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. These may bleed and interfere with digestion. You can take medicine to calm the inflammation and learn ways to ease its effects on your daily life.

Warning Sign: Abdominal Pain

If your belly hurts and you have diarrhea with blood or pus in it, these could be warning signs of ulcerative colitis. These symptoms range from occasional and mild to frequent and severe. Seen here is a section of the large intestine with changes that often happen with 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?

Ulcerative colitis symptoms are similar to those of another form of inflammatory bowel disease called Crohn's. The difference is that UC happens only in your large intestine. Crohn's can occur 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.

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 whether this triggers the condition or is a result of it. Stress and your diet can make your symptoms worse, but they don't cause ulcerative colitis.

Diagnosing Ulcerative Colitis

The most accurate way to check whether 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.

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 like 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

These medications help your body destroy proteins that are linked to inflammation. You usually get them through an IV. Another type of treatment is janus kinase (JAK) inhibitors, which travel quickly through the bloodstream to block inflammation. These are taken by mouth. Your doctor may suggest one of these treatments if you don't get better with other medicines.

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 UC 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.

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.  

Urgent Care for Ulcerative Colitis

The disease can sometimes lead to complications that send you to the hospital. These may include an ulcer that bleeds a lot or severe diarrhea that causes dehydration. In this happens to you, your medical team will work to stop the loss of blood and other 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 increases with the amount of your colon that is involved and how serious it is. The risk also rises after you've had UC for 8-10 years -- and continues to increase over time. Treatment that puts your UC in remission may lower the risk. Colonoscopy screening improves 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 UC with anti-inflammatory medications.

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 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. It can help  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 a shortage of iron in your body. Some 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 prevent the growth of too many harmful bacteria. More research is needed to see if probiotics may help keep ulcerative colitis in check. Probiotics are added to some yogurts, milk, tempeh, and soy beverages. You can also buy them as supplements.

Living With UC: Staying Hydrated

Long-term diarrhea puts you at 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 websites and cellphone apps to find restrooms in airports, train stations, or other large venues ahead of time.
• Carry extra underwear 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.