Ulcerative colitis is a long-term condition affecting your large bowel and rectum. It causes symptoms such as frequent diarrhoea, which can come and go. There are a number of treatments available which can help to control your symptoms. However, if these treatments don’t help to ease your symptoms, you may consider having surgery. If you have severe ulcerative colitis that hasn’t improved with medications, you may be offered more urgent, or emergency surgery.
Ulcerative colitis is the most common type of inflammatory bowel disease. In ulcerative colitis, the lining of your large bowel and rectum (back passage) 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.
The condition affects about one in 500 people in the UK. It usually develops between the ages of 15 and 25. The condition is rare in childhood, but it can occur at any time in your life. It’s equally common in men and women.
Ulcerative colitis is usually an ongoing condition that can last throughout your lifetime. However, you may find that your symptoms follow a relapsing and remitting pattern. This means that your symptoms can disappear and flare-up again from time to time. Flare-ups of ulcerative colitis can be unpredictable. There are a number of treatment options which can help to control your symptoms and prevent flare-ups from happening.
Types of ulcerative colitis
Ulcerative colitis usually starts in the lowest part of your bowel called the rectum, but it can affect your entire large bowel. The amount of large bowel affected by the condition can differ from person to person but usually doesn’t change over time.
Your symptoms can depend on the extent of inflammation in your large bowel. Therefore, it can be helpful to know how much of your large bowel is affected. Your gastroenterologist (a doctor who specialises in identifying and treating conditions affecting the digestive system) may define your condition using terms such as the following.
The symptoms of ulcerative colitis usually come and go. You may have periods without any symptoms, known as remission, and periods when you have symptoms, known as flare-ups.
You may find that you feel perfectly well between flare-ups, when you have no symptoms at all. During a flare-up, the main symptom of ulcerative colitis is frequent diarrhoea, which may be mixed with blood or mucus. You may also have lower abdominal (tummy) pain or cramps and need to rush to the toilet. Other symptoms include:
If you have proctitis, you may not have diarrhoea, but still frequently feel an urgent need to have a bowel movement. You may also have bleeding or mucus from your rectum.
If you have ulcerative colitis, there is a chance that you could develop problems in other parts of your body. These can include mouth ulcers, skin rashes and inflammation (redness or pain) in your eyes, skin or joints. Problems outside the large bowel often occur during a flare-up but can also happen while you’re in remission.
These symptoms may be caused by problems other than ulcerative colitis. If you have any of these symptoms, see your GP for advice.
Ulcerative colitis can lead to a number of complications.
The exact reasons why you may develop ulcerative colitis aren't fully understood at present. It’s likely that a combination of factors are involved. The condition may run in families. If you have a close family member with ulcerative colitis, you’re about 10 times more likely to develop the condition. It's also thought that other factors, such as eating certain types of food or getting some infections, could trigger it.
Your GP will ask about your symptoms and examine you. He or she may also ask about your medical history, if you have any family members with bowel problems and if you’ve travelled abroad recently.
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 a number of things including anaemia and signs of inflammation.
Depending on the results, your GP may refer you to a gastroenterologist. He or she may advise you to have more tests, which can include the following.
At the moment, there isn’t a medical cure for ulcerative colitis. However, there are treatments that can help to settle flare-ups and prevent complications.
Your gastroenterologist can prescribe you medicines to control your symptoms and prevent flare-ups. You may need different treatments for when you’re in remission and when you’re having a flare-up. Medicines for ulcerative colitis include the following.
Your gastroenterologist will advise which treatment is best for you. This may depend on the type of medicine you would prefer and how severe your symptoms are. Always ask your gastroenterologist for advice and read the patient information leaflet that comes with your medicine.
If medicines don't improve your symptoms, your gastroenterologist may recommend an operation to remove your large bowel (a colectomy). Your small bowel will be redirected so that your body is still able to get rid of waste products. There are three ways to do this. You will be given the chance to talk to your gastroenterologist about which kind of operation is best for you.
You may need a more urgent operation if you develop toxic megacolon. It’s likely that a surgeon will remove your large bowel but not your rectum. This means you can choose to have a pouch or permanent ileostomy once you have recovered.
Speak to your gastroenterologist if you would like more information about these procedures.
Having ulcerative colitis can have an emotional impact on your life and you may find that you feel stressed at times. Although stress doesn’t cause ulcerative colitis, it may contribute to your flare-ups. If you start to feel stressed, you could try some simple stress-reduction techniques to help you relax.
Having a long-term condition like ulcerative colitis can affect your sense of wellbeing. Because flare-ups can be unpredictable, you might feel anxious about going out. Having a flare-up plan can help you overcome these feelings. Before going out, it might be useful to find out where public toilets are located. If you’re worried about having an accident, carry spare clothing in your bag so you can change. Talk to your gastroenterologist about what to do when you have a flare-up, as you may need to adjust your medication. You may find it useful to carry a supply of steroid tablets with you when you travel on holiday. This way, if you have a flare-up, you will be able to treat it straight away. If you would like more information about how to manage your flare-ups, talk to your gastroenterologist.
Although getting enough rest is important, regular exercise can help to relieve any tiredness that you may feel. Physical activity can also improve your general health and help to keep your bones strong. This is important because people with ulcerative colitis are more likely to develop osteoporosis (thinning of the bones). Aim to do 30 minutes of activity that gets you slightly breathless at least five days each week.
If you feel like you need some further support, you could attend a self-help group to talk about your feelings. You may also find it helpful to read internet-based blogs or take part in online chat forums and message boards.
Reviewed by Hemali Parekh, Bupa Health Information Team, December 2013.
For answers to frequently asked questions on this topic, see FAQs.
For sources and links to further information, see Resources.
This information was published by Bupa's Health Information Team and is based on reputable sources of medical evidence. It has been reviewed by appropriate medical or clinical professionals. Photos are only for illustrative purposes and do not reflect every presentation of a condition. The content is intended only for general information and does not replace the need for personal advice from a qualified health professional. For more details on how we produce our content and its sources, visit the about our health information page.
1 in 3 people will get cancer in their lifetime