Ulcerative Colitis
Also known as UC, Inflammatory bowel disease
This article is general health information for the selected condition. It is not a diagnosis and does not replace clinical judgement. If you have questions or need treatment advice, please consult a qualified healthcare professional.
What is ulcerative colitis?
Ulcerative colitis is a chronic inflammatory bowel disease affecting the inner lining of the colon and rectum in a continuous pattern. It causes bloody diarrhoea and urgency and follows a relapsing course. Long standing extensive disease increases colorectal cancer risk, so surveillance colonoscopy becomes part of routine care.
Causes
- Dysregulated immune response to gut bacteria
- Genetic susceptibility
- Altered gut microbiome
- Barrier dysfunction of the colonic lining
- Environmental factors, with smoking paradoxically protective here
Symptoms
- Bloody diarrhoea
- Urgency and frequent bowel movements
- Passing mucus
- Lower abdominal cramping relieved by defecation
- Tenesmus, a persistent urge to empty the bowel
- Fatigue and weight loss
- Fever during severe flares
Risk factors
- Family history of inflammatory bowel disease
- Age 15 to 30 or 50 to 70 at onset
- Previous gastrointestinal infection
- Ashkenazi Jewish ancestry
- Recent smoking cessation in some cases
Diagnosis
- Colonoscopy with biopsies showing continuous mucosal inflammation
- Faecal calprotectin to identify inflammation
- Stool cultures to exclude infection including C difficile
- Blood tests for anaemia and inflammatory markers
- Assessment of disease extent to plan surveillance
Treatment
- Aminosalicylates such as mesalazine for mild to moderate disease
- Topical rectal preparations for distal disease
- Corticosteroids for flares, not for maintenance
- Immunomodulators such as azathioprine
- Biologic and small molecule therapies for refractory disease
- Colectomy for severe or medically refractory disease
- Surveillance colonoscopy for cancer prevention
Self care
- Take maintenance medicines even in complete remission
- Attend surveillance colonoscopy when invited
- Keep a symptom diary to spot flares early
- Ensure adequate iron, since chronic blood loss is common
- Avoid anti inflammatory painkillers, which can trigger flares
- Keep vaccinations current, avoiding live vaccines on immunosuppression
- Plan travel with adequate medicine supply and a letter
When to see a doctor
Book an appointment if:
- Increasing stool frequency or blood
- Symptoms returning after remission
- Fatigue suggesting anaemia
- Joint pain, eye redness or new skin lesions
- Weight loss
- Before pregnancy, to optimise treatment
Some symptoms need emergency care rather than an appointment. See the warning signs listed above.
Prevention
- Ulcerative colitis cannot be prevented
- Flares are reduced by consistent maintenance therapy
- Avoid anti inflammatory painkillers
- Attend surveillance colonoscopy to prevent cancer
- Treat infections such as C difficile promptly
- Good inflammation control lowers long term cancer risk
Outlook
Ulcerative colitis follows a relapsing course, and most people achieve long remissions with maintenance treatment. Around one in five eventually needs surgery, which removes the disease entirely since it is confined to the colon. Cancer risk rises with extensive long standing disease, which regular surveillance and good inflammation control substantially mitigate.
Common questions
What is acute severe colitis?
A flare with more than six bloody stools daily plus fever, rapid pulse, anaemia or raised inflammatory markers. It requires urgent hospital admission because of the risk of toxic megacolon and perforation.
Does ulcerative colitis increase cancer risk?
Yes, with extensive long standing disease. Risk rises after roughly eight to ten years, which is why regular surveillance colonoscopy is arranged. Good inflammation control also lowers the risk.
Can surgery cure it?
Removing the colon eliminates the disease, unlike in Crohn disease. Options include an ileostomy or an internal pouch, and the decision involves careful discussion of lifestyle implications.
References
Important: Dard AI is not a medical device and does not diagnose, treat, or replace clinician judgement. This article is general information only. Always consult a qualified healthcare professional about diagnosis and treatment, and seek emergency care for severe or rapidly worsening symptoms.