Ulcerative colitis

This factsheet is for people who have ulcerative colitis, or who would like information about it.

Ulcerative colitis is an inflammatory bowel disease. It’s a chronic condition (one that lasts for a long time) that causes inflammation and ulcers to form in the lining of your large bowel (colon).

About ulcerative colitis

Ulcerative colitis is one of the two main inflammatory bowel diseases; the other being Crohn’s disease. Sometimes, ulcerative colitis only affects your rectum (back passage) – this is called proctitis and is a less severe condition.

In ulcerative colitis, the lining of your large bowel and rectum become inflamed and may develop ulcers. This means that your large bowel can't absorb as much water as usual, which causes you to have diarrhoea.

Ulcerative colitis is known as a relapsing and remitting condition. This means that your symptoms can disappear and then flare-up again from time to time. Flare-ups of ulcerative colitis can be sudden and severe. You may then have long periods with few or no symptoms at all.

Ulcerative colitis affects about one in 500 people in the UK. It usually develops between the ages of 15 and 30, but you can be diagnosed at any time in your life. Ulcerative colitis is equally common in men and women.

Symptoms of ulcerative colitis

The main symptom of ulcerative colitis is frequent diarrhoea, which may have blood or mucus in it. You may also have abdominal (tummy) pain or cramps during bowel movements.

Other symptoms include:

• urgently needing to have a bowel movement
• wind
• loss of appetite
• weight loss
• having a high temperature
• feeling tired

If you have proctitis, you may not have diarrhoea, but still frequently feel an urgent need to have a bowel movement and have bleeding from your rectum.

You may also get associated problems in other parts of your body if you have ulcerative colitis. These can include mouth ulcers, skin rashes and inflammation (redness or pain) in your eyes, skin or joints.

These symptoms may be caused by problems other than ulcerative colitis. If you have any of these symptoms, see your GP for advice.

Complications of ulcerative colitis

If you lose a lot of blood through your bowel movements, you may develop anaemia. This is a condition in which your blood can't carry enough oxygen to meet the needs of your body, either because there are insufficient red blood cells or not enough haemoglobin in the red cells. Anaemia can cause you to feel very tired.

It's possible that your large bowel may expand and even tear if you have a severe flare-up. This is known as toxic megacolon. Symptoms of toxic megacolon include a high temperature and a painful, tender abdomen (tummy). You must seek urgent medical attention if you have these symptoms as the condition can be life-threatening, but most people who receive prompt treatment will recover.

Having ulcerative colitis slightly increases your risk of developing bowel cancer. Your risk is greater if you have had ulcerative colitis for a long time and if it’s severe. Your GP will advise you to have regular colonoscopies if you have had severe ulcerative colitis for eight or more years to check for any signs of cancer developing. If any cancerous cells are found, you may need surgery to remove the affected area of your large bowel.

Causes of ulcerative colitis

The exact reasons why you may develop ulcerative colitis aren't fully understood at present. It may run in the family - about one in seven people with ulcerative colitis have a close relative who also has the condition. It's thought that other factors, such as eating certain types of food or having an infection, could also trigger it.

Diagnosis of ulcerative colitis

Your GP will ask about your symptoms and examine you. He or she may also ask you about your medical history.

Your GP may ask you for a sample of faeces (also called a stool sample) to rule out a bacterial infection. He or she may also ask you to have a blood test. This is to check for anaemia and signs of inflammation.

Depending on the results, your GP might refer you to a gastroenterologist (a doctor who specialises in identifying and treating conditions that affect the digestive system) for more tests. These may include the following.

• Colonoscopy. This allows your doctor to look inside your large bowel using a narrow, flexible, tube-like telescopic camera called a colonoscope. The colonoscope is carefully passed through your anus and rectum and your doctor can view an image of the inside of your bowel on a monitor.
• Flexible sigmoidoscopy. This allows your doctor to look inside your rectum and the lower part of your bowel using a sigmoidoscope, which is a tube-like telescopic camera similar to a colonoscope.
• Biopsy. A biopsy is a small sample of tissue. Your doctor may take a small sample of the tissue from inside your bowel during a colonoscopy or sigmoidoscopy. This will be sent to a laboratory for testing.
• Barium enema X-ray. This test involves placing a fluid containing barium (a substance that shows up on X-rays) into your bowel via your rectum. Your doctor can then view X-ray images of your bowel.

Treatment of ulcerative colitis

At the moment there isn’t a cure for ulcerative colitis without the need for surgery. However, there are treatments that can help to ease your symptoms and prevent complications.

Medicines

Your symptoms can usually be controlled with medicines. Your GP may prescribe you different treatments for when you’re in remission and when you have a flare-up.

For example, when you’re in remission, your GP may prescribe you a medicine called a 5-aminosalicylate to reduce the inflammation and keep your symptoms under control. If you have moderate flare-ups, your GP may increase your dose of this to try to control your symptoms. If this doesn't work, or your flare-ups are quite severe, your GP may prescribe steroids instead. Steroids are very effective because they act quickly to reduce inflammation. However, they can have serious side-effects in the long term, so your GP will gradually reduce your dose to the minimum needed to control your symptoms. You can take steroids and aminosalicylates as tablets, suppositories or as enemas (a liquid injected into your rectum).

If these treatments don't work, your GP may give you medicines to suppress your immune system (immunosuppressants), which usually come in tablet form.

Always ask your GP for advice and read the patient information leaflet that comes with your medicine.

If your symptoms are very severe, you may need to be admitted to hospital to have steroids given to you through a drip.

Surgery

If medicines don't work, your GP may suggest you have an operation. You may need emergency surgery if you develop toxic megacolon.

Surgery for ulcerative colitis involves completely removing your large bowel and redirecting your small bowel so that your body is still able to get rid of waste products. This is called a colectomy and can be done in one of two ways.

• Your surgeon may remove your colon and rectum and join the end of your small bowel to your anus. He or she will create a pouch from the end of your small bowel, which will replace your colon and allow your bowel movements to carry on as usual.
• Your surgeon may remove your colon, rectum and anus and attach your small bowel to an opening in your abdomen. This is called an ileostomy. You will then use an external pouch placed over the opening, called an ileostomy bag, to collect waste.

Speak to your surgeon for more information.

Living with ulcerative colitis

Having ulcerative colitis can be both physically and emotionally stressful. Stress doesn’t cause ulcerative colitis, but it may make your symptoms worse and it may contribute to flare-ups. You could try some simple stress-reduction techniques to help.

Having frequent diarrhoea and an urgent need to go to the toilet can lead to incontinence. If this is a problem for you, keep a spare pair of underwear with you when you go out and make sure you know where the toilets are in advance. If the problem is very severe, speak to your GP about trying incontinence pads.

Produced by Krysta Munford, Bupa Health Information Team, February 2012. 

For answers to frequently asked questions on this topic, see FAQs.

For sources and links to further information, see Resources.