What Is Ulcerative Colitis? Symptoms, Causes, Diagnosis, and Treatment

Ulcerative colitis (UC) is a type of inflammatory bowel disease (IBD) in which the lining of the large intestine (colon) becomes inflamed.

The colon then develops ulcers (open sores) that produce blood, pus, and mucus.

The small intestine is rarely affected.

There are several subtypes of ulcerative colitis, which are named according to the part of the colon affected:

• Ulcerative proctitis, which affects only the rectum
• Proctosigmoiditis, which affects the rectum and lower segment of the colon (sigmoid colon)
• Left-sided colitis, which affects the rectum, sigmoid colon, and descending colon up to the sharp bend near the spleen
• Pan-ulcerative or total colitis, which affects the entire colon

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The most common symptoms of ulcerative colitis are abdominal pain and diarrhea, which often contains blood or pus.

Symptoms of the disease typically develop gradually and come and go.

Periods without active disease — known as remission — may last for months or even years.

Over time, ulcerative colitis can progress to cover more of the colon. This typically leads to more severe disease and greater symptoms.

If left untreated, UC can also lead to a number of complications:

• Malnutrition
• Perforated colon
• Osteoporosis
• Liver disease
• Colorectal cancer
• Toxic megacolon

Ulcerative colitis is believed to be caused by an abnormal response by your body’s immune system.

Your immune system is supposed to defend you against harmful invasive bacteria and viruses. But in some people, the immune system mistakenly attacks the body’s own tissue.

While we don’t know exactly what causes ulcerative colitis, there are two leading theories:

1. The body mistakes food and helpful bacteria for harmful substances.
2. The body doesn't turn off its response to fighting an infection.
   

Experts believe that ulcerative colitis develops because of a combination of environmental factors and genetic predisposition.

Fatty cold-water fish — such as mackerel, tuna, salmon, sardines, and herring — are rich sources of omega-3 fatty acids.

To diagnose ulcerative colitis, your doctor will first take a complete medical history and rule out other possible causes of your symptoms.

This will be done with a combination of your history of symptoms, lab tests, imaging scans, and a view of the inside of your colon using a flexible tube and camera (colonoscopy or sigmoidoscopy).

Ulcerative colitis is a chronic disease with intermittent flares. A flare, or flare-up, is a period of time in which symptoms of ulcerative colitis are severe. Generally speaking, flares can last for weeks or even months, although ulcerative colitis is experienced differently from person to person, and the duration of symptoms varies greatly for each individual.

People living with ulcerative colitis typically experience periods of both active disease and remission.

The goal of treatment is to achieve remission.

Medications are the main treatment for ulcerative colitis. Other treatment options include dietary changes and surgery, if necessary.

Drugs for ulcerative colitis work by reducing inflammation in your colon.

Some drugs are commonly used for maintenance therapy — to help you stay in remission — while others are used to treat disease activity during flares. You may need a combination of drugs for optimal treatment.

Surgery may be necessary if your body isn’t responding well to drugs or if you have severe complications that require urgent treatment. Surgery to remove the entire colon is curative.

There are a few types of drugs used to treat ulcerative colitis.

Aminosalicylates are typically the first kind of drug prescribed for ulcerative colitis. They work by reducing inflammation directly in your digestive tract and can be taken on an ongoing basis.

Corticosteroids, also known simply as steroids, are used to treat disease flares. Most drugs of this type work by suppressing the entire immune system, so they can have severe side effects and shouldn’t be taken for long periods.

Biologics are made of antibodies that are grown in the lab and work by stopping certain proteins in the body from causing inflammation.

Small molecules are oral medications that also work on the immune system but act differently from biologics.

These drugs are used to treat moderate to severe ulcerative colitis.

Immunomodulators are a second-line drug for treating ulcerative colitis. These drugs limit inflammation at its source in the immune system.

Other drugs for ulcerative colitis may include antibiotics and certain pain relievers.

When it comes to food, there’s no known dietary cause of ulcerative colitis, but different foods may aggravate or help limit symptoms of the disease.

You’re more likely to need to change your diet during periods of active disease (flares), when eating soft, bland foods can help limit symptoms like cramping and diarrhea. With guidance from a doctor, a liquid meal replacement diet known as an elemental diet, can also help achieve remission from active disease.

During flares, you may also want to avoid or limit high-fiber and high-fat foods, as well as alcohol, dairy products, and spicy foods.

If you’re losing nutrients and water in your diet due to diarrhea, you may need to focus on increasing your fluid intake and getting enough calories, protein, vitamins, and minerals from foods or supplements.

While people of European descent have traditionally had more cases of ulcerative colitis than others, this is changing. According to a review published in August 2016 in the journal Inflammatory Bowel Diseases, IBD is becoming more prevalent in people of African American, Asian, and Hispanic descent.

Ulcerative colitis tends to run in families, affecting men and women equally overall. But older men are more likely to develop it than older women, according to the Crohn’s and Colitis Foundation.

Ulcerative colitis is a type of IBD, but it's not the same as irritable bowel syndrome (IBS).

Although the disorders share some of the same symptoms, such as abdominal pain and diarrhea, inflammation and ulcers do not occur with IBS.

Another disease often mentioned alongside ulcerative colitis is Crohn’s disease. Ulcerative colitis and Crohn’s are different types of IBDs that affect the digestive tract in different ways.

The two diseases have a lot of common symptoms, but certain symptoms may make your doctor suspect one disease versus the other.

While diarrhea, rectal bleeding, and abdominal pain are common in both diseases, Crohn’s disease more often causes nausea, weight loss, and vomiting. The types of abdominal pain are often somewhat different.

Ulcerative colitis is limited to the lining of the large intestine (colon), whereas Crohn’s disease can affect the entire digestive tract — from your mouth to your anus — and isn’t limited to the inner part of the intestines.

The coronavirus pandemic has forced everyone to take extra precautions when it comes to health and safety. This is especially true for individuals with a compromised immune system. Although research shows that people living with UC are no more susceptible to catching the virus than the general population, organizations including the American College of Gastroenterology and the Crohn’s and Colitis Foundation have issued guidelines to help limit the spread of the infection. It’s also recommended that people with ulcerative colitis get a COVID-19 vaccine.

A number of resources are available to help people with UC manage these difficult times — from medication assistance to virtual therapy for mental health.

The Takeaway

Ulcerative colitis is a chronic inflammatory condition that affects the colon, leading to symptoms such as abdominal pain, frequent bowel movements, and bloody stool. The disease can come and go, with flares and periods of remission lasting for various lengths of time. Managing UC involves a combination of medical treatments and dietary adjustments to help maintain remission and improve quality of life.