Ulcerative Colitis

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Introduction

What is ulcerative colitis?

Ulcerative colitis is an inflammatory disease of the large intestine, or colon. It occurs when inflammation in the colon produces redness, bleeding and pus, which, in turn, causes such symptoms as diarrhea and abdominal pain. Inflammation impairs the ability of the colon to hold its contents, resulting in frequent elimination. Ulcerative colitis is a type of inflammatory bowel disease, along with Crohn’s disease. The exact cause of ulcerative colitis is not known.

Ulcerative colitis can affect one side of the colon or the entire colon. Left-side colon involvement is called limited, or distal, colitis. Ulcerative proctitis describes inflammation occurring in the lower part of the colon and rectum. Symptoms range in severity among affected individuals. In a small number of those affected, problems outside of the large intestine may develop, including arthritis, inflammation of the eyes, mouth ulcers, and skin changes. Ulcerative colitis also increases your risk of developing colon cancer.

Ulcerative colitis affects teenagers and young adults, with disease onset usually occurring in peaks between ages 15 and 30 years, and less commonly between ages 50 and 70. The condition can run in families, with at least 20% of people affected having a family member with the condition. The prevalence of ulcerative colitis is higher in Caucasians and people with Ashkenazi (Eastern European) Jewish ancestry (Source: NDDIC).

Ulcerative colitis itself is not an emergency situation, but serious symptoms may occur. Seek immediate medical care (call 911) for serious symptoms, such as severe abdominal pain, inability to pass gas or stool, and vomiting or vomiting blood.

Seek prompt medical care if you are being treated for ulcerative colitis, but mild symptoms recur or persist.

Symptoms

What are the symptoms of ulcerative colitis?

Symptoms of ulcerative colitis primarily affect the digestive tract and include appetite loss, diarrhea, weight loss, rectal bleeding, nausea, and abdominal cramping. Persistent diarrhea can cause malnutrition, weakness, and electrolyte imbalances; younger individuals may be small or experience delayed growth. A small percentage of those affected may have symptoms in other body areas or organs.

Common symptoms of ulcerative colitis

Extraintestinal symptoms of ulcerative colitis

  • A small percentage of people who have ulcerative colitis will have symptoms involving other organs or areas of the body including:
  • Eye pain and redness
  • Joint aches and pains
  • Mouth ulcers
  • Skin rash or changes

Serious symptoms that might indicate a life-threatening condition

In some cases, ulcerative colitis can produce serious symptoms. Seek immediate medical care (call 911) if you, or someone you are with, have any of these life-threatening symptoms including:

  • Inability to pass gas or stool
  • Severe abdominal pain
  • Vomiting or vomiting blood

Causes

What causes ulcerative colitis?

The exact cause of ulcerative colitis is not known. It is known to run in families and is more prevalent in certain groups, such as people of Ashkenazi Jewish descent. It is thought to have an autoimmune component, in which the immune system, which normally protects us from harmful invaders, interprets foods and other substances as “foreign” and launches an immune response. This reaction results in the release of antibodies and white blood cells into the intestines, which leads to inflammatory symptoms and ulcerations.

What are the risk factors for ulcerative colitis?

A number of factors increase the risk of developing ulcerative colitis. Not all people with risk factors will get ulcerative colitis. Risk factors for ulcerative colitis include:

  • Consumption of excess dietary fats, protein and refined sugar
  • Family history of ulcerative colitis
  • Jewish ancestry
  • Retention of appendix (appendectomy is protective for ulcerative colitis)
  • Use of NSAIDs

Treatments

How is ulcerative colitis treated?

Currently, there is no cure for ulcerative colitis. The goal of treatment is to ease the symptoms, remedy the nutritional deficiencies, and reduce the number of recurrences, or flare-ups. Medication and surgery are used to manage the symptoms of ulcerative colitis.

Medications to treat ulcerative colitis include steroids to reduce the inflammation. These are often combined with drugs that suppress the immune response. Immunomodulators are given if aminosalicylates and corticosteroids have failed or have not achieved optimal response.

Medications for ulcerative colitis

Medications used to treat ulcerative colitis include:

  • Aminosalicylates, such as sulfasalazine (Azulfidine) and mesalamine (Pentasa, Asacol)
  • Antidiarrheals
  • Corticosteroids (steroids)
  • Immunomodulators that suppress the body’s immune response, such as azathioprine (Imuran) and 6-mercaptopurine (Purinethol)
  • Biologic agents (anti-TNF infusion therapy) that can rapidly induce remission in patients with fulminant ulcerative colitis

Surgery for ulcerative colitis

Surgery is performed in more advanced cases of ulcerative colitis or in patients whose symptoms cannot be controlled by medication. Many people with ulcerative colitis will require colon removal at some point because of damage or to prevent cancer. This procedure, known as proctocolectomy, is typically followed by other procedures including:

  • Ileostomy, or creation of an opening in the abdomen called a stoma, which is connected to the ileum of the small intestine. Waste is channeled through the stoma into a colostomy bag, worn over the opening and emptied as needed.
  • Ileoanal anastomosis, which removes the colon and the inside of the rectum but preserves the anus, which is then surgically attached to the ileum. This allows feces to pass out of the body through the anus, avoiding the need for an external waste bag.

Complementary treatments

Some complementary treatments may help some people in their efforts to deal with ulcerative colitis. These treatments, sometimes referred to as alternative therapies, are used in conjunction with traditional medical treatments. Complementary treatments are not meant to substitute for traditional medical care. Be sure to notify your doctor if you are consuming nutritional supplements or homeopathic (nonprescription) remedies as they may interact with the prescribed medical therapy.

Complementary treatments may include:

  • Acupuncture
  • Massage therapy
  • Nutritional dietary supplements, herbal remedies, tea beverages, and similar products
  • Yoga

What are the potential complications of ulcerative colitis?

Complications of untreated or poorly controlled ulcerative colitis can be serious. You can help minimize your risk of serious complications by following the treatment plan that you and your health care professional design specifically for you. Complications of ulcerative colitis include:

Gastrointestinal complications of ulcerative colitis include:

  • Bowel perforation
  • Colon cancer
  • Dehydration and electrolyte imbalance due to long-term diarrhea
  • Fissures (tears in the rectum)
  • Intestinal blockage
  • Nutritional deficiencies
  • Skin ulcerations around the anus and colon
  • Toxic megacolon

Other complications of ulcerative colitis include:

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Medical Reviewer: William C. Lloyd III, MD, FACS
Last Review Date: 2020 Nov 13
  1. Ulcerative Colitis. National Institutes of Health. National Institute of Diabetes and Digestive and Kidney Diseases. https://www.niddk.nih.gov/health-information/digestive-diseases/ulcerative-colitis
  2. Ulcerative Colitis. PubMed. U.S. National Library of Medicine. https://www.ncbi.nlm.nih.gov/pubmedhealth/PMHT0022830/
  3. Molodecky NA, Soon IS, Rabi DM, et al. Increasing incidence and prevalence of the inflammatory bowel diseases with time, based on systematic review. Gastroenterology 2012; 142:46.
  4. Bope ET, Kellerman RD (Eds.) Conn’s Current Therapy. Philadelphia: Saunders, 2013.
  5. Mowat C, Cole A, Windsor A, et al. Guidelines for the management of inflammatory bowel disease in adults. Gut 2011; 60:571.
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