Slideshow: A Visual Guide to Ulcerative Colitis

What Is Ulcerative Colitis?

It's a type of inflammatory bowel disease that causes long-term inflammation of the cells that line the rectum and colon (also called the large intestine). This inflammation can lead to sores called ulcers, which may bleed and interfere with digestion. You can take medications to calm the inflammation and learn strategies to ease its effects on your daily life.

Warning Sign: Abdominal Pain

If your belly hurts and you have bloody diarrhea, it could be a warning sign of ulcerative colitis. These symptoms range from infrequent and mild to persistent and severe. Seen here is a section of the large intestine with changes typical of ulcerative colitis.

Warning Sign: Weight Loss

Long-term inflammation in the colon can cause digestive problems that may bring on:

• Weight loss
• Poor appetite
• Nausea
• Poor growth in children

Other Warning Signs

Some people with ulcerative colitis have symptoms outside the digestive system. These may include:

• Joint pain
• Skin sores
• Fatigue
• Anemia
• Frequent fevers

Ulcerative Colitis or Crohn's?

The symptoms of ulcerative colitis are similar to another form of inflammatory bowel disease called Crohn's. The main difference is that UC happens only in your large intestine. Crohn's can occur in various places throughout your digestive tract, so you may get symptoms anywhere from the anus to the mouth. Irritable bowel syndrome is another disorder known for long-term belly pain and diarrhea, but it doesn't cause inflammation or sores in the intestines.

Who Gets Ulcerative Colitis?

In the U.S., up to 150 out of every 100,000 people have the disease. Although you can get it at any age, it usually develops when you're between 15 and 25. Ulcerative colitis tends to run in families and is more common in whites. People of Eastern European Jewish descent have a higher risk of getting it.

What Causes Ulcerative Colitis?

The exact cause isn't clear, but researchers suspect the immune system -- your body's defense against germs -- is involved. When you have UC, your immune cells may not react in a normal way to bacteria in your digestive tract. Doctors aren't sure if this triggers the condition or is a result of it. Stress or diet can make your symptoms worse, but they don't cause ulcerative colitis.

Diagnosing Ulcerative Colitis

The most accurate way to check if you have ulcerative colitis is to get a colonoscopy. In this procedure, your doctor inserts a tiny camera into your rectum to get an up-close look at the inside of your colon. You'll learn if you have inflammation or ulcers in the area. A colonoscopy can also help your doctor rule out Crohn's disease, diverticulitis, and cancer.

The Course of Ulcerative Colitis

Your symptoms may come and go. During remission, you may have no discomfort at all. This period can last for months or years, but the symptoms eventually return.

Urgent Care for Ulcerative Colitis

The disease can sometimes lead to complications that might send you to the hospital. These may include an ulcer that bleeds a lot or severe diarrhea that causes dehydration. If this happens to you, your medical team will work to stop the loss of blood and fluids. If there is a tear in your colon, you may need surgery to fix it.

Ulcerative Colitis and Colon Cancer

Your risk for colon cancer goes up if you have UC. The risk is increased with the amount of your colon that is involved and by its severity. The risk also rises after you've had UC for 8 to 10 years -- and continues to increase over time. Treatment that puts your UC in remission may lower the risk. Colonoscopy screening tests improve your odds of detecting colon cancer early, when it's easier to treat.

Other Complications

Some people with ulcerative colitis get conditions like osteoporosis, arthritis, kidney stones, eye problems such as uveitis and, in rare cases, liver disease. Researchers believe you may get these complications because of widespread inflammation triggered by the immune system. These problems may improve when you treat your ulcerative colitis with anti-inflammatory medications.

Medications for Ulcerative Colitis

Medicines aim to calm the inflammation inside your colon. The first choice is usually a drug that contains aminosalicylates. If that doesn't help, your doctor may prescribe a steroid such as prednisone. A third option is an immune modifier, which lowers inflammation by changing the activity of your immune system. It can take up to 3 months before you feel the benefits.

Biologic Therapies

They're the newest type of treatment for ulcerative colitis. Most of these medications help your body destroy a protein linked to inflammation called tumor necrosis factor (TNF). You usually get the medicine, also called anti-TNF agents, through an IV. A newer biologic called vedolizumab works in a dfferent way without targeting TNF. Your doctor may suggest biologic therapy if you don't get better with the treatment you take now.

Whipworm Therapy

Studies show mixed results about whether this treatment can fight ulcerative colitis. The idea stems from the fact that the disease is rare in developing countries, where intestinal parasites are far more common. Some researchers think the worms may alter the immune system's response in the intestines. More research is still needed.  

Surgery for Ulcerative Colitis

Up to 45% of people with ulcerative colitis eventually need surgery, either to repair a tear or remove a severely damaged colon. After a surgeon removes your colon, your ulcerative colitis won't come back. Newer surgical techniques mean that people who get their colon taken out usually don't need an external pouch to collect waste, called a colostomy bag.

Ulcerative Colitis in Children

If your child has ulcerative colitis, she may have a poor appetite. Kids with UC may not take in enough calories or have trouble absorbing nutrients from the foods they do eat. To avoid growth problems, your child's doctor may suggest a high-calorie diet. If your child feels embarrassed about urgent trips to the bathroom, a therapist who specializes in long-term illnesses can help her learn strategies to manage the situation.

Living With UC: Reducing Flares

A variety of triggers can make your symptoms worse. Some common ones are stress, smoking, missing doses of medication, and eating certain foods. Try to identify your personal triggers and take steps to avoid them. For instance, you can try meditation to manage stress or use a daily pillbox to remember every dose. If flares continue, talk to your doctor about a change in your treatment plan.

Living With UC: Diet Changes

Diet doesn't cause ulcerative colitis, but some foods may make your symptoms worse. Common culprits include dairy, fatty foods, and too much fiber, which can trigger diarrhea. You may find it helps to keep a journal of what you eat and any symptoms you have. Look for links and try avoiding suspected triggers. If you lose a lot of weight, you may need to work with a dietitian to come up with a high-calorie diet.

Living With UC: Supplements

Because ulcerative colitis often causes bleeding in the colon, it can lead to anemia and not enough iron in your body. Some of the medications you take to treat UC can interfere with the way you absorb nutrients like folic acid and calcium. Ask your doctor whether you need to take supplements.

Living With UC: Probiotics

Typically, probiotics are "friendly" bacteria that are similar to those that live in your intestine and help prevent the growth of too many harmful bacteria. More research is needed to see if probiotics may help keep ulcerative colitis in remission. Probiotics are added to some yogurts, milk, tempeh, and soy beverages, and you can also buy them as supplements.

Living With UC: Staying Hydrated

When you have long-term diarrhea, you're at higher risk of dehydration, which can lead to weakness and kidney problems. To stay hydrated, drink plenty of water -- for every pound you weigh, you may need to drink half an ounce each day. Check with your doctor to see how much fluid you need. 

Living With UC: Relationships

You don't have to let ulcerative colitis get in the way of intimacy. Be open with your partner about any concerns about how your symptoms affect you, and consider seeing a therapist who specializes in long-term illness. Talk to your doctor if sexual problems become an issue.

Living With UC: Travel

With a little extra planning, most people with ulcerative colitis can travel comfortably. Remember these tips:

• Use web sites and cell phone apps to find the restrooms in airports, train stations, or other large venues ahead of time.
• Carry extra underclothing and wet wipes.
• Bring enough medication to last the entire trip, along with copies of your prescriptions.
• Tell your doctor about your plans to see if you need to take other precautions.