Ulcerative colitis - At a glance

This page gives an overview of ulcerative colitis. Use the menu on the left-hand side to discover more.

Ulcerative colitis

  • Is one of a group of conditions known as inflammatory bowel diseaseA group of inflammatory conditions of the intestine. The two major forms are Crohn’s disease and ulcerative colitis.
  • Affects only the large intestineThe section of gut, or gastrointestinal tract, from the stomach to the anus., also known as the colonThe large intestine., and the rectum
  • Causes inflammationThe body’s response to injury. of the intestines that is limited to the inner surface of the wall of the large intestineThe section of gut, or gastrointestinal tract, from the stomach to the anus.
  • Always affects the rectum and extends from here back along the intestineThe section of gut, or gastrointestinal tract, from the stomach to the anus. to a varying degree. For example, ulcerative proctitis affects the rectum alone, while pancolitis affects the entire large intestineThe section of gut, or gastrointestinal tract, from the stomach to the anus.
  • Is caused by a combination of environmental and geneticRelating to the genes, the basic units of genetic material. factors
  • Is less common in people who smoke, although the harmful effects of smoking still outweigh any possible benefit
  • Inflammation may be triggered by substances in the environment called antigens, which may come from bacteriaA group of organisms too small to be seen with the naked eye, which are usually made up of just a single cell., chemicals or pollen
  • Is more common in North America and northern Europe, and is less common in Asia or Africa
  • Is less common among people who work outdoors or in manual occupations
  • Is usually diagnosed in people who are in their 20s and 30s, but can occur at any age
  • May be associated with some medications such as nonsteroidal anti-inflammatoryAny drug that suppresses inflammation drugs.

Symptoms and signs

Ulcerative colitis is characterized by periods of good health, called remission, interrupted by symptomatic episodes, known as flare-upsTerm to describe episodes when the symptoms of a condition worsen.. The symptoms vary from person to person and may include:

  • Pain or cramps in the abdomenThe part of the body that contains the stomach, intestines, liver, gallbladder and other organs.
  • Diarrhoea that is urgent, frequent and usually bloody
  • Nausea and vomiting
  • Frequent sensations of needing to pass a stool, although none is produced
  • Fever
  • Continual tiredness.

Tests and diagnosis

There is no single test for ulcerative colitis. Some simple initial tests may include:

  • Blood tests - to assess liverA large abdominal organ that has many important roles including the production of bile and clotting factors, detoxification, and the metabolism of proteins, carbohydrates and fats. function and look for anaemiaA reduced level of haemoglobin, which carries oxygen in the blood. Anaemia causes tiredness, breathlessness and abnormally pale skin., inflammationThe body’s response to injury., infectionInvasion by organisms that may be harmful, for example bacteria or parasites., antibodiesSpecial proteins in the blood that are produced in response to a specific antigen and play a key role in immunity and allergy. and bloodA fluid that transports oxygen and other substances through the body, made up of blood cells suspended in a liquid. chemical and mineral deficiencies secondary to diarrhoeaWhen bowel evacuation happens more often than usual, or where the faeces are abnormally liquid.
  • Stool tests - to look for bacterial infectionInvasion by organisms that may be harmful, for example bacteria or parasites. or inflammationThe body’s response to injury. in the gastrointestinal tractThe gut, which begins at the mouth and ends at the anus..

Further tests may include:

  • Sigmoidoscopy, which examines the lower part of the colonThe large intestine., or colonoscopyExamination of the colon and rectum with a colonoscope, an imaging instrument that is inserted through the anus., which examines all of the large bowel. A biopsyThe removal of a small sample of cells or tissue so that it may be examined under a microscope. The term may also refer to the tissue sample itself. is sometimes taken at the same time
  • Abdominal X-rays
  • White bloodA fluid that transports oxygen and other substances through the body, made up of blood cells suspended in a liquid. cellThe basic unit of all living organisms. scan (also called scintigraphy)
  • Ultrasound scan
  • CTA scan that generates a series of cross-sectional X-ray images.
  • MRIAn abbreviation for magnetic resonance imaging, a technique for imaging the body that uses electromagnetic waves and a strong magnetic field..

Choosing treatments

A number of therapeutic options are available. Ulcerative colitis can be treated with a combination of:

  • Nutritional therapy
  • Medication
  • Possibly surgery.

Nutritional therapy

Bleeding resulting from inflammationThe body’s response to injury. of the colonThe large intestine. can lead to ironAn element present in haemoglobin in the red cells. deficiency, and diarrhoeaWhen bowel evacuation happens more often than usual, or where the faeces are abnormally liquid. can result in dehydrationWater deficiency in the body. and mineral deficiencies. Nutritional therapy may involve:

  • Increasing your intake of certain foods or taking mineral supplements (speak with your dietician)
  • Maintaining a good fluid intake and eating a well-balanced diet
  • Avoiding foods that trigger symptoms.

Medication

The main classes of medications that are used to treat ulcerative colitis are listed below, which all have an anti-inflammatoryAny drug that suppresses inflammation action.

  • Aminosalicylates
  • Corticosteroids
  • Immunosuppressants
  • Biological therapies.

Medication can also be used to treat specific symptoms, such as diarrhoeaWhen bowel evacuation happens more often than usual, or where the faeces are abnormally liquid..

Surgery

Surgery is sometimes needed when symptoms cannot be managed by medication and nutritional therapy alone. Removing the whole of the large intestineThe section of gut, or gastrointestinal tract, from the stomach to the anus. cures ulcerative colitis completely.

Proctocolectomy and ileostomySurgery that involves bringing part of the small intestine, the ileum, through the abdominal wall. The intestinal contents are collected by a bag worn over the hole, or stoma.

  • Proctocolectomy is the removal of both the large intestineThe section of gut, or gastrointestinal tract, from the stomach to the anus. and the rectum
  • As the rectum has been removed, another procedure called an ileostomySurgery that involves bringing part of the small intestine, the ileum, through the abdominal wall. The intestinal contents are collected by a bag worn over the hole, or stoma. is then needed to divert waste matter to the outside of the body.

Proctocolectomy and the creation of a pouch

  • As above, both the large intestineThe section of gut, or gastrointestinal tract, from the stomach to the anus. and the rectum are removed
  • In this type of surgery, a new rectum is made out of the last section of the small intestineThe section of gut, or gastrointestinal tract, from the stomach to the anus., which is then joined to the anusThe external opening of the back passage, the rectum.. This allows for passage of stools through the anusThe external opening of the back passage, the rectum., rather than a stoma.

Complications of surgery may include:

  • Poor wound healing
  • Infection
  • Adhesions
  • Leak from anastomosis, where two sections of healthy intestineThe section of gut, or gastrointestinal tract, from the stomach to the anus. have been joined together after the removal of a problematic section of intestineThe section of gut, or gastrointestinal tract, from the stomach to the anus.
  • Stoma/pouch dysfunction
  • Pouchitis (inflammationThe body’s response to injury. of the pouch).

The future

Outlook

  • The severity of ulcerative colitis varies from person to person
  • Some people have a mild version and may not feel that unwell. Others have moderate or severe forms of the disease, with a larger impact on their quality of life.

Living with

A team of healthcare professionals are there to help you to learn how to live with ulcerative colitis.

  • Specialist nurses assist with all kinds of issues, such as stoma and post-operative care
  • Dieticians can offer invaluable advice
  • Your doctor will make sure that you get the most from your treatment regime.

Finding ways to maintain your independence will go a long way in helping you to stay positive. Many people with ulcerative colitis lead normal, active lives, studying, having careers and raising families.

On the horizon

There are many new developments in treatment options currently in progress around the globe, and ongoing clinical trials invite patient participation to help with new research.