Let's Talk About Ulcerative Colitis
We’ve got the doctor-approved details on the causes, symptoms, treatments, and a jillion other facts and tips that can make life with UC easier.by Lara DeSanto Health Writer
Whether you've just been diagnosed or worry you could have ulcerative colitis (UC), you're probably nervous, confused, and maybe even a little scared. That's normal, and everyone featured on HealthCentral with a chronic illness has at some point felt just like you do now. But we—and they—are here for you. On this page alone, you'll discover the realities and challenges of the condition, but also the best treatments, helpful lifestyle changes, wisdom from people who have had UC for years, and all the critical information to help you not just manage—but thrive. We're sure you’ve got a lot of questions…and we've got the answers you need.
Our Pro Panel
We went to some of the nation’s top RA experts to bring you the most scientific and up-to-date information possible.
Aline Charabaty Pishvaian, M.D.
Director of the Inflammatory Bowel Disease Center
Sibley Memorial Hospital
Jason Schairer, M.D.
Senior Staff Gastroenterologist
Henry Ford Inflammatory Bowel Disease Center
Neilanjan Nandi, M.D.
Director of the Inflammatory Bowel Disease Center
Drexel University School of Medicine
UC and Crohn's are the two main types of inflammatory bowel disease (IBD). While they do share many symptoms in common, they are distinct diseases. Ulcerative colitis mainly affects only the colon and/or rectum while Crohn's may impact any part of the entire digestive tract.
The conversation around whether you can "cure" UC is hotly debated. Some say the only true cure is a proctocolectomy, which is surgery that removes your colon and rectum completely. However, some symptoms can persist even after surgery. While a total cure may not be possible, the good news is it's possible to reach remission (meaning you have few or no symptoms) with the right treatment.
The term colitis simply refers to inflammation in your colon. It can result from things like bacterial or viral infection or a parasite, but the inflammation usually goes away once your immune system fights off the attacker. Ulcerative colitis, on the other hand, is chronic, meaning the inflammation is long-lasting and related to a serious immune system problem.
There's no such thing as a one-size-fits-all "ulcerative colitis diet." That said, most experts recommend a plant-based, Mediterranean diet, along with working with a registered dietitian to help you come up with a meal plan that works for you and your symptoms.
What Is Ulcerative Colitis, Anyway?
Ulcerative colitis: Even the name is a mouthful. But let's break it down. UC is a chronic autoimmune disease that causes inflammation of the colon (that's the colitis part) and rectum. That inflammation leads to ulcers (that's the ulcerative part), or open sores, in the intestinal lining that can bleed or leak pus and mucus. Along with that may come other symptoms like severe and frequent diarrhea and pain. You may also hear the term "colitis," but know that ulcerative colitis and plain "colitis" are very different things. Colitis is short-term inflammation of the colon, whereas ulcerative colitis is a more serious chronic disease.
UC is one of two main types of inflammatory bowel disease (IBD). Crohn's disease is the other. While Crohn's and UC are similar, there are some key differences—the main one being that UC is typically related to inflammation concentrated in the large intestine, while Crohn's may affect any part of the digestive tract.
What's happening inside your body when you have UC?
Let's start with the immune system. A healthy immune system protects the body from invaders, like bacteria and viruses, by triggering temporary inflammation (called the "immune response") to help fight them off. After the infection is cleared, the inflammation typically goes away.
But that's not how things go down with UC. Instead, the immune system doesn't get the message that the fight is over, so the level of inflammation stays high—and healthy tissue becomes collateral damage. In the case of UC, the lining of the colon and rectum become the misdirected target. However, this kind of chronic inflammation can eventually lead to symptoms body-wide.
UC affects about 238 out of 100,000 adults in the United States or a little under 1 million people. Typically, people with UC are first diagnosed in their 30s, although UC can occur at any age—even in kids.
What Causes UC in the First Place?
If you've been diagnosed with UC, one of your first questions might be, "Why did this happen to me?" Unfortunately, there's no easy answer. According to scientists, there are a number of factors that work together to determine whether a person develops UC.
Here are the main risk factors for ulcerative colitis include:
Genetics. UC often runs in families, and a number of genetic differences have been identified in people with IBD, according to an article in The Lancet. If you have a parent or sibling with the disease, your own risk is increased 10-fold. But even with that big jump, it's still hardly a given that you'll develop it: Only about 10% to 25% of people with UC have a first-degree relative with IBD (either UC or Crohn's).
Age. Typically, UC first appears in people between the ages of 15 and 30. It's also more likely to develop in people over 60, possibly because of the aging immune system and body as a whole.
Race and ethnicity. While UC affects people of all races and ethnicities, Caucasian people and those of Ashkenazi Jewish descent are at increased risk.
High-fat diet. While you may find that certain foods trigger your symptoms more than others, there's no one diet that specifically causes UC. However, some research shows that consistently eating a lot of high-fat foods may slightly increase your risk.
Do I Have UC Symptoms?
One of the most common symptoms of UC is probably also the scariest: seeing blood in your poop. You can thank those intestinal ulcers for that. Blood can also be seen with inflammation alone as the lining of the colon becomes friable and bleeds easily. This can happen before ulcers develop. You may also have diarrhea that just won't quit even after three to five days, persistent abdominal pain (ranging from squeezing and cramping to sharp pain), or frequent urges to relieve yourself even though there's nothing much to show for it.
In other words, if you're having these symptoms for days and you can rule out a bad batch of take-out, something UC-related could be going on.
UC symptoms can range from mild to severe, and your doctor will take all your symptoms into account when assessing your case. Here are some of the main symptoms to watch for:
Blood or pus in your stool (It may be bright red, pink, or almost black.)
Frequent, persistent diarrhea (Those with moderate disease may have 4 to 6 bowel movements per day because your inflamed colon just can't process food properly.)
Tenesmus (It's the sudden and frequent feeling that you need to have a bowel movement, but nothing happens when you try to go.)
Abdominal pain or discomfort (This may feel like squeezing pressure, cramping, or tenderness on the lower left abdomen.)
Weight loss (Because a lot of what you're eating isn’t being absorbed into your body.)
Fever (It's usually persistent but low-grade; chronic inflammation can literally heat your temp.)
Fatigue (This is deep-in-your bones, can't-get-through-the-day exhaustion.)
Reduced appetite (Because who feels like eating when you're pooping all the time?)
Also important to know: The systemic inflammation from UC can cause non-digestive symptoms too, including anemia (due to blood loss), eye and skin problems like skin ulcers and inflammation, and even arthritis-like joint pain.
When to Call Your Doctor
If you’re having any of the above symptoms, make an appointment with your primary care doctor. The sooner you treat your UC, the better for your overall health. If your doc suspects UC, they will likely refer you to a gastroenterologist (GI), which is a type of physician specializing in digestive health. Your GI can further evaluate your symptoms, run any necessary tests, and give you a diagnosis.
Even if you're already diagnosed with UC, see a doctor ASAP if you have heavy regular diarrhea, bleeding from the rectum or blood clots in your stool, constant abdominal pain, or a high fever.
How Do Doctors Diagnose UC?
There's no way around it. You're probably going to have to collect some poo. Your doctor will also evaluate your symptoms, take a full medical history, and do a complete exam and will likely order the following tests:
Stool sample. Told you it was coming. You'll get a special container to collect the "specimen" to bring to your doctor. (Try not to be embarrassed. Poop is literally their job.) The lab will be looking for blood or white blood cells in your stool—a sign of UC—and aiming to rule out other infections.
Blood tests. Your doctor will want to determine whether you have anemia, which is a symptom of UC due to the blood loss it can cause; he'll also want to look for signs of infection and inflammation in the body. Blood tests will also screen for certain antibodies (proteins) called perinuclear anti-neutrophil antibodies (pANCA) and anti-saccharomyces cerevisiae antibody (ASCA) that may help indicate whether you have UC.
Colonoscopy. The gold standard for diagnosing UC? While you’re under anesthesia, your doctor will use a flexible tube with a camera to look through your GI tract and check for signs of UC. They may also use ultrasound during this procedure to get a better look at the intestinal lining. It is likely they will also take biopsies of the colon and send them to a pathologist to look at under a microscope.
Imaging tests. Your GI may use x-rays, computerized tomography (CT) scans, or magnetic resonance imaging (MRI) of your abdominal area to get a picture of the extent of your disease, including checking for complications like intestinal blockage.
What Is the Best Treatment for UC?
The key goal of UC treatment is to stop the inflammation and reduce your symptoms—hopefully to the point of remission (meaning you have few symptoms, if any). But how exactly your UC is treated comes down to the severity of your disease. Your GI will recommend different approaches based on whether your UC is mild, moderate, or severe.
You're probably in the mild range if you’re having fewer than four bowel movements a day and just mild cramping. On the other end of the spectrum, severe disease may involve more than six bowel movements a day and more extreme abdominal pain.
Treatment options include medications and, in severe cases, surgery—along with certain lifestyle changes.
Medications for UC: You've Got Options
Good news: There are more medication options for UC available now than ever before. Work with your doctor to figure out the best treatment plan for you.
UC medications include:
Aminosalicylates (5-ASAs). This group of drugs, which includes mesalamine, helps to reduce inflammation in your intestines. If your UC is mild to moderate, your doc may consider this option for you. These drugs can be taken daily as either an oral pill or a rectal suppository, depending on the location of the symptoms you want to target (for example, a suppository may work especially well if you're experiencing inflammation mainly in your rectum, not your colon).
Steroids. Steroids can help decrease inflammation throughout the body. They can be given orally, rectally, through an IV, or as an injection. Because they come with a high risk of side effects, steroids are a short-term treatment option, typically only prescribed if you’re in an active flare to get moderate-to-severe inflammation under control quickly.
Immunomodulators: These immune system-modifying drugs are given in a daily pill or via weekly injection and help reduce your body's immune response, thereby stopping further inflammation. Sometimes your doc will prescribe a short course of steroids along with an immunomodulator, since immunomodulators can take several months to take effect.
Biologics: Biologic drugs target key proteins in the immune system that are involved in inflammation, going straight to the source of your UC. These drugs are usually prescribed for moderate-to-severe UC and can help you get to or maintain remission from your disease, according to a study in Gut and Liver. They're either given as a self-injection, usually every two to four weeks or through an IV at a health care provider's office every two to eight weeks.
Your doc also may suggest certain over the counter (OTC) drugs, including pain relievers and anti-diarrhea medications, along with supplements to help combat any nutritional deficiencies you have as a result of your UC, like iron or vitamin D.
Surgery for Ulcerative Colitis
Thankfully, surgery isn't super common for people with UC nowadays, thanks to newer drugs that are effective even for severe UC (hello, biologics!). That said, there are some cases when surgery needs to be considered, such as when your UC doesn’t respond to medications or there are complications, such as uncontrolled bleeding or a perforated colon.
Typically, the surgery for severe UC is a proctocolectomy, which involves removing the colon and rectum. We know this probably sounds drastic, but many people actually get their life back after these procedures. There are two main versions of the surgery:
J-pouch: This procedure involves creating a pouch inside your body to replace some of the function of the removed large intestine. It's created from part of your small intestine and is connected to your anus, so once you heal, you'll be able to go to the bathroom like usual.
Ostomy: This one will require wearing an external pouch (called an ostomy bag) to collect waste moving forward. This second option can sound particularly daunting—and while it certainly is a big adjustment, know that it's totally possible to live an active, happy life with an ostomy.
It's also important to know that while surgery can stop many of your UC symptoms, some issues may persist even after this surgery, including complications like pouchitis (when your J-pouch gets inflamed).
Lifestyle Changes That Can Help
You may also find relief by making changes to your daily life, including your physical activity, diet, and more. Here are some areas to focus on:
Exercise. Research shows physical activity can be a big help for people with UC, helping to boost the immune system, reduce inflammation, and lower stress.
Sleep. Getting a quality night's sleep is crucial for people with UC, who may already struggle with fatigue due to anemia and other symptoms. If you’re struggling with getting enough rest, getting your digestive symptoms under control can help.
Diet. There's no specific "ulcerative colitis diet." That said, you may find that certain foods trigger your UC symptoms more than others. Common culprits include high-fat foods, sugary foods, and foods containing insoluble fiber. Keeping a food diary can help you pinpoint them. Work with your doctor or a registered dietitian to figure out an eating plan that works for you.
Mental health. Living with a chronic illness like UC raises your risk for mental health issues, like depression and anxiety. You may want to consider seeing a therapist to help guide you through the stresses of UC.
What Triggers a UC Flare?
One of the most frustrating things about UC is how unpredictable it can be. But getting to know your disease and pinpointing specific triggers can help you take control of your life and reduce flares. While everyone is different, here are some things that may worsen UC symptoms:
Not taking your UC medication as directed (Skipping doses can lead to an increase in symptoms or reduce the effectiveness of the drug.)
Taking nonsteroidal anti-inflammatory drugs (NSAIDs), like aspirin, ibuprofen, and naproxen, which can irritate your digestive tract
Stress, which triggers the release of cortisol and adrenaline, which can in turn jack up inflammation
Smoking, another huge driver of inflammation in the body (and more of that is exactly what you don't need)
Eating certain foods (Keep a food/symptom diary and work with a pro to figure out foods that bother you—everyone’s triggers are different, but there are some common offenders to consider.)
Taking antibiotics, which can rid your gut of important healthy bacteria (Talk to your GI before you take any antibiotics—they may recommend you take an anti-diarrheal to help combat any issues.)
Does UC Have Serious Complications?
It can—especially if left untreated or if you don’t follow directions for your medications. Common complications of UC include:
Rectal bleeding, which can lead to anemia
A perforated colon, a dangerous condition where large intestine ruptures
Increased risk of colon cancer; the chronic inflammation can increase the likelihood of cancerous cells developing. Depending on how long you’ve had UC symptoms, you may need more frequent colonoscopies to screen for this cancer, according to a study in Clinical Endoscopy.
Deficiencies in vitamins and minerals, such as iron, calcium, and vitamin. These deficiencies can lead to things like anemia and bone loss in the form of osteopenia or osteoporosis.
Inflammation throughout the body, such as the eyes, skin, and joints. This can lead to things like dry eye, rashes, and arthritis.
Preventing Ulcerative Colitis
While there is no known way to keep you from getting UC, sticking to those healthy-lifestyle habits we talked about above can help you prevent complications and feel better overall. The cheat sheet:
Follow your treatment plan, including taking meds as prescribed and keeping up with your scheduled checkups with your GI
Get regular exercise.
Prioritize your emotional and mental health.
What's Life Like for People With UC?
Life with UC varies from person to person depending on your specific disease and symptoms. But it's not uncommon for people to battle daily digestive issues, tiredness, and more. You may also have to deal with people who don't really understand your condition and can't fully grasp what you're going through, since you may, on the outside, look totally healthy (that's why it's sometimes called an "invisible" illness).
But as you adjust to life with UC, you'll learn more and more ways to make your life easier—whether that's sitting in an aisle seat at the movies so you can make quick trips to the restroom, avoiding trigger foods, or putting together a self-care routine for when flare-ups strike.
But if UC is relatively new to you, or you're exhausted and in constant pain, we understand how daunting it can be to search for good care and try new treatments. So, start small: First educate yourself about UC, then work toward building confidence in who you are as a person living with this chronic disease.
We'll be honest here: Managing UC can be exhausting and stressful. In fact, having IBD raises your risk of mental health problems like anxiety and depression, according to a study in the Canadian Journal of Gastroenterology and Hepatology. You may feel pressure to put on a happy face and disguise any issues—especially when those issues often involve time spent in the bathroom (or frantically searching for one). Not everyone is comfortable talking about digestive health—but simply talking with friends and family about UC can make you feel less lonely and combat any stigma surrounding your symptoms. The more your support system understands what you're going through, the more they can help you.
Finding healthy ways to live well with UC is essential to any treatment plan. By prioritizing your emotional health, you're setting yourself up to follow through with all other aspects of UC management.
Sex and Pregnancy With UC
It's unfortunate that UC often first strikes people at a young age, when you may be dating or even considering starting a family. And regardless of your age, UC can affect all areas of your life, including sex.
But know this: You can absolutely have fulfilling relationships with UC. Find a way to explain your condition to new people in a way that's comfortable for you. For example, you might say something like, "I have a chronic illness related to my digestive system that can make my stomach act up sometimes." You may find that the more often you're open and honest about your UC, the easier it will get.
So, if you're dating, maybe you consider bringing up the fact that you have UC on the second or third (or first!) date. The more confident you seem, the more others will feel comfortable, too.
Eventually, your UC will follow you into bedroom, which can feel terrifying in all sorts of new ways. Like, what if you fart or, worse, have an actual accident? Here's an important lesson: The people who are truly worth your time will show you compassion in these moments.
When it comes to having babies, know that UC typically doesn’t affect fertility. That said, some people with UC worry about passing the condition onto their children, or they worry about whether their UC will flare during pregnancy. Talking with your doctor about your family planning early can help you figure out how to proceed and give you time to get your body as healthy as possible (AKA remission!) before you try to conceive. They may also advise you to stop certain medications you're taking for your UC that may be unsafe during pregnancy.
Where Can I Find UC Communities?
Sometimes, it can feel like you’re the only person in the world with UC—an incredibly isolating feeling. But take heart: There are many others out there who know exactly what you’re going through—and they're ready and willing to help guide you through the UC journey.
Follow because: Jenna Ziegler's blog chronicles what it was like to go from "social girl to hermit" when she was first diagnosed with UC—and how she learned to thrive again.
Follow because: Want some UC comedy and honesty in your Instagram feed? Then follow this comedic IBD duo, who share memes, raise awareness, and more.
Follow because: Brittany Roman-Green dedicates her career as a nutritionist to helping people with UC and Crohn's "get into symptom remission, expand their diet, and boost energy," according to her Instagram. Follow her on the 'gram or on her blog for practical tips about eating with IBD (including meal ideas!), helpful Q+A sessions, and more.
Follow because: On her Instagram, Kelly shares what it's like to live day-to-day with UC. Follow this yoga teacher and foodie for inspirational content and advice.
Follow because: Ijmal Razi Haider has UC, uses his Instagram to share advice about the condition along with inspirational quotes and more. Follow him for empowering messages in your feed.
About IBD: Hosted by Amber Tresca, who has UC herself, “About IBD” raises awareness about what it’s really like to live with these conditions by sharing information and patient stories.
Invisible Not Broken: Hosts Monica Michelle and Eva Minkoff bring all kinds of Spoonie stories to light—UC and beyond.
American Journal of Gastroenterology Author Podcasts: If you like to get into the nitty-gritty medical side of UC, check out the podcasts from the American Journal of Gastroenterology. Search the archives for UC- and IBD-specific episodes to hear straight from the experts about the latest IBD research.
Top Support Groups and Nonprofits
The Crohn's and Colitis Foundation: The Crohn's and Colitis Foundation is an invaluable resource for anyone living with UC. Local and national chapters can connect you with other people living with IBD, whether through an in-person or online support group, fundraising events, or even Camp Oasis, a summer camp for kids and teens.
Girls with Guts: This organization aims to empower women and girls with IBD to share their stories, increasing overall awareness for UC and Crohn's. They offer a private online forum where you can connect with other UCers and annual retreats to connect with the community face-to-face.
The Great Bowel Movement: This organization aims to get the conversation started around IBD and break down the stigma. They offer opportunities to get involved and become an advocate for your condition.
You're not alone in this UC journey. These are just a few of the ways to find your people!
UC Information from the National Institutes of Health: Ulcerative Colitis. (2014). https://www.niddk.nih.gov/health-information/digestive-diseases/ulcerative-colitis
The Crohn’s and Colitis Foundation: The Crohn’s and Colitis Foundation. (2019). https://www.crohnscolitisfoundation.org/
IBD Information from the Centers for Disease Control and Prevention: Inflammatory bowel disease (IBD). (2017). https://www.cdc.gov/ibd/
UC Information from the Mayo Clinic: Ulcerative colitis. (2019). https://www.mayoclinic.org/diseases-conditions/ulcerative-colitis/symptoms-causes/syc-20353326
UC and genetics study: Lancet. (2016). "Inherited Determinants of Crohn's Disease and Ulcerative Colitis Phenotypes: A Genetic Association Study." ncbi.nlm.nih.gov/pmc/articles/PMC4714968/
UC and high-fat diets study: Gut. (2014). "Long-term Intake of Dietary Fat and Risk of Ulcerative Colitis and Crohn's Disease." gut.bmj.com/content/63/5/776.short
Biologics and remission: Gut and Liver. (2015). "Current and Emerging Biologics for Ulcerative Colitis." ncbi.nlm.nih.gov/pmc/articles/PMC4282853/
UC and exercise: BioMed Research International. (2014). "The Role of Physical Exercise in Inflammatory Bowel Disease." ncbi.nlm.nih.gov/pmc/articles/PMC4022156/
IBD and emotional health: Canadian Journal of Gastroenterology and Hepatology. (2017). "Prevalence of Anxiety and Depression in Patients with Inflammatory Bowel Disease." hindawi.com/journals/cjgh/2017/6496727/