Patient education: Ulcerative colitis in adults (The Basics)

What is ulcerative colitis? — Ulcerative colitis is a condition that causes diarrhea, belly pain, and bloody bowel movements. These symptoms happen because the large intestine becomes inflamed and gets sores, called "ulcers." The large intestine is also called the colon (figure 1).

What are the symptoms of ulcerative colitis? — Symptoms can be mild or severe. They might happen just once. Or they might go away and come back over and over again. Possible symptoms include:

●Diarrhea that might happen 10 or more times a day

●Bloody bowel movements

●Bleeding from the anus

●Mucus coming out of the anus

●Belly cramps

●Fever

●Weight loss

●Swelling and pain in the hips and knees

●Redness and pain in the eyes

●Skin rash

●Ulcers or sores in your mouth

Is there a test for ulcerative colitis? — Yes. There are a few tests that can help doctors diagnose ulcerative colitis. Doctors usually use a test called a "sigmoidoscopy" or a similar test called a "colonoscopy" (figure 2). For these tests, the doctor puts a thin tube into your rectum (the lower part of the large intestine) and threads it up into your colon. The tube has a camera attached to it, so the doctor can look inside your colon. The tube also has tools attached, so the doctor can take samples of tissue to look at under the microscope. Other tests might include X-rays or scans.

Do I need to change my diet? — It depends. There is no specific type of diet that has been proven to help people with ulcerative colitis feel better. But some people do notice that certain foods seem to make symptoms worse. If this happens to you, your doctor might suggest avoiding those foods for a while to see if you feel better. For example, some people feel better if they avoid dairy foods like milk, yogurt, and cheese.

If you do avoid certain foods, your doctor might suggest taking supplements. This can help make sure you are getting the nutrients you need.

How is ulcerative colitis treated? — Depending on your symptoms, your doctor might prescribe:

●Medicines you take as a pill – A common one, mesalamine, is also called "5-ASA."

●Medicines that you put directly into your rectum – These reduce swelling in mild cases. It takes about 1 to 2 weeks before they start working.

●A brief course of a steroid medicine – This helps reduce swelling.

●Medicines that work on your immune system – These medicines can help protect your colon from damage. They include "biologic" medicines such as adalimumab (brand name: Humira), infliximab (brand name: Remicade), ustekinumab (brand name: Stelara), and vedolizumab (brand name: Entyvio). They also include medicines called "small molecules" such as tofacitinib (brand name: Xeljanz) and ozanimod (brand name: Zeposia).

For most people, symptoms improve after just a few weeks of treatment. If your symptoms do not get better, your doctor might try a different medicine or give you a steroid medicine through an IV (a thin tube that goes into a vein). This treatment is given in the hospital.

In many cases, symptoms repeat a pattern of going away and then coming back. Many people need to take medicine for life in order to keep their ulcerative colitis under control.

Is surgery an option? — When medicines don't work, surgery can help. There are 2 types:

●Surgery to remove the colon, rectum, and anus. People who have this surgery can no longer have bowel movements in the normal way. Instead, their bowel movements come out through a hole in their belly. A plastic bag catches the waste.

●Surgery to remove just the colon and rectum. After this surgery, the doctor reconnects the small intestine to the anus. People who have this surgery can have bowel movements in the normal way.

What if I want to get pregnant? — In most cases, ulcerative colitis does not affect a person's ability to get pregnant. If you want to have a baby, talk to your doctor or nurse before you start trying to get pregnant. They can make sure you get all the tests you need before and during your pregnancy. It is important for ulcerative colitis to be properly treated during pregnancy. Your doctor or nurse might want to switch your medicines. That's because some of the medicines used to treat ulcerative colitis might not be safe for a baby. Your doctor might also want to put you on a higher dose of folic acid than women without ulcerative colitis need.

Conditions like ulcerative colitis run in families. So, if you have a child, they might get it, too.

More on this topic

Patient education: Diarrhea in adolescents and adults (The Basics)
Patient education: Bloody stools (The Basics)
Patient education: Colonoscopy (The Basics)
Patient education: Colostomy care (The Basics)
Patient education: Colectomy (The Basics)

Patient education: Ulcerative colitis (Beyond the Basics)
Patient education: Inflammatory bowel disease and pregnancy (Beyond the Basics)
Patient education: Sulfasalazine and the 5-aminosalicylates (Beyond the Basics)