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Ulcerative colitis is a relatively common long-term condition that causes inflammation in the colon. Dietary changes and medications can often help manage symptoms, but surgery is an option in severe cases.
The colon removes nutrients from undigested food and eliminates waste products through the rectum and anus as feces.
In severe cases of ulcerative colitis, ulcers form on the lining of the colon. These ulcers may bleed, which produces pus and mucus.
Uclerative colitis is a form of inflammatory bowel disease (IBD) that is similar to Crohn’s disease.
Various medication options are available, and doctors can tailor treatment to meet individual needs.
In this article, we cover the symptoms, risk factors, and possible causes of ulcerative colitis, as well as some treatment options.
The first symptom of ulcerative colitis is usually diarrhea.
Stools become progressively looser, and some people may experience abdominal pain with cramps and a severe urge to go to the bathroom.
Diarrhea may begin slowly or suddenly. Symptoms depend on the extent and spread of inflammation.
The most common symptoms of ulcerative colitis include:
- abdominal pain
- bloody diarrhea with mucus
Some people may also experience:
- fatigue or tiredness
- weight loss
- loss of appetite
- anemia
- elevated temperature
- dehydration
- a constant urge to pass stools
Symptoms are often worse early in the morning.
Symptoms may be mild or absent for months or years at a time. However, they will usually return without treatment and vary depending on the affected part of the colon.
Symptoms may vary depending on the area of inflammation.
The sections below discuss the various types of ulcerative colitis, many of which affect different parts of the colon:
Ulcerative proctitis
This type affects only the end of the colon, or the rectum. Symptoms tend to include:
- rectal bleeding, which may be the only symptom
- rectal pain
- an inability to pass stools despite frequent urges
Ulcerative proctitis is usually the mildest type of ulcerative colitis.
Proctosigmoiditis
This involves the rectum and the sigmoid colon, which is the lower end of the colon.
Symptoms include:
- bloody diarrhea
- abdominal cramps
- abdominal pain
- a constant urge to pass stool
Left-sided colitis
This affects the rectum and the left side of the sigmoid and descending colon.
Symptoms usually include:
- bloody diarrhea
- abdominal cramping on the left side
- weight loss
Pancolitis
This affects the whole colon. Symptoms include:
- occasionally severe, bloody diarrhea
- abdominal pain and cramps
- fatigue
- considerable weight loss
Fulminant colitis
This is a rare, potentially life threatening form of colitis that affects the whole colon.
Symptoms tend to include severe pain and diarrhea, which can lead to dehydration and shock.
Fulminant colitis can present a risk of colon rupture and toxic megacolon, which causes the colon to become severely distended.
According to the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK), some
- eating smaller, more regular meals, such as five or six small meals per day
- drinking plenty of fluids, especially water, to prevent dehydration
- avoiding caffeine and alcohol, which can both increase diarrhea
- avoiding sodas, which can increase gas
- keeping a food diary to identify which foods make symptoms worse
A doctor may suggest temporarily following a specific diet depending on symptoms, such as:
- a low fiber diet
- a lactose-free diet
- a low fat diet
- a low salt diet
It may help to take supplements or eliminate particular foods from the diet. However, a person should discuss any complementary or alternative measures with a doctor before trying them.
Here, find out more about what to eat and avoid with ulcerative colitis.
The exact causes of ulcerative colitis are unclear. However, they may involve the following:
Genetic factors
Environment
The following environmental factors might affect the onset of ulcerative colitis:
- diet
- air pollution
- cigarette smoke
Immune system
The body might respond to a viral or bacterial infection in a way that causes the inflammation associated with ulcerative colitis.
Once the infection resolves, the immune system continues to respond, which leads to ongoing inflammation.
Another theory suggests that ulcerative colitis may be an autoimmune condition. A fault in the immune system may cause it to fight nonexistent infections, leading to inflammation in the colon.
Some known risk factors for ulcerative colitis include:
- Age: Ulcerative colitis can affect people at any age but is more common at 15–30 years of age.
- Ethnicity: White people and those of Ashkenazi Jewish descent have a higher risk of developing the condition.
- Genetics: Although recent studies have identified specific genes that may play a role in ulcerative colitis, the link is unclear due to the role of environmental factors.
A doctor will ask about a person’s symptoms and medical history. They will also ask whether any close relatives have had ulcerative colitis, IBD, or Crohn’s disease.
They will also check for signs of anemia, or low iron levels in the blood, and tenderness around the abdomen.
Several tests can help rule out other possible conditions and diseases, including Crohn’s disease, infection, and irritable bowel syndrome.
These include:
- blood tests
- stool tests
- X-ray
- barium enema, during which a healthcare professional passes a fluid called barium through the colon to show any changes or anomalies in a scan
- sigmoidoscopy, in which a healthcare professional inserts a flexible tube with a camera at the end, called an endoscope, into the rectum
- colonoscopy, wherein a doctor examines the whole colon using an endoscope
- a CT scan of the abdomen or pelvis
A person with ulcerative colitis will need to see a doctor who specializes in treating conditions of the digestive system, or a gastroenterologist.
They will assess the type and severity of the condition and create a treatment plan.
Some home care strategies and remedies may help manage the symptoms of ulcerative colitis.
Natural medicine
Here are some options that people may use:
- Probiotics: A 2019 review suggests that some probiotics may help manage IBD.
- Herbal remedies: Other
research from 2019 found that some herbal remedies may help reduce symptoms and manage the condition. Examples include aloe vera gel and wheatgrass juice. - Fruits and other plant-based foods: Some
earlier research shows that ingredients naturally present in blueberries, black raspberries, cocoa, Indian quince, green tea, grapes, olive oil, and Indian gooseberries may have a beneficial effect. - Spices: Garlic, ginger, fenugreek, saffron, turmeric, and Malabar tamarind may help with IBD symptoms.
Research has not yet confirmed the possible benefits of the options above, but moderate amounts appear safe to add to the diet. However, it is worth checking with a healthcare professional first.
Here, learn more about natural remedies for ulcerative colitis.
Lifestyle options
Scientists have also found that the following may help:
Education: The more a person knows about a health condition, the more in control they tend to feel. Learning about ulcerative colitis can help ease anxiety and lead to effective coping and management techniques,
Exercise: Some research suggests that aerobic exercise may have an anti-inflammatory effect, which could benefit people with ulcerative colitis. One
Mindfulness: In a
Support
Developing a virtual or face-to-face support network that includes members of a community and medical professionals can make managing ulcerative colitis easier for people and their loved ones.
IBD Healthline is a free app for people with the condition. The app is available on the AppStore and Google Play. Download it here.
The possible complications of ulcerative colitis can range from a lack of nutrients to potentially fatal bleeding from the rectum.
Possible complications include:
Colorectal cancer
Ulcerative colitis, especially if symptoms are severe or extensive, increases the risk of developing colon cancer.
According to the NIDDK, colon cancer risk is highest when ulcerative colitis affects the entire colon for
Toxic megacolon
This complication occurs in a few cases of severe ulcerative colitis.
In toxic megacolon, gas becomes trapped, causing the colon to swell. When this occurs, there is a risk of colon rupture, septicemia, and shock.
Other complications
Other possible complications of ulcerative colitis include:
- inflammation of the skin, joints, and eyes
- liver disease
- osteoporosis
- perforated colon
- severe bleeding
- severe dehydration
To prevent bone density loss, a doctor may prescribe vitamin D supplements, calcium, or other medications.
Attending regular medical appointments, closely following a doctor’s advice, and being aware of symptoms can help prevent these complications.
The outlook for ulcerative colitis varies widely. While it is a lifelong condition, the overall mortality rate for people with ulcerative colitis is the same as for people without it, according to
However, some ulcerative colitis complications, such as toxic megacolon, can be life threatening. In addition, at least
Ulcerative colitis involves remissions and flares, periods when symptoms improve and worsen. Some people may experience remission all year and experience few or no symptoms, while others may experience at least one flare at some time during the year.
Learn more about how ulcerative colitis can affect life expectancy.