
Ulcerative colitis may be
mild, moderate, or severe.
people have periods of remission (when the condition is not active) that may last up to
several years. These periods are interrupted by occasional flare-ups of
moderate symptoms. About 5 to 10 out of 100 people who have ulcerative colitis
have symptoms all the time.1
have the same symptoms that adults have. Also, children with the disease may
grow more slowly than normal and go through puberty later than expected.
Problems from ulcerative colitis can include:
Some people who have ulcerative colitis also have
irritable bowel syndrome (IBS). It isn't as
serious as ulcerative colitis. IBS causes belly pain along with diarrhea or
Most women with ulcerative colitis can have a normal pregnancy and deliver a healthy baby. Symptoms may be worse
during the first 3 months of
pregnancy. Some medicines to treat the disease can be
used during pregnancy.
You have an increased risk of
ulcerative colitis if you:
Call a doctor immediately if you have been diagnosed with
ulcerative colitis and you have:
If you have any of these symptoms and you have been
diagnosed with ulcerative colitis, your disease may have become significantly
worse. Some of these symptoms also may be signs of
toxic megacolon. This is a condition in which the colon swells
to many times its normal size. Toxic megacolon requires emergency treatment.
Left untreated, it can cause the colon to leak or rupture. This can be
People with ulcerative colitis usually know their
normal pattern of symptoms. Call your doctor if there is a change in your usual
symptoms or if:
Watchful waiting is not appropriate when you
have any of the above symptoms. If your symptoms are caused by ulcerative
colitis, delaying the diagnosis and treatment may make the disease worse. And it can
increase your risk of other problems.
Even when the disease is in
remission, your doctor will want to see you regularly to check for
complications. Some of these problems can be hard to detect. It is always a good idea to
call your doctor's office for advice.
Health professionals who can diagnose ulcerative
For the treatment and management of ulcerative colitis,
you are likely to be referred to a gastroenterologist.
evaluated for surgery, you may be referred to a:
To prepare for your appointment, see the topic Making the Most of Your Appointment.
Ulcerative colitis can be fairly easy to diagnose, because it normally affects
only the colon and rectum. And it usually causes an obvious change
in daily bowel habits, such as frequent stools with blood or mucus.
Other exams and tests that may be used include:
Some people have symptoms of inflammatory bowel disease (IBD), but neither
Crohn's disease nor ulcerative colitis can be diagnosed. These people have a
form of IBD called indeterminate colitis. Doctors believe that it has features of both Crohn's disease and ulcerative colitis.
ulcerative colitis depends mainly on how bad the disease is. It usually includes medicines and changes in diet. A few people have symptoms that are long-lasting
and severe, in some cases requiring more medicines or
You may need to treat other problems, such as
anemia or infection. Treatment in children and teens may include taking
nutritional supplements to restore normal growth and sexual development.
If you don't have any symptoms or if your disease is not active
remission), you may not need treatment. But your doctor may suggest that you take medicines to keep the disease in remission.
If you do have
symptoms, they usually can be managed with medicines to put the disease in
remission. It often is easier to keep the disease in remission than to treat a
Mild symptoms may respond to:
These symptoms usually require steroid medicines to
control inflammation. The dose you need may be higher than that
needed to treat mild symptoms. When inflammation goes away, you will take
aminosalicylates to keep the condition in remission.
Severe symptoms also may be treated with:
You may need treatment in the hospital if you have severe ulcerative colitis with symptoms outside the digestive
tract, such as fever or
anemia. Treatment includes replacing fluids and
electrolytes lost because of severe diarrhea.
Your doctor will want to see you for a follow-up visit
about every 6 months while your condition is stable. You'll need to see the doctor more often if you
are having problems. Many people are so familiar
with their condition that they can handle minor flare-ups on
their own. In some cases, you may be able to talk with your doctor on the
phone for minor problems.
If you are taking medicines, you may need to have lab tests
You cannot prevent
ulcerative colitis, because the cause is unknown.
You can take steps at home to reduce symptoms of ulcerative colitis.
Medicines to treat your condition: If you have only mild symptoms,
antidiarrheal medicines may help. For disease in the rectum alone, you can try medicines given in a suppository, enema, or foam.
Medicines to avoid: In general, doctors recommend that you don't use
nonsteroidal anti-inflammatory drugs (NSAIDs, such as ibuprofen or naproxen).
These medicines may cause flare-ups. But some people may be more likely to have
flare-ups from NSAIDs than other people. Talk to your doctor about whether to avoid
A change in your diet may help reduce symptoms. Keep a food diary to find out which foods make your symptoms worse. During a flare-up, avoid or reduce these foods. But instead of cutting out a whole group of high-nutrient foods, try replacing them with healthy choices.
If you have had or are planning to have surgery
that will create an ostomy, you may feel self-conscious or
embarrassed. After a period of adjustment, most people are able to resume all
of their usual activities. In fact, you may feel better than before surgery
because you may no longer have painful symptoms. Support groups are available
for people with ostomies.
colitis can affect every aspect of your life. You may want to seek
counseling or social support from family, friends, or clergy.
Children tend to have a harder time than adults in managing the disease. So
your support is very important.
Children may feel self-conscious if
they don't grow as fast as other children their age. Encourage your child to
take medicine as prescribed. Offer your help with the treatment so that your
child can feel better, start growing again, and lead a more normal life.
Medicines usually are the main treatment for
ulcerative colitis. They control or prevent
inflammation in the intestines and help to:
The choice of medicine usually depends on how bad
the disease is, the part of the colon affected, and any complications you may have.
If you are pregnant or are planning to become pregnant, talk to your doctor about which medicines might be okay for you to use. Sometimes severe ulcerative colitis can harm your baby more than the medicines you take to keep it under control. Some medicines, though, should never be taken when you are pregnant. Your doctor can tell you which medicines are okay while you are pregnant or breast-feeding.
Ulcerative colitis affects only the
large intestine. So surgery that removes the entire large intestine can cure
the disease. Some people who have the disease in the entire colon eventually need surgery to remove the colon. Surgery also can often cure the rare problems that the disease causes outside of the colon, such as skin and eye problems. But it may not cure liver problems and some joint problems.
surgery for ulcerative colitis in several situations,
such as when other treatment fails to manage symptoms, when holes form in the
large intestine, or if
dysplasia is found during colonoscopy or
Removal of the colon to cure ulcerative colitis involves
one of these surgeries:
Ileoanal anastomosis is done
most often. Proctocolectomy with ileostomy is preferred for people who cannot
tolerate anesthesia for a long period of time because of illness or age.
In most cases, surgery can be scheduled at your convenience. Emergency
surgery usually isn't needed unless an acute attack causes
toxic megacolon, severe uncontrolled bleeding, or a
rupture in the intestine. The risk of problems after surgery
can be high if surgery is done during a severe or rapidly worsening attack or
if emergency surgery is needed.
Even though there is little
scientific proof that it works, many people who have
ulcerative colitis consider nontraditional or
complementary medicine in addition to prescription medicines. They may turn to
these other treatments because there is no cure other than removal of the
Probiotics and fatty acids are the most promising
complementary therapies being studied for ulcerative colitis. But there is
still not much known about their value. As with any treatment, talk with your
doctor before using any of these treatments.
Several studies have shown that the nicotine patch
may help treat active ulcerative colitis. It is not yet known how long the
benefits of the nicotine patch last or if the patch can help prevent flare-ups. If the patch works, it most likely benefits people whose
symptoms began or became worse after quitting smoking.
But because of the addictive
power and other harmful effects of nicotine, most doctors still prefer to use
traditional medicines to treat ulcerative colitis before trying the nicotine
The American College of Gastroenterology is an organization of digestive disease specialists. The website contains information about common gastrointestinal problems.
The American Society of Colon and Rectal Surgeons is the leading
professional society representing more than 1,000 board-certified colon and
rectal surgeons and other surgeons dedicated to treating people with diseases
and disorders affecting the colon, rectum, and anus.
Crohn's and Colitis Foundation of America (CCFA) is a
nonprofit, voluntary organization dedicated to finding the cure for Crohn's
disease and ulcerative colitis. This organization sponsors basic and clinical
research, offers educational programs for patients and health professionals,
and provides supportive services.
The GastroKids website helps parents, children, and teens learn more
about reflux and GERD, celiac disease, inflammatory bowel disease, and other
digestive disorders in children. This website is part of the NASPGHAN Foundation
(North American Society for Pediatric Gastroenterology, Hepatology and Nutrition).
This clearinghouse is a service of the U.S. National
Institute of Diabetes and Digestive and Kidney Diseases (NIDDK), part of the
U.S. National Institutes of Health. The clearinghouse answers questions;
develops, reviews, and sends out publications; and coordinates information
resources about digestive diseases. Publications produced by the clearinghouse
are reviewed carefully for scientific accuracy, content, and readability.
CitationsOsterman MT, Lichtenstein GR (2010). Ulcerative colitis. In M Feldman et al., eds. Sleisenger and Fordtran's Gastrointestinal and Liver Disease, 9th ed., vol. 2, pp. 1975–2013. Philadelphia: Saunders Elsevier.American Gastroenterological Association (2010). AGA medical position statement on the diagnosis and management of colorectal neoplasia in inflammatory bowel disease. Gastroenterology, 138(2): 738–745. Available online: http://www.gastro.org/practice/medical-position-statements.Kornbluth A, Sachar DB (2010). Ulcerative colitis practice guidelines in adults: American College of Gastroenterology, Practice Parameters Committee. American Journal of Gastroenterology, 105(3): 501–523. Available online: http://www.nature.com/ajg/journal/v105/n3/full/ajg2009727a.html.
October 8, 2012
E. Gregory Thompson, MD - Internal Medicine & Peter J. Kahrilas, MD - Gastroenterology
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