This type of inflammatory bowel disease affects the innermost lining of your digestive tract. Learn about available treatments for this often exhausting condition.
Ulcerative colitis (UL-sur-uh-tiv koe-LIE-tis) is an inflammatory bowel disease (IBD) that causes inflammation and ulcers (sores) in your digestive tract. Ulcerative colitis affects the innermost lining of your large intestine, also called the colon, and rectum. In most people, symptoms usually develop over time, rather than suddenly.
Ulcerative colitis can be draining and can sometimes lead to life-threatening complications. While it has no known cure, there are several new treatments that can greatly reduce signs and symptoms of the disease and bring about long-term remission.
The colon is a long tubelike organ in the abdomen. It's the longest part of the large intestine. The colon carries waste to be expelled from the body. The rectum makes up the last several inches of the colon.
Ulcerative colitis symptoms can vary, depending on the severity of inflammation and where it occurs. Signs and symptoms may include:
Most people with ulcerative colitis have mild to moderate symptoms. The course of ulcerative colitis may vary, with some people having long periods when it goes away. This is called remission.
Health care providers often classify ulcerative colitis according to its location. Symptoms of each type often overlap. Types of ulcerative colitis include:
See your health care provider if you experience a persistent change in your bowel habits or if you have signs and symptoms such as:
Although ulcerative colitis usually isn't fatal, it's a serious disease. In some cases, ulcerative colitis may cause life-threatening complications.
The exact cause of ulcerative colitis remains unknown. Previously, diet and stress were suspected. However, researchers now know that these factors may aggravate but don't cause ulcerative colitis.
One possible cause is an immune system malfunction. When your immune system tries to fight off an invading virus or bacterium, an irregular immune response causes the immune system to attack the cells in the digestive tract, too.
Heredity also seems to play a role in that ulcerative colitis is more common in people who have family members with the disease. However, most people with ulcerative colitis don't have this family history.
Ulcerative colitis affects about the same number of women and men. Risk factors may include:
Possible complications of ulcerative colitis include:
Endoscopic procedures with tissue biopsy are the only way to definitively diagnose ulcerative colitis. Other types of tests can help rule out complications or other forms of inflammatory bowel disease, such as Crohn's disease.
To help confirm a diagnosis of ulcerative colitis, you may have one or more of the following tests and procedures:
Ulcerative colitis treatment usually involves either medication therapy or surgery.
Several categories of medications may be effective in treating ulcerative colitis. The type you take will depend on the severity of your condition. The medications that work well for some people may not work for others. It may take time to find a medication that helps you.
In addition, because some medications have serious side effects, you'll need to weigh the benefits and risks of any treatment.
Anti-inflammatory medications are often the first step in the treatment of ulcerative colitis and are appropriate for most people with this condition. These include:
These medications also reduce inflammation, but they do so by suppressing the immune system response that starts the process of inflammation. For some people, a combination of these medications works better than one medication alone.
Immunosuppressant medications include:
"Small molecule" medications. More recently, orally delivered agents, also known as "small molecules," have become available for IBD treatment. These include tofacitinib (Xeljanz), upadacitinib (Rinvoq) and ozanimod (Zeposia). These medications may be effective when other therapies don't work. Main side effects include the increased risk of shingles infection and blood clots.
The U.S. Food and Drug Administration (FDA) recently issued a warning about tofacitinib, stating that preliminary studies show an increased risk of serious heart-related problems and cancer from taking this medication. If you're taking tofacitinib for ulcerative colitis, don't stop taking it without first talking with your health care provider.
This class of therapies targets proteins made by the immune system. Types of biologics used to treat ulcerative colitis include:
You may need additional medications to manage specific symptoms of ulcerative colitis. Always talk with your health care provider before using over-the-counter medications. Your provider may recommend one or more of the following.
Surgery can eliminate ulcerative colitis and involves removing your entire colon and rectum (proctocolectomy).
In most cases, this involves a procedure called ileoanal anastomosis (J-pouch) surgery. This procedure eliminates the need to wear a bag to collect stool. Your surgeon constructs a pouch from the end of your small intestine. The pouch is then attached directly to your anus, allowing you to expel waste in the usual way. This surgery may require 2 to 3 steps to complete.
In some cases a pouch is not possible. Instead, surgeons create a permanent opening in your abdomen (ileal stoma) through which stool is passed for collection in an attached bag.
You will need more-frequent screening for colon cancer because of your increased risk. The recommended schedule will depend on the location of your disease and how long you have had it. People with inflammation of the rectum, also known as proctitis, are not at increased risk of colon cancer.
If your disease involves more than your rectum, you will require a surveillance colonoscopy every 1 to 2 years. This begins as soon as eight years after diagnosis if the majority of colon is involved. Or 15 years after diagnosis if only the left side of your colon is involved.
Sometimes you may feel helpless when facing ulcerative colitis. But changes in your diet and lifestyle may help control your symptoms and lengthen the time between flare-ups.
There's no firm evidence that what you eat actually causes inflammatory bowel disease. But certain foods and beverages can aggravate your signs and symptoms, especially during a flare-up.
It can be helpful to keep a food diary to keep track of what you're eating, as well as how you feel. If you discover that some foods are causing your symptoms to flare, you can try eliminating them.
Here are some general dietary suggestions that may help you manage your condition:
Although stress doesn't cause inflammatory bowel disease, it can make your signs and symptoms worse and may trigger flare-ups.
To help control stress, try:
Many people with digestive disorders have used some form of complementary and alternative medicine. However, there are few well-designed studies showing the safety and effectiveness of complementary and alternative medicine.
Although research is limited, there is some evidence that adding probiotics along with other medications may be helpful, but this has not been proved.
Symptoms of ulcerative colitis may first prompt you to visit your primary health care provider. Your provider may recommend you see a specialist who treats digestive diseases (gastroenterologist).
Because appointments can be brief, and there's often a lot of information to discuss, it's a good idea to be well prepared. Here's some information to help you get ready, and what to expect.
Your time is limited, so preparing a list of questions ahead of time can help you make the most of your time. List your questions from most important to least important in case time runs out. For ulcerative colitis, some basic questions to ask include:
Your provider is likely to ask you a number of questions. Being ready to answer them may reserve time to go over points you want to spend more time on. Your provider may ask: