Ulcerative Colitis: Questions to Ask Your Doctor

Medically Reviewed by Minesh Khatri, MD on March 25, 2023
Written by Peter Jaret
5 min read

Ulcerative colitis (UC) can be a complicated and confusing illness. Your doctor can help make sense of it. The first step is knowing what questions to ask. Here's a checklist of questions, along with notes on what your doctor may discuss with you.

Food doesn’t cause you to get UC, and there’s no diet that cures the disease. But when you have ulcerative colitis, certain things you eat can worsen your symptoms during a flare.

Your doctor may give you a checklist of some foods that often cause problems during a flare, including "gassy" foods like broccoli, cauliflower, beans, and whole grains. Some dietitians recommend eating five or six small meals rather than two or three large ones. Drinking plenty of fluids, especially water, can also help.

But no two people with ulcerative colitis are exactly alike. A food that bothers one person may cause no problems at all in someone else. Although a variety of popular IBD diets have gotten a lot of hype, doctors say no one diet has been proven to effectively treat the disease.

Doctors and dietitians encourage people with UC to keep a food-and-symptoms diary for several weeks. When you keep track of what you eat and how you feel afterward, you can spot specific foods that seem to give you problems.

A dietitian may also want to review your diary to make sure that you're eating a well-balanced diet that includes all the nutrition you need.

Many experts recommend keeping a diary for at least 3 weeks. Keep in mind that your goal should be to eat as wide a variety of foods as you can to ensure well-balanced nutrition. Diets that cut out many foods are hard to follow, and you may fall short on key nutrients.

During a flare-up, parts of the large intestine become inflamed, causing diarrhea and discomfort. Many experts recommend going on a low-residue diet -- one that cuts out foods that are hard to digest or that contain indigestible fiber. That means avoiding fruits and vegetables, nuts and seeds, and whole grains.

Some doctors recommend a liquid diet during severe flare-ups. With no food passing through the large intestines, the bowels have time to heal.

Again, keep in mind that different people may respond differently.

Falling severely short on certain nutrients is typically linked with Crohn's disease, which can affect the small intestine as well, where most nutrients are absorbed. Because ulcerative colitis affects the large intestine, it can cause severe and sometimes bloody diarrhea, putting people at risk for iron deficiency and anemia.

You can measure your iron level with a simple blood test.

Ulcerative colitis can also deplete stores of folate. That's especially dangerous for women of child-bearing age, since folate deficiency is linked to birth defects. Fluid loss from diarrhea can also cause electrolyte imbalances.

Severe infections can occur in the large intestine, but they are uncommon. Ulcerative colitis is also linked to a higher risk of colon cancer. For that reason, doctors recommend more frequent colonoscopy exams. Your doctor may discuss other risks with you.

If you smoke, set a goal to stop. Studies show that smoking worsens the symptoms of inflammatory bowel disease, especially Crohn's. Smoking also adds to cancer risk.

Finding ways to ease stress may also help you control your symptoms. Stress doesn't cause inflammatory bowel disease, but it can make your symptoms feel worse and may trigger flare-ups. Many people find that moderate exercise, relaxation techniques, or soaking in a warm bath can help.

There are several types of medications that treat ulcerative colitis. People with UC are most often prescribed drugs known as aminosalicylates (5-ASA preparations), which work to reduce inflammation in the bowel wall and work to prevent flare-ups. They work well for mild to moderate disease of the colon. These medications include balsalazide (Colazal), mesalamine (Asacol, Pentasa), olsalazine (Dipentum), and sulfasalazine (Azulfidine).

Corticosteroids such as prednisone are prescribed during flares to get the disease into remission, meaning your symptoms go away. For moderate to severe inflammatory bowel disease, these medications are given through a needle in your vein (IV) at the hospital.

Biologics are medications that work on the immune system to block chemicals involved in inflammation. They include adalimumab (Humira), certolizumab (Cimzia), golimumab (Simponi), infliximab (Remicade), and vedolizumab (Entyvio). They’re often recommended to lessen the use of corticosteroids, which can have serious long-term adverse effects. Biologics can help bring the disease under control and help you stay in remission.

Your doctor will discuss the best medication, given your symptoms and overall health.

Anti-inflammatory drugs such as 5-ASAs are used to stop mild flares. To treat more severe flares, doctors usually turn to medications such as corticosteroids.

Doctors have a wide variety of tests that help diagnose and track inflammatory bowel diseases. Imaging tests and colonoscopies are done to check the bowels. Biopsies are sometimes taken to look at cells in the lining of the intestines. Blood tests are used to spot nutritional shortfalls and anemia, a common side effect of ulcerative colitis. Stool sample tests can detect infections in the intestines.

Surgery is considered a last resort, done when the disease doesn’t respond to medication. It’s also done in some cases if there are cancerous areas in the colon.

Surgery to remove the colon is called a colectomy. Afterward, you need a permanent external bag to drain the stool.

The answer depends on many things, including how severe your disease is, your overall health, and how well you respond to treatment. Many people effectively manage their symptoms with a proper diet and medication and maintain a high quality of life. Your doctor can help give you an idea of what to expect.