What Is Ulcerative Colitis?
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Medically reviewed by Kumkum Sarkar Patel, MD
Ulcerative colitis (UC) is a long-term condition that causes inflammation and ulcers (sores) in the tissue that lines your rectum and colon—which make up most of your lower intestine. This condition is one of the main types of inflammatory bowel disease (IBD) and causes symptoms like abdominal pain, diarrhea, and blood stools, among others.
Researchers aren’t exactly sure what causes this condition to occur, but experts believe that genetics and abnormal immune system reactions may play a role. Current estimates show that between 600,000 and 900,000 Americans have ulcerative colitis. While treatment depends on the severity of your symptoms, fortunately, several options can help you treat and manage this condition well.
Types of Ulcerative Colitis
There are several types of ulcerative colitis. Healthcare providers categorize these types based on the part of the colon or rectum that becomes inflamed and develops sores. These types include:
Ulcerative proctitis: Occurs in 30% to 60% of all ulcerative colitis cases and causes inflammation in the rectum (the final portion of the colon leading to the anus). This type is less severe and causes symptoms like rectal bleeding and using the bathroom frequently.
Proctosigmoiditis: Affects the rectum and the adjoining section of the large intestine, known as the sigmoid colon. Compared to proctitis, this type can cause more severe symptoms, including bloody diarrhea and abdominal pain.
Left-sided colitis: If the inflammation extends from the rectum to the sigmoid colon and further on to the descending colon, left-sided colitis is the diagnosis. Along with cramping and bloody diarrhea, this type causes pain on the left side and can lead to unintentional weight loss.
Pancolitis: Develops when inflammation affects the entire colon. This type occurs in about 15% to 35% of all cases and causes symptoms like cramping, bloody diarrhea, and fatigue.
Ulcerative Colitis Symptoms
Ulcerative colitis affects everyone differently. Some people may have milder cases, while others have more severe symptoms. In many cases, symptoms of ulcerative colitis can come and go. You can experience some periods of remission (where you don't have any symptoms) and periods of activity (where you do experience symptoms).
Primary Symptoms
UC symptoms can appear suddenly or gradually. Most people who develop this condition experience their first symptoms between the age of 15 and 30 years old. Common symptoms include:
Abdominal pain and cramps
Pus or blood in the stools (poops)
Bleeding in the rectum
Frequent or sudden urge to use the bathroom
Advanced Symptoms
In more advanced cases of UC, the inflammation and ulcers spread to other parts of the large intestine. Severe symptoms of this condition may include:
What Causes Ulcerative Colitis?
Ulcerative colitis occurs when the tissue that lines your rectum and colon becomes inflamed. Inflammation is your immune system’s response to infection or tissue damage. As inflammation worsens, you can develop sores or ulcers inside your colon and rectum, which causes more severe symptoms.
Researchers aren’t exactly sure what causes ulcerative colitis to develop. Some experts believe that genetics play a role. In fact, up to 25% of people with UC also have a parent or sibling with a type of inflammatory bowel disease (such as UC or Crohn's disease).
Other experts suggest that an abnormal immune system response to your gut microbiome (or the bacteria and microorganisms in your intestines) can also influence UC to develop. However, more research is needed to better understand the cause of this condition.
Risk Factors
Anyone can develop UC, but some factors can increase your risk of the condition, such as:
Family history of ulcerative colitis
Being between the ages of 15 and 30
Personal history of an intestinal infection
Living in an industrialized city or country
Using certain medications such as hormone replacement therapy (HRT) or non-steroidal anti-inflammatory drugs (NSAIDs)
Diagnosis
To diagnose ulcerative colitis, healthcare providers need to rule out other conditions that can cause similar symptoms. Bloody diarrhea and abdominal pain are also common with conditions like Crohn's disease, gastroenteritis, and colon cancer. During your appointment, your healthcare provider will first ask about your medical history—including underlying conditions you have, medications you're taking, and symptoms you're experiencing.
Once your provider learns more information, they may order one or more of the following tests to make an accurate diagnosis:
Blood test: Detect signs of ulcerative colitis as well as the presence of UC complications, such as anemia
Stool study: Takes a sample of your poop to check for signs of colon infections
Colonoscopy: Uses an endoscope (a long, flexible tube with a camera attached) in your colon to collect tissue samples to assess tissue damage
Flexible sigmoidoscopy: Evaluates the health of your rectum and sigmoid colon with the use of a narrow and flexible tube that lights up
X-ray: Creates images of the abdomen to screen for complications of UC
CT scan: Scans the pelvis and abdomen to check for signs of the condition
Enterography: Checks where inflammation is occurring and assesses how far it has spread
Treatment
If you receive a diagnosis for UC, your exact treatment plan will depend on the severity of your condition and the symptoms you're experiencing.
Medications
There are several classes of medications that healthcare providers prescribe to treat ulcerative colitis. These medications include:
Aminosalicylates: Azulfidine (sulfasalazine) or Paser (aminosalicylic acid) for mild to moderate cases of UC
Corticosteroids: Deltasone (prednisone) or Cortef (hydrocortisone) for more severe symptoms
Immunosuppressant drugs: Imuran (azathioprine) or Trexall (methotrexate), which suppress the immune system response
Biologics: Remicade (infliximab), Humira (adalimumab), or Entyvio (vedolizumab) for moderate to severe cases of UC
Janus kinase inhibitors: Xeljanz (tofacitinib), which can help when other medications aren't improving your symptoms
Surgery
If medications aren't working, your healthcare team may suggest surgery to improve your symptoms. You may also need surgery if you have colorectal cancer (a complication of UC) or if you have other life-threatening complications.
During surgery, the procedure aims to remove portions of the colon and rectum. There are two common types of surgery for UC, which include:
Ileoanal reservoir surgery: Removes the colon and rectum and creates a pouch from the ileum (the end of the small intestine) that connects to the anus to create a new way for stools to pass through your body.
Ileostomy: Attaches the ileum to an opening in the abdomen and completely removes the rectum and colon. You pass stools through this opening into a colostomy bag.
How To Prevent Flare-ups
If you’re living with ulcerative colitis, there are several steps you can take to prevent flare-ups—which are periods of activity that cause symptoms to occur. Consider the following strategies:
Visiting your provider regularly to screen for colon cancer and other complications of UC
Managing stress through activities like yoga, meditation, regular exercises, and sleeping eight hours each night
Avoiding the use of NSAIDs like Motrin (ibuprofen) which can trigger symptoms
Keeping a food diary to understand which foods you can eat and which foods can trigger a flare-up
Working with a nutritionist to develop a meal plan that is right for you and helps manage your symptoms
Drinking plenty of fluids
Avoiding trigger foods, caffeine, and carbonated beverages
Eating more frequent, smaller meals throughout the day instead of larger ones
Related Conditions
Ulcerative colitis can raise your risk of developing several other health conditions. These include:
Colorectal cancer
Anemia (lack of healthy red blood cells)
Toxic megacolon (rapid swelling of the colon)
Malnutrition
Blood clots
Osteoporosis (thinning and weakening of the bones)
Sclerosing cholangitis (inflammation that spreads from the colon to the liver)
Living With UC
While ulcerative colitis is a life-long condition and can cause certain complications, it doesn't usually affect your life expectancy. The severity of your condition will depend on your symptoms, but flare-ups tend to be shorter in duration than periods of remission. In most cases, medications are enough to manage the condition. But up to 15% of people with UC may need surgery.
When you're experiencing a flare-up, UC symptoms can significantly affect your ability to carry out daily tasks. This may increase your risk of chronic fatigue, depression, and anxiety. That said, with the proper support and care, most people with UC can lead normal lives. Talking to your healthcare provider for adjustments to treatment, asking your loved ones for emotional support, and working with a mental health professional to learn to cope with your diagnosis can help improve your quality of life.
Frequently Asked Questions
How serious is ulcerative colitis?
Most people with ulcerative colitis have mild or moderate forms, which can be effectively managed. However, some have more severe symptoms which can affect their daily life. More advanced cases can also increase the risk of life-threatening complications like colorectal cancer or toxic megacolon.
What foods are bad for ulcerative colitis?
If you have UC, try to avoid high-fiber foods or foods that can cause larger stools. These include leafy greens or beans, nuts, seeds, raw fruits, and whole grains. Fried or greasy foods, dairy, carbonated beverages, coffee, and alcohol can also make symptoms worse.
Is ulcerative colitis considered a disability?
While the symptoms of ulcerative colitis can be severely disabling, having ulcerative colitis doesn’t always qualify you for disability benefits. According to the U.S. Social Security Administration, you’re qualified if you’ve been diagnosed with UC and fit into some additional criteria. These include obstruction of the colon that requires surgery, anemia (low red blood cell count), and low levels of albumin.
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