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    Ulcerative Colitis

    Ulcerative Colitis - Topic Overview




    Is this topic for you?

    Ulcerative colitis and Crohn's disease are the most common types of inflammatory bowel disease. Ulcerative colitis affects only the colon and rectum. Crohn’s can affect any part of the digestive tract. To learn more about Crohn’s disease, see the topic Crohn’s Disease.
    What is ulcerative colitis?

    Ulcerative colitis is a disease that causes inflammation and sores (ulcers) in the lining of the large intestine (colon ). It usually affects the lower section (sigmoid colon) and the rectum. But it can affect the entire colon. In general, the more of the colon that’s affected, the worse the symptoms will be.
    Ulcerative colitis can affect people of any age. But most people who have it are diagnosed before the age of 30.
    What causes ulcerative colitis?

    Experts are not sure what causes ulcerative colitis. They think it might be caused by the immune system overreacting to normal bacteria in the digestive tract. Or other kinds of bacteria and viruses may cause the disease.
    You are more likely to get ulcerative colitis if other people in your family have it.
    What are the symptoms?

    The main symptoms are:
    • Belly pain or cramps.
    • Diarrhea.
    • Bleeding from the rectum.
    Some people also may have a fever, may not feel hungry, and may lose weight. In severe cases, people may have diarrhea 10 to 20 times a day.
    Ulcerative colitis can also cause other problems, such as joint pain, eye problems, or liver disease.
    In most people, the symptoms come and go. Some people go for months or years without symptoms (remission). Then they will have a flare-up. About 5 to 10 out of 100 people with ulcerative colitis have symptoms all the time.1
    Ulcerative colitis sometimes leads to more serious problems. It can cause scarring of the bile duct. This can lead to liver damage. In rare cases, severe disease causes the colon to swell to many times its normal size (toxic megacolon). This can be deadly and needs emergency treatment.
    People who have ulcerative colitis for 8 years or longer have a greater chance of getting colon cancer. The longer you have had ulcerative colitis, the greater your risk.2 Talk to your doctor about your need for cancer screening. Screening tests help find cancer early, when it is easier to treat.3
    How is ulcerative colitis diagnosed?

    To diagnose ulcerative colitis, doctors ask about the symptoms, do a physical exam, and do a number of tests. Testing can help the doctor rule out other problems that can cause similar symptoms, such as Crohn’s disease, irritable bowel syndrome, or diverticulitis.
    Tests that may be done include:
    • A colonoscopy. In this test, a doctor uses a thin, lighted tool to look at the inside of your entire colon. At the same time, the doctor may take a sample (biopsy) of the lining of the colon.
    • Blood tests, which are done to look for infection or inflammation.
    • Stool sample testing to look for blood, infection, and white blood cells.

    Ulcerative colitis affects everyone differently. Your doctor will help you find treatments that reduce your symptoms and help you avoid new flare-ups.
    If your symptoms are mild, you may only need to use over-the-counter medicines for diarrhea (such as Imodium). Talk to your doctor before you take these medicines.
    Medicines used to treat ulcerative colitis include:
    • Aminosalicylates. These can be used to reduce or stop symptoms (sometimes at the same time as steroid medicines). After your symptoms are under control, you may take these medicines to help prevent flare-ups.
    • Steroid medicines. These can help reduce or stop symptoms. They are only used for short periods because they can cause side effects, such as bone thinning (osteoporosis).
    • Medicines that control the immune system (immunomodulators). You may need these if your disease is severe and aminosalicylates don't keep it from flaring up.
    Some people find that certain foods make their symptoms worse. If this happens to you, it makes sense to not eat those foods. But be sure to eat a healthy, varied diet to keep your weight up and to stay strong.
    If you have severe symptoms and medicines don't help, you may need surgery to remove part or all of your colon. Removing the entire colon cures ulcerative colitis. It also prevents colon cancer.
    How will ulcerative colitis affect your life?

    Ulcerative colitis can be hard to live with. During a flare-up it may seem like you are always running to the bathroom. This can be embarrassing and can take a toll on how you feel about yourself. Not knowing when the disease will strike next can be stressful.
    If you are having a hard time, seek support from family, friends, or a counselor. Or look for an ulcerative colitis support group. It can be a big help to talk to others who are coping with this disease.

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    Ulcerative Colitis - Cause

    The cause of ulcerative colitis is unknown. It may result from an abnormal response by the body's immune system to normal intestinal bacteria. Disease-causing bacteria and viruses also may play a role in causing the condition.
    Ulcerative colitis can run in families-some people may have a genetic tendency to have it.


    Ulcerative Colitis - Symptoms

    The symptoms of ulcerative colitis may include:
    • Diarrhea or rectal urgency. Some people may have diarrhea 10 to 20 times a day. The urge to go to the bathroom may wake you up at night.
    • Rectal bleeding. Ulcerative colitis usually causes bloody diarrhea and mucus. You also may have rectal pain and an urgent need to empty your bowels.
    • Abdominal (belly) pain, often described as cramping. Your abdomen may be sore when touched.
    • Constipation. This symptom may develop depending on what part of the colon is affected. Constipation is much less common than diarrhea.
    • Loss of appetite.
    • Fever. In severe cases, fever or other symptoms that affect the entire body may develop.
    • Weight loss. Ongoing (chronic) symptoms, such as diarrhea, can lead to weight loss.
    • Too few red blood cells (anemia). Some people develop anemia because of low iron levels caused by bloody stools or intestinal inflammation.
    You also may have symptoms and complications outside the digestive tract, such as joint pain, eye problems, skin rash, or liver disease.

    Other conditions with symptoms similar to ulcerative colitis include Crohn's disease, diverticulitis, irritable bowel syndrome (IBS), and colon cancer.

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    Ulcerative Colitis - What Happens

    Ulcerative colitis may be mild, moderate, or severe. It may be described as dependent on corticosteroids, unresponsive to steroids, active, or not active (in remission).
    Ulcerative colitis also may be defined by the part of the large intestine affected: the rectum (proctitis), the left side of the colon (left-sided colitis), or the entire colon (pancolitis).
    Most people with ulcerative colitis have periods of remission that may last up to several years. These periods are interrupted by occasional flare-ups of moderate symptoms. About 5 to 10 out of 100 people who have ulcerative colitis have symptoms all the time.1
    Children may have the same symptoms as adults. Also, children with ulcerative colitis may grow more slowly than normal and go through puberty later than expected.
    Complications and long-term effects

    • Inflammation and scarring of the bile ducts (primary sclerosing cholangitis) may occur. A bile duct is a passage that carries fluid produced in the liver to the small intestine.
    • Severe inflammation and ulceration sometimes irritate muscles in the colon, causing colon walls to stretch. The colon may swell to many times its normal size, a condition known as toxic megacolon. This is an emergency that requires immediate treatment, but it is rare.
    • Narrowed areas of the intestine (strictures) may occur in ulcerative colitis, causing difficulty in passing stools.
    • Your risk of cancer of the colon and rectum is higher than average if you have had ulcerative colitis for 8 years or longer. With regular screening, some cancers can be detected early and treated successfully.
    • Ulcerative colitis can cause rare complications such as scarring of the pancreas and inflammation of the membrane surrounding the heart (pericarditis).
    Some people who have ulcerative colitis also have irritable bowel syndrome (IBS), which is not as serious as ulcerative colitis. IBS causes abdominal pain along with diarrhea or constipation.
    Most women with ulcerative colitis can have a normal pregnancy and deliver a healthy baby. Symptoms may become worse during the first 3 months of pregnancy. Some medicines to treat the disease can be used during pregnancy.

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    Ulcerative Colitis - What Increases Your Risk

    You have an increased risk of ulcerative colitis if you:

    • Have a family history of ulcerative colitis. Your risk increases if an immediate family member such as a parent, brother, or sister has the disease.
    • Are of Ashkenazi Jewish ancestry. For more information on genetic diseases in this group, see the topic Ashkenazi Jewish Genetic Panel (AJGP).

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    Ulcerative Colitis - When To Call a Doctor

    Call a doctor immediately if you have been diagnosed with ulcerative colitis and you have any of the following:
    • Fever over 101°F (38.3°C) or shaking chills
    • Lightheadedness, passing out, or rapid heart rate
    • Stools that are almost always bloody
    • Severe dehydration
    • Severe belly pain with or without bloating
    • Pus draining from the area around the anus or pain and swelling in the anal area
    • Repeated vomiting
    • Not passing any stools or gas
    If you have any of these symptoms and you have been diagnosed with ulcerative colitis, your disease may have become significantly worse. Some of these symptoms also may be signs of toxic megacolon, a condition in which the colon swells to many times its normal size. Toxic megacolon requires emergency treatment. Untreated toxic megacolon can cause the colon to leak or rupture, which can be fatal.


    People who have ulcerative colitis usually know their normal pattern of symptoms. Call your doctor if there is a change in your usual symptoms or if:
    • Your symptoms become significantly worse than usual.
    • You have persistent diarrhea for more than 2 weeks.
    • You have lost weight.
    Watchful Waiting

    Watchful waiting is not appropriate when you have any of the above symptoms. If your symptoms are caused by ulcerative colitis, delaying the diagnosis and treatment may make the disease worse and increase your risk of complications.
    Even when the disease is in remission, your doctor will want to see you regularly to check for complications, some of which can be hard to detect. It is always appropriate to call your doctor's office for advice.
    Who To See

    Health professionals who can diagnose ulcerative colitis include:
    For the treatment and management of ulcerative colitis, you are likely to be referred to a gastroenterologist.
    To be evaluated for surgery, you may be referred to a:
    To prepare for your appointment, see the topic Making the Most of Your Appointment.

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    Ulcerative Colitis - Exams and Tests

    Ulcerative colitis can be relatively easy to diagnose because it normally affects only the colon and rectum and usually causes an obvious change in daily bowel habits, such as frequent stools containing blood or mucus. Your doctor will conduct a medical history and physical exam before doing other tests.
    The colon and rectum can be examined with flexible sigmoidoscopy or colonoscopy, tests in which a doctor examines the inside of the large intestine using a small, lighted scope. In general, colonoscopy is the preferred test because it can be used to examine the entire colon. But flexible sigmoidoscopy may be all that is needed to diagnose ulcerative colitis. Both procedures can be used to take a sample (biopsy) of intestinal tissue. The diagnosis of ulcerative colitis is made by ruling out other causes of diarrhea and assessing the results of these tests.
    Other exams and tests that may be used to evaluate ulcerative colitis include:
    • Abdominal X-ray, which provides a picture of structures and organs in the abdomen.
    • Barium enema, a test that allows the doctor to examine the large intestine (colon).
    • Computed tomography (CT) scan, which uses X-rays to produce detailed pictures of structures inside the body.
    • Magnetic resonance imaging (MRI), which uses a magnetic field and pulses of radio wave energy to provide pictures of organs and structures inside the body.
    • Stool analysis (including a test for blood in the stool), to look for blood, signs of bacterial infection, parasites, or the presence of white blood cells.
    • Standard blood and urine tests, to check for anemia, inflammation, or malnutrition. Depending on the symptoms, an erythrocyte sedimentation rate (ESR, or sed rate) or a C-reactive protein (CRP) blood test may be done to look for infection or inflammation.
    • Biopsy of a sample of tissue from the lining of the intestine. Biopsies are collected during sigmoidoscopy or colonoscopy to confirm the diagnosis of ulcerative colitis. A biopsy also may be done to find out whether a tumor is present. Multiple biopsies are often done to screen for cancer in people who have had ulcerative colitis for 8 years or more. Bowel biopsies are painless (other than the potential discomfort of the scope procedure) and remove only a tiny piece of tissue.
    Some people have symptoms of inflammatory bowel disease and neither Crohn's disease nor ulcerative colitis can be diagnosed. These people have a form of inflammatory bowel disease called indeterminate colitis, which doctors believe is a combination of Crohn's disease and ulcerative colitis.

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    Ulcerative Colitis - Treatment Overview

    Treatment for ulcerative colitis depends mainly on the severity of the disease and usually includes medicines to control symptoms, such as diarrhea, and changes in diet. A few people have symptoms that are persistent and severe, in some cases requiring treatment with additional medicines or surgery.
    For more information about making good food choices, see:
    Bowel Disease: Changing Your Diet.
    The goals of treatment include:
    • Relieving symptoms and ending sudden (acute) attacks as quickly as possible.
    • Treating complications, such as anemia or infection. Treatment may include taking nutritional supplements to restore normal growth and sexual development in children and teens.
    • Preventing or delaying new attacks.
    Initial treatment

    If you don't have any symptoms of ulcerative colitis or if your disease is not active (in remission), you may not need treatment. If you do have symptoms, they usually can be managed with medicines to put the disease in remission. It often is easier to keep the disease in remission than to treat a flare-up.
    Mild symptoms may respond to antidiarrheal medicines and changes in your diet. Sometimes you may need to use enemas or suppositories. Talk with your doctor before taking antidiarrheals. Prescription medicines may be used to treat mild symptoms and keep the disease in remission. Usually, corticosteroids (such as hydrocortisone or prednisone) are given for a few weeks to control active disease. Aminosalicylates (such as sulfasalazine or mesalamine) will often also be used to reduce or stop symptoms, sometimes at the same time as corticosteroids.
    When your symptoms are under control, you may continue to take aminosalicylates to keep the disease in remission. Aminosalicylates relieve inflammation in the intestines.
    Moderate to severe symptoms usually require corticosteroids to control inflammation. The required dose of steroids may be higher than that needed to treat mild colitis. When inflammation goes away, you will take aminosalicylates to keep the condition in remission.
    Immunomodulator medicines, such as azathioprine (AZA) or 6-mercaptopurine (6-MP), also may be needed for severe cases that cannot be controlled with aminosalicylates alone. These medicines suppress the body's immune system to prevent inflammation. Immunomodulators also may be needed to avoid long-term use of steroids, which can cause side effects such as increased risk of infection and osteoporosis.
    For severe ulcerative colitis, when corticosteroids don't work, your doctor may have you try biologics (such as infliximab). Biologics may work to put you in remission when other medicines don't. They have also been shown to help heal the lining of the intestine.
    Ongoing treatment

    The goal of ongoing treatment is to keep ulcerative colitis from causing symptoms (keep it in remission). Most people take aminosalicylates (such as sulfasalazine or mesalamine) to prevent symptoms from recurring. Aminosalicylates relieve inflammation in the intestines. If you do have flare-ups, you may be given corticosteroids (such as hydrocortisone or prednisone) to control the inflammation.


    Usually, steroids are given only long enough to control inflammation. If your condition is so severe that aminosalicylates alone cannot keep you in remission and you would need long-term use of steroids, you may take immunomodulator medicines (such as azathioprine [AZA], 6-mercaptopurine [6-MP], or cyclosporine). These strong medicines suppress the immune system to prevent inflammation.
    If these medicines don't work, your doctor may have you try biologics (such as infliximab). Biologics also block the inflammatory response in your body and help reduce the inflammation in your colon.
    Your doctor will want to see you for a follow-up visit about every 6 months while your condition is stable and more frequently if you are having problems. If you are taking medicines, you may have laboratory tests every 2 to 3 months. Many people who have ulcerative colitis are so familiar with the course of their condition that they can handle minor flare-ups on their own. In some cases, you may be able to consult with your doctor on the phone for minor problems.
    Treatment if the condition gets worse

    You may have to receive treatment in the hospital if you have severe, persistent ulcerative colitis with symptoms outside the digestive tract, such as fever or anemia. Treatment includes replacing fluids and electrolytes lost because of severe diarrhea.
    Your doctor may increase your dose of corticosteroids (such as hydrocortisone or prednisone) to control active disease or may increase your immunomodulator medicines (such as azathioprine [AZA], 6-mercaptopurine [6-MP], or cyclosporine) or biologics (such as infliximab) to suppress your immune system. But steroids are usually not used as long-term therapy.
    Surgery may be necessary if your symptoms do not improve with medicines or you have complications such as bleeding or perforation of the intestine. Removal of the large intestine (colon) cures ulcerative colitis. Some people with severe ulcerative colitis need urgent surgery to remove their colon. Several types of surgery can be done. For more information, see the Surgery section of this topic.
    Some people who have precancerous changes in their colon may decide to have surgery to prevent cancer even if they have no symptoms. In some cases, people decide to have their colon removed to improve their quality of life and to eliminate the risk of colon cancer.

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    Ulcerative Colitis - Prevention

    You cannot prevent ulcerative colitis because the cause is unknown. But you can take steps to reduce the severity of the disease.
    Antibiotics may make ulcerative colitis symptoms worse and should only be used when necessary.

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    Ulcerative Colitis - Home Treatment

    If ulcerative colitis does not cause symptoms, no treatment is needed. If you have only mild symptoms, antidiarrheal medicines and changes in diet and nutrition may help. For disease in the rectum alone, you can try topical medicines (suppository, enema, or foam). Ask your doctor about these products. For more information about making good food choices, see:
    Bowel Disease: Changing Your Diet.
    In general, doctors recommend that you do not use nonsteroidal anti-inflammatory drugs (NSAIDs, such as ibuprofen or naproxen). These medicines may cause flare-ups of ulcerative colitis. But some people may be more likely to have flare-ups from NSAIDs than others. Talk to your doctor about whether to avoid these medicines.
    If you have had or are planning to have surgery that will create an opening from the intestines to the outside of the body through which stool passes (ostomy), you may feel self-conscious or embarrassed. After a period of adjustment, most people are able to resume all of their usual activities. In fact, you may feel better than before surgery because you may no longer have painful symptoms. Support groups are available for people with ostomies.
    Bowel Disease: Caring for Your Ostomy
    Children with ulcerative colitis may feel self-conscious if they do not grow as fast as other children their age. Encourage your child to take medicine as prescribed. Offer your help with the treatment so that your child can feel better, start growing again, and lead a more normal life. Children tend to have a harder time managing ulcerative colitis than adults. So your support is very important.

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    Ulcerative Colitis - Medications

    Medicines usually are the treatment of choice for ulcerative colitis. They control or prevent inflammation in the intestines and help:
    • Relieve symptoms.
    • Promote healing of damaged tissues.
    • Put the disease into remission and keep it from flaring up again.
    • Postpone or prevent the need for surgery.
    Medication Choices

    The choice of medicine usually depends on the severity of the disease, the part of the colon affected, and whether complications are present.


    If you are pregnant or planning to become pregnant, talk to your doctor about which medicines might be okay to use for ulcerative colitis. Sometimes severe ulcerative colitis can harm your baby more than the medicines you are taking to keep it under control. Some medicines, though, should never be taken when you are pregnant. Your doctor can tell you which medicines are okay for you while you are pregnant or breast-feeding.
    What To Think About

    Aminosalicylates are the most common medicines used to treat ulcerative colitis. Most of the time, these medicines are all a person needs to keep the disease in remission (a period of time with no symptoms). When aminosalicylates do not work, corticosteroids are most often the next medicine tried. Corticosteroids will only be used long enough to stop the inflammation in your colon. After the inflammation goes down, aminosalicylates will most likely be used to keep you in remission.
    If aminosalicylates are not strong enough to keep you in remission, or if corticosteroids don't work, your doctor may have you try different medicines. These medicines include immunomodulators, cyclosporine, and infliximab. All of these medicines control the immune response in your body and will reduce the inflammation in your intestine. The inflammation is what causes the symptoms of ulcerative colitis.

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