What is Ulcerative Colitis? Symptoms, Causes, & Treatment

Ulcerative colitis is a chronic inflammatory bowel disease that causes inflammation and ulcers in the lining of your large intestine (colon) and rectum. Unlike other digestive conditions, this inflammation stays in the innermost layer of your bowel wall and typically starts in the rectum, then may spread upward through the colon.

This condition affects about 1 in 250 people and can develop at any age, though it most commonly appears between ages 15 and 30. While ulcerative colitis is a lifelong condition, many people find effective ways to manage their symptoms and live full, active lives.

What are the symptoms of ulcerative colitis?

The main symptoms of ulcerative colitis involve changes in your bowel movements and abdominal discomfort. These symptoms can range from mild to severe and may come and go in flare-ups followed by periods of remission.

Here are the most common symptoms you might experience:

• Diarrhea, often with blood or mucus
• Abdominal pain and cramping, usually on the left side
• Urgent need to have bowel movements
• Feeling like you can't completely empty your bowels
• Rectal pain and bleeding
• Fatigue and weakness
• Loss of appetite and unintended weight loss
• Low-grade fever during flare-ups

Some people also experience symptoms outside their digestive system. These can include joint pain, skin problems, eye inflammation, or mouth sores. These symptoms often improve when your intestinal inflammation is well-controlled.

The severity of symptoms can vary greatly from person to person. Some people have mild symptoms that barely affect their daily life, while others experience more intense flare-ups that require immediate medical attention.

What are the types of ulcerative colitis?

Ulcerative colitis is classified based on where the inflammation occurs in your colon. Understanding your specific type helps your doctor choose the most effective treatment approach.

The main types include:

• Ulcerative proctitis: Inflammation limited to the rectum, often the mildest form
• Left-sided colitis: Inflammation extends from the rectum up through the left side of the colon
• Extensive colitis: Inflammation affects most or all of the colon
• Acute severe colitis: A rare but serious form affecting the entire colon with severe symptoms

Your type may change over time. Some people start with proctitis and later develop more extensive disease, while others maintain the same pattern throughout their condition.

What causes ulcerative colitis?

The exact cause of ulcerative colitis isn't fully understood, but researchers believe it develops when your immune system mistakenly attacks healthy tissue in your colon. This happens due to a combination of genetic, environmental, and immune system factors working together.

Several factors may contribute to developing ulcerative colitis:

• Genetics: Having family members with inflammatory bowel disease increases your risk
• Immune system dysfunction: Your body's defense system attacks your own intestinal tissue
• Environmental triggers: Certain bacteria, viruses, or other factors may trigger the immune response
• Gut bacteria imbalance: Changes in the normal bacteria in your intestines may play a role

Contrary to old beliefs, stress and diet don't cause ulcerative colitis, though they can trigger flare-ups in people who already have the condition. The disease isn't contagious and can't be passed from person to person.

Some rare contributing factors researchers are studying include certain medications, previous infections, and exposure to specific environmental toxins, though these connections aren't yet fully proven.

When to see a doctor for ulcerative colitis?

You should see a doctor if you experience persistent changes in your bowel habits, especially if you notice blood in your stool or have ongoing abdominal pain. Early diagnosis and treatment can help prevent complications and improve your quality of life.

Seek medical attention if you have:

• Blood or mucus in your stool for more than a few days
• Persistent diarrhea that doesn't improve
• Abdominal pain that interferes with daily activities
• Unexplained weight loss or loss of appetite
• Fatigue that doesn't improve with rest

Some situations require immediate medical care. Go to the emergency room if you experience severe abdominal pain, high fever, rapid heart rate, signs of dehydration, or if you're passing large amounts of blood.

Even if your symptoms seem mild, it's worth discussing them with your doctor. Many people wait too long to seek help, which can lead to more severe symptoms and complications down the road.

What are the risk factors for ulcerative colitis?

While anyone can develop ulcerative colitis, certain factors may increase your likelihood of developing this condition. Understanding these risk factors can help you recognize symptoms early and seek appropriate care.

The main risk factors include:

• Age: Most commonly develops between ages 15-30, with a smaller peak around age 50-70
• Family history: Having a parent, sibling, or child with inflammatory bowel disease
• Ethnicity: More common in people of Jewish descent, though it affects all ethnic groups
• Geography: More prevalent in developed countries and urban areas
• Previous appendectomy: Interestingly, having your appendix removed may slightly reduce risk

Some less common risk factors being studied include certain medications like NSAIDs (non-steroidal anti-inflammatory drugs), hormonal factors, and specific dietary patterns, though these connections aren't definitively proven.

Having risk factors doesn't mean you'll definitely develop ulcerative colitis. Many people with multiple risk factors never develop the condition, while others with no apparent risk factors do.

What are the possible complications of ulcerative colitis?

While most people with ulcerative colitis manage their condition successfully, it's important to understand potential complications so you can work with your healthcare team to prevent them. Many complications can be avoided with proper treatment and monitoring.

The more common complications include:

• Severe bleeding: Chronic blood loss can lead to anemia
• Dehydration: From persistent diarrhea and reduced fluid intake
• Bone loss: Due to inflammation and certain medications
• Increased infection risk: From medications that suppress your immune system
• Skin, eye, and joint problems: Inflammation affecting other parts of your body

Rare but serious complications require immediate attention. These include toxic megacolon (dangerous swelling of the colon), bowel perforation, and severe dehydration that can lead to kidney problems.

Long-term, people with extensive ulcerative colitis have a slightly increased risk of colon cancer, especially if the disease has been active for many years. Regular colonoscopy screening helps detect any changes early when they're most treatable.

How can ulcerative colitis be prevented?

Unfortunately, there's no proven way to prevent ulcerative colitis since it's largely influenced by genetics and immune system factors beyond our control. However, you can take steps to reduce your risk of flare-ups once you have the condition.

While prevention isn't possible, some lifestyle factors may help reduce flare-up frequency:

• Managing stress through relaxation techniques, exercise, or counseling
• Eating a balanced diet and identifying your personal trigger foods
• Getting regular exercise to support overall immune function
• Not smoking (smoking may actually worsen ulcerative colitis symptoms)
• Taking medications as prescribed, even during symptom-free periods

Some people find that keeping a food and symptom diary helps them identify patterns and potential triggers. This information can be valuable for your healthcare team in developing your treatment plan.

The most important "prevention" strategy is working closely with your healthcare team to manage your condition effectively and catch any changes early.

How is ulcerative colitis diagnosed?

Diagnosing ulcerative colitis involves several steps because no single test can definitively confirm the condition. Your doctor will combine your medical history, physical examination, and various tests to make an accurate diagnosis.

The diagnostic process typically includes:

• Medical history and physical exam: Discussing your symptoms and family history
• Blood tests: Checking for anemia, inflammation markers, and ruling out infections
• Stool samples: Testing for infections, blood, and inflammation markers
• Colonoscopy: Direct visualization of your colon lining with tissue samples
• CT or MRI scans: Imaging to see the extent of inflammation

The colonoscopy is usually the most important test because it allows your doctor to see the characteristic inflammation pattern of ulcerative colitis and rule out other conditions like Crohn's disease or colon cancer.

Sometimes diagnosis takes time, especially if your symptoms are mild or similar to other digestive conditions. Your doctor might need to repeat some tests or try different approaches to get a clear picture of what's happening.

What is the treatment for ulcerative colitis?

Treatment for ulcerative colitis aims to reduce inflammation, control symptoms, and help you achieve and maintain remission. Your treatment plan will be tailored to your specific symptoms, the extent of your disease, and how you respond to different medications.

Common treatment approaches include:

• Anti-inflammatory medications: Aminosalicylates (like mesalamine) to reduce inflammation
• Corticosteroids: For moderate to severe flare-ups, used short-term
• Immunosuppressants: Medications that calm your overactive immune system
• Biologic therapies: Targeted treatments that block specific inflammatory pathways
• JAK inhibitors: Newer oral medications that reduce inflammation

Most people start with milder medications and progress to stronger ones if needed. Your doctor will monitor you closely to find the most effective treatment with the fewest side effects.

In rare cases where medications aren't effective or complications develop, surgery to remove the colon and rectum might be recommended. While this is major surgery, it can be curative and allow people to live symptom-free lives.

How to manage ulcerative colitis at home?

Home management plays a crucial role in controlling ulcerative colitis symptoms and preventing flare-ups. While medication is essential, your daily habits and self-care strategies can significantly impact how you feel.

Effective home management strategies include:

• Dietary modifications: Avoiding trigger foods during flare-ups, eating smaller frequent meals
• Stress management: Regular exercise, meditation, or yoga to reduce stress levels
• Adequate hydration: Drinking plenty of fluids, especially during diarrhea episodes
• Proper medication adherence: Taking prescribed medications consistently, even when feeling well
• Sleep hygiene: Getting 7-8 hours of quality sleep to support immune function

Keep a symptom diary to track what foods, activities, or stressors might trigger your symptoms. This information helps you and your healthcare team make better treatment decisions.

During flare-ups, focus on gentle, easily digestible foods and avoid high-fiber, spicy, or fatty foods that might irritate your intestines. Probiotics may help some people, though you should discuss this with your doctor first.

How should you prepare for your doctor appointment?

Preparing for your doctor appointment helps ensure you get the most from your visit and provides your healthcare team with the information they need to help you effectively. Good preparation can save time and lead to better care.

Before your appointment, gather the following information:

• A detailed list of your symptoms, including when they started and how often they occur
• All medications you're currently taking, including supplements and over-the-counter drugs
• Your family medical history, especially any digestive or autoimmune conditions
• A list of questions you want to ask your doctor
• Any previous test results or medical records related to your symptoms

Consider keeping a symptom diary for a week or two before your appointment. Note what you eat, your stress levels, and any symptoms you experience. This information can help identify patterns your doctor needs to know about.

Don't hesitate to bring a trusted friend or family member to your appointment. They can help you remember important information and provide emotional support during what might be a stressful visit.

What's the key takeaway about ulcerative colitis?

Ulcerative colitis is a manageable chronic condition that affects everyone differently. While receiving this diagnosis can feel overwhelming, remember that many people with ulcerative colitis live full, active lives with proper treatment and self-care.

The most important things to remember are that early diagnosis and treatment improve outcomes significantly, and working closely with your healthcare team helps you find the right combination of medications and lifestyle strategies for your specific situation.

Modern treatments have transformed the outlook for people with ulcerative colitis. With today's medications and management strategies, most people can achieve and maintain remission, preventing complications and maintaining their quality of life.

Stay hopeful and stay connected with your healthcare team. Ulcerative colitis is a journey, but you don't have to navigate it alone.