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.
The disease can affect
people of any age. But most people who have it are diagnosed before the age of
30.
What causes ulcerative colitis?
Experts aren't
sure what causes it. 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 it.
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.
The disease 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.footnote 1
How is ulcerative colitis diagnosed?
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, and
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 look for
infection or inflammation.
Stool sample testing to look for blood,
infection, and white blood cells.
How is it treated?
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.
Many people need prescription medicines, such as aminosalicylates, steroid medicines, or other medicines that reduce the body's immune response. These medicines can stop or reduce symptoms and prevent flare-ups.
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 your colon. Removing the colon
cures ulcerative colitis. It also prevents colon cancer.
How will ulcerative colitis affect your life?
People who have ulcerative colitis
for 8 years or longer also have a greater chance of getting
colon cancer. The longer you have had ulcerative colitis, the greater your risk.footnote 2 Talk to your
doctor about your need for cancer screening. These tests help find cancer
early, when it is easier to treat.footnote 3
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 it
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 a support group. It
can be a big help to talk to others who are coping with this disease.
The cause of
ulcerative colitis is unknown. It may be caused by an
abnormal response by the body's
immune system to normal intestinal bacteria. Disease-causing bacteria and viruses also may play a role.
Ulcerative colitis can run in families.
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. The disease usually causes
bloody diarrhea and mucus. You also may have rectal pain and an urgent need to
empty your bowels.
Belly pain, often described as cramping.
Your belly 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
symptoms, such as diarrhea, can lead to weight loss.
Too few red
blood cells (anemia). Some people get anemia because of low
iron levels caused by bloody stools or intestinal inflammation.
Most
people have periods of remission (when the condition is not active) 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.footnote 1
Children may
have the same symptoms that adults have. Also, children with the disease may
grow more slowly than normal and go through puberty later than expected.
Complications and long-term effects
Problems from ulcerative colitis can include:
Narrowed areas of the
intestine (strictures). They can make it hard to pass
stools.
Increased risk of cancer of the colon and rectum. This risk is higher than average if you have had
ulcerative colitis for 8 years or longer.
Inflammatory bowel disease, which also increases the risk of melanoma, a serious type of skin cancer. Your doctor may recommend regular screening by a dermatologist.footnote 4
Irritable bowel syndrome
Some people who have ulcerative colitis also have
irritable bowel syndrome (IBS). It isn't as
serious as ulcerative colitis. IBS causes belly pain along with diarrhea or
constipation.
Pregnancy and ulcerative colitis
Most women with ulcerative colitis can have a normal pregnancy and deliver a healthy baby. Symptoms may be worse
during the first 3 months of
pregnancy. Some medicines to treat the disease can be
used during pregnancy.
What Increases Your Risk
You have an increased risk of
ulcerative colitis if you:
Have a family history of the disease.
Your risk increases if an immediate family member such as a parent, brother, or
sister has the disease.
Call a doctor immediately if you have been diagnosed with
ulcerative colitis and you have:
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, such as passing little or no urine for 12 or more hours.
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. This is a condition in which the colon swells
to many times its normal size. Toxic megacolon requires emergency treatment.
Left untreated, it can cause the colon to leak or rupture. This can be
fatal.
People with 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 it can
increase your risk of other problems.
Even when the disease is in
remission, your doctor will want to see you regularly to check for
complications. Some of these problems can be hard to detect. It is always a good idea to
call your doctor's office for advice.
Who to see
Health professionals who can diagnose ulcerative
colitis include:
Ulcerative colitis can be fairly easy to diagnose, because it normally affects
only the colon and rectum. And it usually causes an obvious change
in daily bowel habits, such as frequent stools with blood or mucus.
Your
doctor may:
Conduct a
medical history and physical exam.
Look inside your colon and rectum with
flexible sigmoidoscopy or
colonoscopy . The doctor uses a small, lighted scope to look inside the intestine. In general,
colonoscopy is preferred, because it can be used to see the entire
colon. Both procedures can be used to take a sample (biopsy) of intestinal tissue. Biopsies are
collected during sigmoidoscopy or colonoscopy to see if you have ulcerative colitis. A biopsy also may be done to look for cancer.
Other exams and tests that may be used include:
Abdominal X-ray . It provides a picture of the inside of the abdomen.
Barium enema . It allows the doctor to examine
the colon.
Some people have symptoms of inflammatory bowel disease (IBD), but neither
Crohn's disease nor ulcerative colitis can be diagnosed. These people have a
form of IBD called indeterminate colitis. Doctors believe that it has features of both Crohn's disease and ulcerative colitis.
Treatment Overview
Treatment for
ulcerative colitis depends mainly on how bad the disease is. It usually includes medicines and changes in diet. A few people have symptoms that are long-lasting
and severe, in some cases requiring more medicines or
surgery.
You may need to treat other problems, such as
anemia or infection. Treatment in children and teens may include taking
nutritional supplements to restore normal growth and sexual development.
If you don't have any symptoms or if your disease is not active
(in
remission), you may not need treatment. But your doctor may suggest that you take medicines to keep the disease in remission.
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.
Aminosalicylates. These medicines relieve inflammation in the intestines. They are also taken to keep the disease in remission.
Steroid medicines. Your doctor may prescribe these for a few weeks to control active disease.
Changes in your diet.
Moderate to severe symptoms
These symptoms usually require steroid medicines to
control inflammation. The dose you need may be higher than that
needed to treat mild symptoms. When inflammation goes away, you will take
aminosalicylates to keep the condition in remission.
Severe symptoms also may be treated with:
Immunomodulator medicines or
cyclosporine. These strong medicines suppress the
immune system to prevent inflammation.
Biologics. They block the
inflammatory response in your body and help reduce the inflammation in your
colon. They may be used if other medicines don't control your symptoms.
Surgery. Removal of the
large intestine (colon) cures ulcerative colitis. But surgery may not cure all of the problems that the condition can cause in other areas of the body, such as the liver and joints. Surgery also is done to treat problems such as
bleeding or toxic megacolon.
Treatment in the hospital
You may need treatment in the hospital if you have severe ulcerative colitis with symptoms outside the digestive
tract, such as fever or
anemia. Treatment includes replacing fluids and
electrolytes lost because of severe diarrhea.
Follow-up visits
Your doctor will want to see you for a follow-up visit
about every 6 months while your condition is stable. You'll need to see the doctor more often if you
are having problems. Many people are so familiar
with their condition that they can handle minor flare-ups on
their own. In some cases, you may be able to talk with your doctor on the
phone for minor problems.
If you are taking medicines, you may need to have lab tests
regularly.
Prevention
You cannot prevent
ulcerative colitis, because the cause is unknown.
Home Treatment
You can take steps at home to reduce symptoms of ulcerative colitis.
Over-the-counter medicines
Medicines to treat your condition: If you have only mild symptoms,
antidiarrheal medicines may help. For disease in the rectum alone, you can try medicines given in a suppository, enema, or foam.
Medicines to avoid: In general, doctors recommend that you don't use
nonsteroidal anti-inflammatory drugs (NSAIDs, such as ibuprofen or naproxen).
These medicines may cause flare-ups. But some people may be more likely to have
flare-ups from NSAIDs than other people. Talk to your doctor about whether to avoid
these medicines.
Diet
A change in your diet may help reduce symptoms. Keep a food diary to find out which foods make your symptoms worse. During a flare-up, avoid or reduce these foods. But instead of cutting out a whole group of high-nutrient foods, try replacing them with healthy choices.
If you have had or are planning to have surgery
that will create an 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.
Ulcerative
colitis can affect every aspect of your life. You may want to seek
counseling or social support from family, friends, or clergy.
Helping a child
Children tend to have a harder time than adults in managing the disease. So
your support is very important.
Children may feel self-conscious if
they don't 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.
Medications
Medicines usually are the main treatment for
ulcerative colitis. They control or prevent
inflammation in the intestines and help to:
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.
Medicine choices
The choice of medicine usually depends on how bad
the disease is, the part of the colon affected, and any complications you may have.
Treatment of mild to moderate disease often begins with
aminosalicylates. These are a type of disease-modifying antirheumatic drug (DMARD) . They relieve inflammation in the intestines and help
the disease go into remission. They may also keep the disease from becoming
active again.
Steroid medicines may be added if
symptoms continue. They relieve inflammation in the
intestines.
For severe cases, you may have stronger treatment with another DMARD or intravenous (IV)
corticosteroids.
If you're pregnant or breastfeeding
If you are pregnant or are planning to become pregnant, talk to your doctor about which medicines might be okay for you to use. Sometimes severe ulcerative colitis can harm your baby more than the medicines you take 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 while you are pregnant or breastfeeding.
Surgery
Ulcerative colitis affects only the
large intestine. So surgery that removes the entire large intestine can cure
the disease. Some people who have the disease in the entire colon eventually need surgery to remove the colon. Surgery also can often cure the rare problems that the disease causes outside of the colon, such as skin and eye problems. But it may not cure liver problems and some joint problems.
People
may need
surgery for ulcerative colitis in several situations,
such as when other treatment fails to manage symptoms, when holes form in the
large intestine, or if
dysplasia is found during colonoscopy or
biopsy.
Removal of the colon to cure ulcerative colitis involves
one of these surgeries:
In
ileoanal anastomosis , the surgeon removes some or all
of the large intestine (colon) and the diseased lining of the
rectum. Then the end of the small intestine (the ileum) is connected to the
anal canal. This allows you to have bowel
movements without an ostomy.
In
proctocolectomy and ileostomy , the
large intestine and rectum are removed, leaving the lower end of the small
intestine (the ileum). The surgeon sews the anus closed and makes a small
opening called a stoma in the skin of the lower belly. The ileum is connected
to the stoma, creating an opening to the outside of the body.
What to think about
Ileoanal anastomosis is done
most often. Proctocolectomy with ileostomy is preferred for people who cannot
tolerate anesthesia for a long period of time because of illness or age.
In most cases, surgery can be scheduled at your convenience. Emergency
surgery usually isn't needed unless an acute attack causes
toxic megacolon, severe uncontrolled bleeding, or a
rupture in the intestine. The risk of problems after surgery
can be high if surgery is done during a severe or rapidly worsening attack or
if emergency surgery is needed.
Other Treatment
Even though there is little
scientific proof that it works, many people who have
ulcerative colitis consider nontraditional or
complementary medicine in addition to prescription medicines. They may turn to
these other treatments because there is no cure other than removal of the
colon.
Other treatment choices
Treatments include:
Special diets or nutritional supplements,
such as
probiotics .
Fatty acids found in oily
fish, such as salmon and tuna.
Probiotics and fatty acids are the most promising
complementary therapies being studied for ulcerative colitis. But there is
still not much known about their value. As with any treatment, talk with your
doctor before using any of these treatments.
Nicotine patch
Several studies have shown that the nicotine patch
may help treat active ulcerative colitis. It is not yet known how long the
benefits of the nicotine patch last or if the patch can help prevent flare-ups. If the patch works, it most likely benefits people whose
symptoms began or became worse after quitting smoking.
But because of the addictive
power and other harmful effects of nicotine, most doctors still prefer to use
traditional medicines to treat ulcerative colitis before trying the nicotine
patch.
Other Places To Get Help
Organizations
National Institute of Diabetes and Digestive and Kidney Diseases (U.S.)
www.digestive.niddk.nih.gov
North American Society for Pediatric Gastroenterology, Hepatology and Nutrition: GI Kids
Osterman MT, Lichtenstein GR (2010). Ulcerative colitis. In M Feldman et al., eds., Sleisenger and Fordtran's Gastrointestinal and Liver Disease, 9th ed., vol. 2, pp. 1975-2013. Philadelphia: Saunders Elsevier.
American Gastroenterological Association (2010). AGA medical position statement on the diagnosis and management of colorectal neoplasia in inflammatory bowel disease. Gastroenterology, 138(2): 738-745. Available online: http://www.gastro.org/practice/medical-position-statements.
Kornbluth A, Sachar DB (2010). Ulcerative colitis practice guidelines in adults: American College of Gastroenterology, Practice Parameters Committee. American Journal of Gastroenterology, 105(3): 501-523. Available online: http://www.nature.com/ajg/journal/v105/n3/full/ajg2009727a.html.
Singh S, et al. (2014). Inflammatory bowel disease is associated with an increased risk of melanoma: A systematic review and meta-analysis. Clinical Gastroenterology Hepatology, 12(2): 210-218. DOI: 10.1016/j.cgh.2013.04.033. Accessed March 25, 2015.
Credits
ByHealthwise Staff Primary Medical ReviewerE. Gregory Thompson, MD - Internal Medicine Adam Husney, MD - Family Medicine Specialist Medical ReviewerPeter J. Kahrilas, MD - Gastroenterology
Osterman MT, Lichtenstein GR (2010). Ulcerative colitis. In M Feldman et al., eds., Sleisenger and Fordtran's Gastrointestinal and Liver Disease, 9th ed., vol. 2, pp. 1975-2013. Philadelphia: Saunders Elsevier.
American Gastroenterological Association (2010). AGA medical position statement on the diagnosis and management of colorectal neoplasia in inflammatory bowel disease. Gastroenterology, 138(2): 738-745. Available online: http://www.gastro.org/practice/medical-position-statements.
Kornbluth A, Sachar DB (2010). Ulcerative colitis practice guidelines in adults: American College of Gastroenterology, Practice Parameters Committee. American Journal of Gastroenterology, 105(3): 501-523. Available online: http://www.nature.com/ajg/journal/v105/n3/full/ajg2009727a.html.
Singh S, et al. (2014). Inflammatory bowel disease is associated with an increased risk of melanoma: A systematic review and meta-analysis. Clinical Gastroenterology Hepatology, 12(2): 210-218. DOI: 10.1016/j.cgh.2013.04.033. Accessed March 25, 2015.
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