Ulcerative colitis

Ulcerative colitis is a long-term condition where your large bowel (the colon and rectum) becomes swollen and inflamed.

Your colon is your large intestine, which is another word for the bowel. Your rectum is the end of the bowel, and it's where poo is stored.

When you have ulcerative colitis, the lining of your large bowel gets swollen and inflamed, and ulcers form on it. These ulcers can bleed and produce pus.

The condition can affect people of any age, but it's usually diagnosed between the ages of 15 and 40.

The main symptoms of ulcerative colitis are:

• diarrhoea that keeps coming back, and may contain blood, mucus or pus
• pain in the abdomen
• needing to poo often

You may also have:

• extreme tiredness (fatigue)
• loss of appetite
• weight loss

Some people get symptoms in other parts of the body too. For example, some develop:

• painful and swollen joints (arthritis)
• mouth ulcers
• areas of skin that are painful, red and swollen
• eyes that are irritated and red

• you have symptoms of ulcerative colitis and you haven't been diagnosed with the condition

Some people with ulcerative colitis go for weeks or months with very mild symptoms, or none at all. This is known as remission. It may be followed by periods when the symptoms become particularly troublesome. These are known as flare-ups or relapses.

Symptoms of a flare-up vary from person to person. They may include:

• diarrhoea 6 or more times a day
• blood or mucus in your poo
• severe abdominal pain
• symptoms in other parts of your body

Severe ulcerative colitis can also cause symptoms like:

• shortness of breath
• a fast or irregular heartbeat
• a high temperature (fever)
• blood in your poo becoming more obvious

• you have ulcerative colitis and think you're having a flare-up

Doctors don't know the exact cause of ulcerative colitis. It's likely that a combination of factors is responsible, including:

• problems with your immune system, where the immune system mistakenly attacks the lining of your large bowel and makes it inflamed
• genetics, which means the genes you inherit from your family
• environmental factors, like air pollution, medicine, and viruses or bacteria in your gut

To help find out if you have ulcerative colitis, your doctor will ask you a few things:

• what your symptoms are like and how they come and go
• what you eat
• any recent travel (for example, you may have picked up travellers' diarrhoea)
• any medicine you're taking, including medicines you bought without a prescription
• if anyone else in your family has a bowel condition
• any health problems you've had in the past

Your doctor may also:

• examine your abdomen (tummy)
• ask for a stool (poo) sample and use a qFIT test to check for blood and mucus, infection or inflammation via a faecal calprotectin test
• arrange blood tests to check for inflammation or anaemia

If your doctor thinks you have ulcerative colitis, you may be referred to hospital for more tests. These could include:

• colonoscopy: a thin, flexible tube with a camera is put into your bottom to look at the whole of your large bowel
• sigmoidoscopy: a thin, flexible tube with a camera is put into your bottom to look at the end of your large bowel
• X-ray
• MRI scan or computerised tomography (CT)

You will be told which tests you need and what you have to do to prepare for them.

Treatment for ulcerative colitis is meant to relieve your symptoms and stop them coming back.

What you're given will depend on how severe your symptoms are and how often they flare up. Mild flare-ups can usually be treated at home. Severe flare-ups, though, usually need treatment in hospital, so that the risk of complications is lowered.

Your care will usually come from several different healthcare professionals working together.

Most people with ulcerative colitis are given medicine to treat their symptoms. This includes medicines like:

• aminosalicylates (ASAs), which are often the first treatment option. They are used to get inflammation under control and to keep it that way, and they can be given rectally as well as orally
• corticosteroids, which are used to get inflammation under control quickly, but are not suitable for long-term use

If you have lots of flare-ups, or aminosalicylates don't keep your inflammation under control, you may need other treatments, such as:

• immunosuppressants like azathioprine or mercaptopurine, which are used to reduce the activity of the immune system
• biologic medicines, like adalimumab, infliximab, golimumab, ustekinumab or vedolizumab
• other advanced medicines like filgotinib, ozanimod, tofacitinib and upadacitinib

Surgery for ulcerative colitis may be an option if:

• you choose to have surgery instead of taking medicines that may cause side effects
• medicines don't control your symptoms
• your quality of life is severely affected by your condition
• you have serious complications of ulcerative colitis

The operation involves removing part or all of your large bowel (this is called a colectomy). Because of this, your small intestine has to take over the job of passing waste out of your body.

During the surgery, your small intestine will either be:

• joined to the surface of your tummy (known as an ileostomy or a colostomy). After this type of surgery, poo comes out through the opening on your tummy and is collected in special bags that you wear
• joined directly to your rectum (the end of your large bowel), so your poo comes out of your bottom as usual
• used to make an internal pouch that's connected to your bottom (known as an ileo-anal pouch or J-pouch). This means your poo can pass through your bottom as usual

No evidence shows that any particular diet causes ulcerative colitis. But alongside your medicines, some changes to what you eat may help control symptoms for some people.

You could:

• eat 5 to 6 small meals rather than 3 main meals
• try to eat a healthy, varied diet that includes a wide variety of fruit, vegetables, nuts, seeds, proteins and wholegrains
• drink plenty of water

You could also speak to your IBD team about:

• keeping a food diary to find out if any particular foods affect your symptoms
• removing trigger foods from your diet, but do not make major changes to your diet without talking to your IBD team, and make sure you are still getting all the nutrients you need
• taking a food supplement if you are struggling to get enough nutrients from your diet
• being referred to a dietitian

Stress doesn't cause ulcerative colitis. But managing stress may reduce how often you get symptoms.

To help manage stress, you could:

• exercise, and speak to your IBD team about a suitable exercise plan
• try relaxation techniques like yoga, meditation and breathing exercises
• talk to others, for example in a local support group for people with Crohn's disease or colitis
• speak to your doctor if you think you may have depression

Ulcerative colitis doesn't usually affect a woman's chance of becoming pregnant.

Surgery for the condition might affect your fertility, though, especially pouch surgery.

Most women with ulcerative colitis will have a normal pregnancy and a healthy baby. But if you're pregnant or planning a pregnancy, you should discuss it with your IBD team, because they may need to change your medicine.

If you're having a flare-up, you may also be advised to avoid getting pregnant until it's under control.

If you have ulcerative colitis, you may be at an increased risk of developing other problems. These can include:

• osteoporosis
• poor growth and development in children and young people

Some complications are more serious, though rare. They can include:

• primary sclerosing cholangitis (PSC), which is inflammation in the bile ducts and can lead to liver damage
• narrowing in the bowel (strictures), which may become blocked or make it difficult for stool to pass through
• toxic megacolon, where severe inflammation in the colon may lead to trapped gas, so the colon becomes very enlarged and can rupture
• a higher risk of getting bowel cancer
• a higher risk of getting blood clots in your legs or lungs