How To Prevent Ulcerative Colitis

Medically reviewed by Robert Burakoff, MD

Ulcerative colitis (UC) is a type of inflammatory bowel disease (IBD) that causes chronic inflammation in the inner lining of the large intestine (your colon and rectum). The inflammation can lead to symptoms like abdominal pain, diarrhea, and bloody stools. The cause of UC is not fully understood, but research suggests genetic and environmental factors contribute to its development.

There is no known way to prevent ulcerative colitis. However, there are things you can do to lower your risk of developing the condition, including taking measures to protect your gut health. This is especially true if you have known risk factors, such as a family history of UC or a diet high in processed foods.

Who Is Most at Risk?

Ulcerative colitis can affect people of all ages, but the onset of symptoms most commonly occurs between ages 15-30. UC symptoms may also first develop when someone is 50-70 years old.

Certain risk factors are associated with a higher likelihood of developing UC, including: 

• Family history: Having a first-degree relative, like a parent or sibling, with IBD—which includes Crohn's disease, as well—means you're more likely to develop UC.

• Race and ethnicity: UC affects people of all races and ethnicities, though it is more common in white people than in other racial groups. Specifically, people with Ashkenazi Jewish heritage have a two to four times higher risk of UC than the general population.

• Dietary habits: People who primarily eat a diet high in processed and pre-packaged foods, red meats, refined carbohydrates, and sugars are at a higher risk of developing UC. Evidence suggests that this type of diet—common in the United States—reduces gut microbiome diversity and may contribute to UC development.

• Sex: Some research suggests men are more likely to develop UC. However, most research shows the condition affects both sexes equally.

• Smoking history: People who used to smoke have higher rates of UC than people who never smoked or who currently smoke. Just because quitting smoking may increase your risk of UC doesn't mean you should continue smoking—the benefits of quitting far outweigh the risks of smoking.

The Link Between Smoking and Ulcerative Colitis?

Research hasn't been able to determine a direct relationship, but some findings show nicotine may suppress the immune system and increase mucus production in the gastrointestinal tract, protecting against UC. However, smoking should not be viewed as a way to prevent UC.

Genetics

Ulcerative colitis tends to run in families. Your risk of UC increases by up to 30% if a close relative, such as a parent or sibling, has the condition. Several gene variants (changes) are linked to an increased risk.

Research suggests that some gene variants associated with ulcerative colitis may change the function of the intestinal lining, which acts as a protective barrier from bacteria and toxins.

For example, variants in the HLA-DRB1 gene may cause the intestinal lining to break down, allowing more bacteria and other harmful microbes or substances to contact intestinal tissues. This can trigger an immune response, leading to chronic inflammation and digestive problems like UC.

Other gene variants that play a role in overactive or abnormal immune responses in the intestines and lead to chronic inflammation may also increase the risk of ulcerative colitis.

Genetic Testing

While genetic testing may be available for UC, it is not routine. If you have a family history of UC, talk to your healthcare provider about whether they recommend genetic testing. Genetic testing won't definitively determine whether you will develop UC, but it can provide valuable information for you and your healthcare provider.

If genetic testing shows an increased risk of UC, consider adopting lifestyle habits that reduce inflammation and support a healthy gut. Your healthcare provider may recommend more frequent screening tests to help identify and treat ulcerative colitis early, which may help prevent severe symptoms and complications.

Although genetic testing is not a routine part of UC care, it may be helpful for people with a diagnosis. Genetic testing can provide insights into the reasons behind the development of ulcerative colitis, such as a weakened intestinal lining. Healthcare providers can use this information to develop the most effective treatment plans.

How To Reduce Risk

There is no guaranteed way to prevent ulcerative colitis, but certain lifestyle habits may help lower your risk. Meanwhile, screening tests can help detect ulcerative colitis early so you can begin treatment, which may slow disease progression and reduce your risk of complications.

Diet

Some research suggests diet may play a role in ulcerative colitis development. While no specific diet is proven to prevent the condition, researchers are investigating the connection between dietary patterns and gut health. A diet high in calories and pre-packaged and processed foods may contribute to inflammation and an imbalanced gut microbiome (dysbiosis).

The gut microbiome is a community of bacteria and other microorganisms in the intestines that play a critical role in digestion and immune function. An imbalance in this microbiome is associated with IBDs like ulcerative colitis. Eating a nutrient-dense diet and limiting your intake of processed and fried foods may help maintain a healthy gut microbiome and lower the risk of inflammation and UC. 

Dietary choices that may help prevent intestinal inflammation and promote gut health include: 

• Following the Mediterranean diet: This diet is rich in fruits, vegetables, whole grains, and healthy fats.

• Following an anti-inflammatory diet: This diet focuses on consuming anti-inflammatory foods, including fruits and vegetables, and incorporating anti-inflammatory spices like ginger, turmeric, and paprika into foods. It also limits your intake of red meat, full-fat dairy products, and fried foods.

• Avoiding alcohol: Avoiding or limiting your intake of alcohol can help reduce or prevent inflammation. 
  

Exercise

Regular exercise doesn't only benefits your physical and mental health—evidence suggests it may lower the risk of ulcerative colitis by: 

• Decreasing inflammation: Exercise helps regulate the body's inflammatory responses. This could decrease systemic (bodywide) inflammation, which may benefit gut health.

• Strengthening intestinal lining: The intestinal lining protects intestinal tissues from bacteria and toxins. Exercise strengthens this protective barrier, which may help prevent inflammation that can trigger the development of UC.

• Boosting gut microbiome: Exercise increases the diversity of the gut microbiome, which contributes to a healthier gut environment and may help prevent UC.
  

Stress Management

While stress isn't a direct cause of ulcerative colitis, there's growing evidence that chronic stress can cause systemic inflammation and negatively affect gut health. Incorporating stress management techniques into your daily routine can reduce the impact of stress on your gut health.

Finding what helps you decompress and lower your stress may take some time. Effective stress management techniques include: 

• Deep breathing exercises

• Meditation

• Yoga

• Get enough sleep (typically seven to nine hours a night)

• Tai chi

• Hobbies like reading, knitting, gardening, and sports

• Quality time with friends and family 
  

Fecal Occult Blood Test

A fecal occult blood test is a noninvasive test that checks for blood in the stool (poop) the naked eye can't see. Hidden (occult) blood can be an early warning sign of intestinal inflammation. The test can be done at home or in an office. It involves collecting and swabbing a sample of stool.

If fecal occult blood test results are positive, you likely have bleeding in your gastrointestinal tract. Your healthcare provider will probably recommend follow-up testing, such as a colonoscopy, to determine what's causing the bleeding. UC is just one condition that could be causing bleeding.

Colonoscopy or Sigmoidoscopy

Both of these are imaging tests where a gastroenterologist (a medical doctor who specializes in diagnosing and treating digestive issues) inserts a flexible, narrow tube with a light and camera on the end into your rectum so they can see the inside of your large intestine. A colonoscopy gives a view of your entire colon. A sigmoidoscopy can give a view of only the lower part of your colon.

Healthcare providers use these procedures to look for inflammation and ulcers (sores) in the colon and rectum. They may also take a sample to test for the presence of a disease. Based on imaging and sample testing results, a healthcare provider can make a diagnosis. Early diagnosis of UC means you can start treatment and help prevent disease progression.

After diagnosis, healthcare providers can use either imaging procedure to help monitor treatment effectiveness and the extent of intestinal inflammation. Doing this can help prevent complications.

Discuss With Your Healthcare Provider

If you're concerned about your risk of developing ulcerative colitis—especially if you have a family history of the disease or are experiencing any digestive problems—having an open and honest conversation with your healthcare provider is a proactive way to address your concerns. Your provider can develop a plan that may lower your risk. 

Depending on your risk factors and symptoms, your provider may recommend a fecal occult blood test or an imaging procedure to assess your gut health. Questions you can ask your healthcare provider about ulcerative colitis include:

• Should I take any preventive measures, given my family history or other risk factors?

• Would you recommend a fecal occult blood test or other tests for me at this time?

• Are there any dietary modifications that might help support my gut health?

• Are there specific lifestyle changes I should consider that may reduce my risk?

A Quick Review

While there is no guaranteed way to prevent ulcerative colitis, prioritizing lifestyle habits like eating a nutritious diet, regularly exercising, and practicing stress management techniques can support your gut health and may lower your risk. 

If you are concerned about your risk, particularly if you have a family history of ulcerative colitis, talk to your healthcare provider. They can create a plan that promotes a healthy gut and may help protect against developing ulcerative colitis.

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