Ulcerative Colitis

What is ulcerative colitis?

Ulcerative colitis (UC) is a chronic inflammatory bowel disease (IBD) characterized by inflammation of the large intestine (colon and rectum). The inflammation is typically confined to the innermost lining (mucosa) of the intestine. It almost always involves the rectum (a condition known as proctitis) and extends proximally in a continuous fashion to involve a variable portion of the colon. When the entire colon is affected, it is called pancolitis.

The inflammation causes the colon to become red, swollen, and develop tiny open sores, or ulcers, that can bleed and produce pus and mucus. UC is an autoimmune condition, meaning the body's own immune system mistakenly attacks the healthy tissue of the colon. The disease course is typically marked by periods of active symptoms (flares) and periods of remission.

What are the symptoms of ulcerative colitis?

The symptoms of ulcerative colitis can vary depending on the severity and extent of inflammation, but they often develop over time. The most common signs and symptoms include:

• Diarrhea: Often with blood or pus. This is the hallmark symptom.
• Rectal bleeding: Passing a small amount of blood with stool.
• Abdominal pain and cramping.
• Tenesmus: A persistent, urgent feeling that you need to have a bowel movement, even if your bowel is empty.
• Urgency to defecate.
• Fatigue.
• Weight loss and loss of appetite.
• Fever.

What causes ulcerative colitis?

The exact cause of ulcerative colitis remains unknown. It is not caused by something you ate or by stress, although these factors can sometimes trigger a flare of symptoms. Researchers believe that UC is the result of a complex interaction of several factors:

• Genetics: UC can run in families. Having a first-degree relative with IBD increases your risk.
• Immune System Dysfunction: It is thought that a virus or bacterium may trigger the immune system to attack the lining of the large intestine. Normally, this immune response would turn off once the infection is gone, but in people with UC, the inflammation continues.
• Environmental Factors: While not clearly defined, factors in the environment may play a role in triggering the disease in genetically susceptible individuals.

How is ulcerative colitis diagnosed?

The diagnosis of ulcerative colitis involves ruling out other possible causes for your symptoms. The diagnosis is typically confirmed with an endoscopic procedure.

• Colonoscopy or Flexible Sigmoidoscopy: This is the most definitive test. A thin, flexible, lighted tube with a camera on the end is used to view the entire colon (colonoscopy) or just the lower part of the colon (sigmoidoscopy). The doctor will look for the characteristic signs of inflammation and ulceration. During the procedure, small tissue samples (biopsies) are taken from the colon lining for examination under a microscope to confirm the diagnosis.
• Stool Studies: To rule out infections, such as from bacteria like Clostridioides difficile, as a cause of your symptoms.
• Blood Tests: To check for anemia (a sign of bleeding) and markers of inflammation, such as C-reactive protein (CRP).
• Imaging: While not typically needed for diagnosis, a CT scan may be performed in cases of severe symptoms to look for complications like toxic megacolon.

How is ulcerative colitis treated?

Treatment for ulcerative colitis has two main goals: to induce remission (get the inflammation under control) and then to maintain remission (prevent the inflammation from returning). Treatment depends on the severity and extent of your disease.

Medications:

• Aminosalicylates (5-ASA): These are often the first-line treatment for mild to moderate UC. They can be given orally or as a rectal suppository or enema.
• Corticosteroids: These fast-acting anti-inflammatory drugs are used to treat moderate to severe flares but are not for long-term use due to side effects.
• Immunomodulators: These drugs, such as azathioprine, modify the immune system to reduce inflammation. They are used for long-term maintenance.
• Biologic Therapies: These are advanced medications that target specific proteins involved in the inflammatory process. They are used for moderate to severe UC that hasn't responded to other treatments. Examples include anti-TNF agents, integrin receptor antagonists, and interleukin inhibitors.

Surgery:
For some patients, surgery may be necessary. This may be for an emergency situation like toxic megacolon, or electively for disease that is refractory to medical therapy, for side effects of medications, or for the development of dysplasia (precancerous cells) or cancer. The standard surgical procedure is a proctocolectomy, the removal of the colon and rectum. This cures the disease. Intestinal continuity can be restored with an ileal pouch-anal anastomosis (IPAA), also known as a J-pouch.

Self-Care for Ulcerative Colitis

While medications are the cornerstone of treatment, certain self-care strategies can help you manage your symptoms during a flare.

• Dietary Changes: There is no specific diet that causes or cures UC, but some people find that certain foods can worsen their symptoms, especially during a flare. Common trigger foods include spicy foods, high-fiber foods, fatty foods, and dairy. Keeping a food diary can help you identify your personal triggers.
• Stress Management: While stress doesn't cause UC, it can make your symptoms worse. Finding ways to manage stress, such as through exercise, relaxation techniques, or mindfulness, can be helpful.
• Stay Hydrated: Chronic diarrhea can lead to dehydration. It's important to drink plenty of fluids, especially water.

Is there a cure for ulcerative colitis?
Currently, there is no medical cure for ulcerative colitis. Medications can effectively control the inflammation and lead to long periods of remission, but the disease can flare up again. The only definitive cure is the surgical removal of the colon and rectum (proctocolectomy).

Does ulcerative colitis increase my risk of colon cancer?
Yes, having ulcerative colitis for 8 years or longer, especially if it involves a large portion of your colon, increases your risk of developing colorectal cancer. Because of this, regular surveillance colonoscopies are recommended to look for precancerous changes (dysplasia).

Can I live a normal life with ulcerative colitis?
Yes. While living with a chronic disease has its challenges, most people with ulcerative colitis are able to live full and active lives. With effective medical treatment and a good relationship with your healthcare team, you can manage your symptoms and maintain a good quality of life.

• Lightner AL, Strong SA. Medical Management of Ulcerative Colitis. In: Steele SR, Hull TL, Hyman N, Maykel JA, Read TE, Whitlow CB, eds. The ASCRS Textbook of Colon and Rectal Surgery. 4th ed. Springer; 2022:765-779.
• National Institute of Diabetes and Digestive and Kidney Diseases. Ulcerative Colitis. Published September 2020. Accessed October 12, 2025. https://www.niddk.nih.gov/health-information/digestive-diseases/ulcerative-colitis
• Crohn's & Colitis Foundation. What is Ulcerative Colitis? Accessed October 12, 2025. https://www.crohnscolitisfoundation.org/patientsandcaregivers/what-is-ulcerative-colitis