Ulcerative Colitis

IBD (Ulcerative Colitis) · Inflammatory Bowel Disease (Ulcerative Colitis)

Symptoms and Complications

Bloody diarrhea is the main symptom of ulcerative colitis, caused by the inflammation in the bowel. People with colitis can have anywhere from 3 to 20 bowel movements daily, even losing control of their bowels and having diarrhea during sleep, in severe cases.

Other signs and symptoms of ulcerative colitis include:

  • lower abdominal pain and cramps (especially during defecation)
  • rectal bleeding
  • anemia (iron deficiency) due to blood loss in diarrhea
  • urgency to defecate (urgent bowel movements) or incontinence (loss of bowel control)
  • weight loss or other signs of malnutrition (e.g., tiredness or malaise)
  • fever over 99.5°F (37.5°C), especially when disease symptoms are severe

Some people with colitis develop arthritis, skin rashes, or inflammation of the eye, and about 4% get liver disease. In children, ulcerative colitis can lead to limited growth. There are also acute complications like bleeding and potentially severe inflammation of the intestinal wall (toxic megacolon).

People with ulcerative colitis are also at increased risk of developing colorectal cancer. The risk of colorectal cancer increases over time, but regular examination by your doctor can help to reduce the risk.

Making the Diagnosis

A doctor can diagnose ulcerative colitis based on your family and medical history, and your symptoms. The doctor will also collect a stool sample to ensure there isn't a bacterial infection in your colon. You'll also have to give a blood sample to check for high numbers of white blood cells, which is a sign of immune system activity and might mean that you have an immune disease such as colitis.

Your doctor is likely to recommend that you have a colonoscopy or perhaps a barium enema.

Colonoscopy allows your doctor to look at the intestinal walls by inserting a colonoscope (a flexible lighted tube with a tiny camera in the tip) up the rectum and into the colon. The test is important to determine how much inflammation is present. If the inflammation extends beyond the colon, it may indicate Crohn's disease.

During a barium enema, barium (a contrast dye) is placed into the bowel in an enema form and sometimes air is added. The barium fills and coats the lining of the bowel, creating a picture of the rectum, colon, and a portion of the small intestine. This test usually takes about 20 minutes and can be somewhat uncomfortable.

Treatment and Prevention

Certain dietary restrictions can help control flare-ups in people with ulcerative colitis, although treatment with medications is also required. For example, some people find that milk triggers their symptoms, so they exclude it from their diet. During a flare-up, avoiding bran, fruit, and raw vegetables can help manage symptoms, because these foods may worsen diarrhea.

Aminosalicylates are anti-inflammatory medications. Examples include mesalamine* (5-ASA or 5 aminosalicylic acid), olsalazine, and sulfasalazine. Aminosalicylates often control symptoms completely. Side effects include nausea, vomiting, heartburn, headaches, orange-colored urine, and gastrointestinal bleeding (in rare cases).

Corticosteroids work to reduce inflammation, especially when there is a flare-up of ulcerative colitis. They can be used as suppositories or enemas, but are often taken in pill form. Examples of corticosteroids include budesonide, hydrocortisone, and prednisone. The side effects of steroid medication include weight gain, acne, high blood pressure, increased risk of infections, increased risk of abnormally high blood sugar levels (diabetes mellitus). Osteoporosis and other health complications can occur with long-term steroid treatment.

Immune-suppressing medications, such as azathioprine or methotrexate, help suppress the immune system so that the body stops attacking its own tissues. These may be tried if the medications listed above do not control symptoms.

Tumor necrosis factor (TNF) blockers (or biologics), such as infliximab, are given as injections to people with moderate-to-severe symptoms when other treatments are not effective.

About one-third of people with ulcerative colitis eventually need surgery because of bleeding, or to prevent colorectal cancer. Surgery is the only permanent cure for ulcerative colitis, and people who have their colon removed can still lead normal lives with proper diet and treatment.

Normally, contents flow from the stomach through the small intestine to the large intestine (colon) and finally to the rectum, where it passes from the body. Until recently, surgery involved removing the colon and rectum and creating a small opening in the side of the abdomen around the belt line. The surgeon connected the free end of the small intestine (the part called the ileum) to the opening, and a pouch was worn over the hole to collect waste and be emptied as needed (usually 3 or 4 times a day).

A newer procedure called an ileoanal anastomosis allows people to have more normal bowel movements after their surgery. The surgeon removes the colon but leaves the outer muscles of the rectum intact, attaching the ileum to the inside of the rectum and the anus. This creates an internal pouch of intestinal tissue. The pouch can occasionally become inflamed (pouchitis), but this can be treated with antibiotics.


*All medications have both common (generic) and brand names. The brand name is what a specific manufacturer calls the product (e.g., Tylenol®). The common name is the medical name for the medication (e.g., acetaminophen). A medication may have many brand names, but only one common name. This article lists medications by their common names. For more information on brand names, speak with your doctor or pharmacist.

Jenifer K. Lehrer, MD, Department of Gastroenterology, Frankford-Torresdale Hospital, Aria Health System, Philadelphia, PA. Review provided by VeriMed Healthcare Network.

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Reviewer: Jenifer K. Lehrer
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