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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.
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.
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.
The main symptoms are:
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
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:
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.
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.
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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.
The symptoms of ulcerative colitis may include:
Other conditions with symptoms similar to ulcerative colitis include Crohn's disease, diverticulitis, irritable bowel syndrome (IBS), and colon cancer.
Ulcerative colitis may be mild, moderate, or severe.
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.
Problems from ulcerative colitis can include:
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.
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.
You have an increased risk of ulcerative colitis if you:
Call a doctor immediately if you have been diagnosed with ulcerative colitis and you have:
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:
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.
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:
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:
Other exams and tests that may be used include:
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 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.
Mild symptoms may respond to:
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:
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.
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.
You cannot prevent ulcerative colitis, because the cause is unknown.
You can take steps at home to reduce symptoms of ulcerative colitis.
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.
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.
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.
Medicines usually are the main treatment for ulcerative colitis. They control or prevent inflammation in the intestines and help to:
The choice of medicine usually depends on how bad the disease is, the part of the colon affected, and any complications you may have.
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.
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:
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.
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.
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.
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.
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.
Current as ofMarch 27, 2018
Author: Healthwise StaffMedical Review: E. Gregory Thompson, MD - Internal MedicineAdam Husney, MD - Family MedicinePeter J. Kahrilas, MD - Gastroenterology
Current as of:
March 27, 2018
Medical Review:E. Gregory Thompson, MD - Internal Medicine & Adam Husney, MD - Family Medicine & Peter J. Kahrilas, MD - Gastroenterology
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