Ulcerative Colitis

Ulcerative colitis is a chronic disease that causes inflammation in the colon and rectum.

Last Updated: February 21, 2024

Although the illness can manifest at any age, it is typically identified in young adults (15–25). The prevalence of ulcerative colitis is found to be similar in males and females.

It's believed that the autoimmune system has a role in causing ulcerative colitis. The immune system, which protects the body from outside invaders, mistakes healthy tissue for harmful invaders and launches an attack.

Location is frequently used by experts when determining how to classify ulcerative colitis. When the inflamed area is localized to the rectum, near the anus, this is called rectal proctitis. Inflammation of the sigmoid colon and the rectum is called proctosigmoiditis. When inflammation spreads from the descending and sigmoid colon to the rectum, a diagnosis of left-sided colitis is made. When the whole sections of the colon can be affected this is called pancolitis.

Depending on the degree of inflammation and the site of infection, people with ulcerative colitis may have a wide range of symptoms. Some possible symptoms are:

  • Abdominal pain
  • Diarrhea is sometimes bloody or pus-filled
  • Rectal bleeding
  • Urgency to defecate
  • Inability to defecate
  • Weight loss
  • Fatigue
  • Fever
  • Stunting in growth in children

Ulcerative colitis can be diagnosed with the use of one or more of the following tests and procedures:

  • Blood tests to check for anemia or infection, or inflammation
  • Stool studies to rule out bacterial, viral, and parasitic diseases
  • Colonoscopy to view the whole colon; also tissue samples are obtained throughout this operation for biopsy. Another option is Flexible sigmoidoscopy when the colon is irritated;
  • Imaging studies such as X-rays, CT scans, and MRIs are also performed to rule out structural causes such as perforated colon or megacolon.


Anti-inflammatory drugs are usually the initial step in treating ulcerative colitis. Including are the following:

  • 5-aminosalicylates such as sulfasalazine, mesalamine, balsalazide, and olsalazine;
  • Corticosteroids such as prednisone and budesonide are used for moderate to severe ulcerative; colitis that doesn't respond to other treatments.

Immunosuppressants are drugs that diminish inflammation by decreasing the immunological response; for example, are the following:

  • Azathioprine/mercaptopurine;
  • Cyclosporine.

Biologics are treatments that target immune system proteins. Examples of these are the following:

  • Remicade, adalimumab, and golimumab are TNF inhibitors that neutralize an immune-system protein. These are for severe ulcerative colitis patients who can not handle other treatments;
  • Vedolizumab;
  • Ustekinumab.

Ulcerative colitis symptoms may require extra drugs such as the following:

  • Antidiarrheals such as Loperamide for severe diarrhea;
  • NSAIDs for minor pain, but not ibuprofen, naproxen sodium, or diclofenac sodium, which might worsen symptoms and disease severity;
  • Antispasmodic medications for cramping;
  • Supplemental iron because chronic intestinal bleeding can cause iron deficiency anemia.

Surgery is the last resort when medications are no longer viable. Complete colon and rectum removal or proctocolectomy are the procedures doctors usually advise for patients not responding to treatments.

Once ulcerative colitis is under control, precautions should be taken to keep it that way. Some strategies are:

  • Reduce emotional stress by sleeping seven hours a night, working out frequently, and using relaxation techniques like meditation;
  • NSAID use to relieve pain or fever.

Some foods may make symptoms worse, so they should be avoided. Examples are the following:

  • Foods high in fats
  • Foods and drinks high in sugar
  • Carbonated drinks
  • Foods high in fiber
  • Alcohol.


NHS Inform (2022). Ulcerative colitis. Retrieved December 26, 2022, from https://www.nhs.uk/conditions/ulcerative-colitis


Mayo Clinic (2022). Ulcerative colitis. Retrieved December 26, 2022, from https://www.mayoclinic.org/diseases-conditions/ulcerative-colitis/diagnosis-treatment/drc-20353331


Cleveland Clinic (2022). Ulcerative Colitis. Retrieved December 26, 2022, from https://my.clevelandclinic.org/health/diseases/10351-ulcerative-colitis

Last Updated: February 21, 2024