What is ulcerative colitis?

Ulcerative colitis is a type of inflammatory bowel disease (IBD) in which there is chronic inflammation of the digestive system. Ulcerative colitis mainly affects the large bowel. It causes inflammation and ulcers in the lining of the bowel, which results in pain and bloody diarrhoea

There are an estimated 33,000 diagnosed cases of ulcerative colitis in Australia, equally affecting both men and women. [1]

Digestive system

The series of organs within the body that contribute to the digestion of food. It begins at the mouth and ends at the anus, and includes the stomach, small and large intestines as well as the pancreas, gallbladder and liver.

Inflammation

A body’s protective immune response to injury or infection. The accumulation of fluid, cells and proteins at the site of an infection or physical injury, resulting in swelling, heat, redness, pain and loss of function.

Inflammatory bowel disease

A group of conditions characterised by chronic, episodic inflammation of the bowels, including Crohn's disease and ulcerative colitis.

Ulcers

An open sore in the skin or mucous membranes such as those of the stomach lining, intestine or mouth.

1. Inflammatory bowel disease (Crohn's & Colitis). GESA- Gastroenterological society of Australia. Accessed 25 July 2014 from

External link

Causes

The lining of your bowel normally secretes mucus and absorbs water from your stool (faeces). In ulcerative colitis, this lining becomes inflamed, swollen and develops erosions that turn into ulcers. This causes pain and spasms with watery, profuse  diarrhoea. These ulcers can bleed easily and quite badly. 

There is no known cause for ulcerative colitis, but there is much research being conducted to find an answer. 

Ulceration in your large intestine, severe colicky pain, blood and mucous in your stool.Ulcerative colitis causes inflammation and ulcers in the lining of the colon. 

Common theories on the cause of ulcerative colitis include: 

Immune reaction

One theory is that the immune system mistakenly attacks the bowel. The trigger for this is unknown, although an infection is thought to be one possibility.

Genetics

It is thought that ulcerative colitis may be caused by genetic mutations, which could be passed down through generations. This is supported by the finding that individuals with ulcerative colitis often have relatives with inflammatory bowel disease (IBD), such as ulcerative colitis or Crohn's disease.

Genetic

Related to genes, the body's units of inheritance or origin.

Immune system

The organs and cells involved in protecting the body against infection.

Infection

Entry into the body of microorganisms that can reproduce and cause disease.

Inflammation

A body’s protective immune response to injury or infection. The accumulation of fluid, cells and proteins at the site of an infection or physical injury, resulting in swelling, heat, redness, pain and loss of function.

Inflammatory bowel disease

A group of conditions characterised by chronic, episodic inflammation of the bowels, including Crohn's disease and ulcerative colitis.

Mucus

A thick, viscous liquid that is secreted for lubrication and to form a protective lining over certain tissues.

Mutations

An inheritable change in the base sequence of the genome of an organism.

Ulcers

An open sore in the skin or mucous membranes such as those of the stomach lining, intestine or mouth.

1. Inflammatory bowel disease (Crohn's & Colitis). GESA- Gastroenterological society of Australia. Accessed 25 July 2014 from

External link

Risk factors

Risk factors for ulcerative colitis include:

  • Age - it is more common among people 15-40 years of age, though it can happen at any age, and;
  • Ethnicity -  ulcerative colitis has a higher incidence among Caucasian people whose ancestry is European, in particular those who hail from the Ashkenazi Jewish community who lived in Russia and Eastern Europe. It is also common among Africa people, but rare among Asian people  [1] .

1. Inflammatory bowel disease (Crohn's & Colitis). GESA- Gastroenterological society of Australia. Accessed 25 July 2014 from

External link

Types

The unique feature of ulcerative colitis is that it almost always starts at the rectum and travels back along the bowel. The degree to which it extends back up the bowel can vary. This is often used to assess the severity of the condition, as follows:

Ulcerative proctitis

The mildest form of the disease, this is when ulcerative colitis only affects the rectum and is the mildest form of the disease. 

Proctosigmoiditis

This is when the condition affects the rectum and the lowest part of the large intestine. The symptoms are often bloody  diarrhoea, cramping on the left-hand side of the abdomen and the inability to have a bowel movement even though you feel the urge.

Left-sided colitis

This type affects the rectum and extends up to involve all of the large intestine on the left-side of the abdomen. Symptoms may include severe diarrhoea, bleeding, left-sided pain, loss of appetite and weight loss.

Pan colitis

This is a very rare type of ulcerative colitis where all areas of the bowel - both the small and large intestines - are involved. This is the most severe form of the disease, with symptoms including severe cramping, diarrhoea and weight loss. Complications requiring surgery or hospitalisation are common.

Abdomen

The part of the body that lies between the chest and the pelvis.

Large intestine

The final section of the gastrointestinal tract, which primarily absorbs water and vitamins from digested food.

Rectum

The final part of the large intestine, leading to the anus.

1. Inflammatory bowel disease (Crohn's & Colitis). GESA- Gastroenterological society of Australia. Accessed 25 July 2014 from

External link

Signs and symptoms

The symptoms of ulcerative colitis tend to happen in bouts or flare-ups and most appear to be worse in the mornings. You may have no symptoms for months at a time, then have a severe flare-up that may last weeks. The symptoms of a flare-up can include:

  • Diarrhoea - it can contain blood, mucus and/or pus. Commonly, there can be urgent waves of diarrhoea and occasionally, you can lose control of your bowels;
  • Abdominal and anal pain;
  • Weight loss, reduced appetite and nausea;
  • Tiredness and fatigue;
  • Rectal ulcers and bleeding, and;
  • Occasionally, fevers and chills.

You may also experience painful joints, mouth ulcers, irritated eyes and vision problems, or skin rashes. In rare cases, there may be symptoms of liver and bile duct disease, such as itchy skin and jaundice.

Ulcerative colitis can cause severe stomach pain.Ulcerative colitis can cause pain in the abdomen. 

Abdomen

The part of the body that lies between the chest and the pelvis.

Bile

A fluid made in the liver and stored in the gall bladder.

Fatigue

A state of exhaustion and weakness.

Fevers

An increase in body temperature above the normal temperature range. Fever is often caused by the body's immune reaction to infection.

Jaundice

A yellowing of the skin, the whites of the eyes and the mucous membranes, due to an accumulation of bilirubin in the blood. Often a symptom of liver problems.

Joints

A connecting surface or tissue between two bones.

Liver

A large, internal organ of the body, located on the upper right-hand side of the abdomen. The liver has hundreds of distinct functions, including producing bile, regulating the body's metabolism and detoxifying the blood.

Mucus

A thick, viscous liquid that is secreted for lubrication and to form a protective lining over certain tissues.

Pus

A bodily fluid that is the result of an inflammatory response at an infection site. Its colour can range from whitish to yellow to green, depending on the composition. Pus is mainly composed of dead bacteria, white blood cells and cellular debris.

Ulcers

An open sore in the skin or mucous membranes such as those of the stomach lining, intestine or mouth.

Rectal

Relating to the rectum, the final part of the large intestine leading to the anus.

1. Inflammatory bowel disease (Crohn's & Colitis). GESA- Gastroenterological society of Australia. Accessed 25 July 2014 from

External link

Methods for diagnosis

Full physical examination and medical history

A physical examination can allow your doctor to detect any tender areas in your abdomen, check for changes in your anal region and visually identify any areas of inflammation.

Blood tests 

Your doctor will likely order blood tests, such as a full blood count, to assess for possible causes of your symptoms and exclude potential complications (see below).

Stool test

An analysis of your stool can help identify the presence of inflammation or infection in the digestive system.

Colonoscopy

This procedure involves inserting a thin, flexible tube attached to a small camera through the anus to view the inside lining of the bowel. Biopsies of the lining of the bowel are often taken at the time of colonoscopy, which are then sent to a laboratory.

A colonoscopy is generally performed under light sedation to keep you relaxed and pain-free. Often it is necessary to take medications, such as laxatives and enemas, beforehand to clean out the bowel, so that there is a clear view of the inside of the bowel.

Colonoscopy procedure uses a colonoscope to image the bowels and detect inflammation.Colonoscopy. 

Biopsy

Samples of tissue taken at the time of colonoscopy are assessed for characteristic changes under a microscope, which can confirm the diagnosis of ulcerative colitis. 

Abdomen

The part of the body that lies between the chest and the pelvis.

Anus

The opening at the end of the anal canal, between the buttocks, through which faecal matter and intestinal gas exits the body.

Digestive system

The series of organs within the body that contribute to the digestion of food. It begins at the mouth and ends at the anus, and includes the stomach, small and large intestines as well as the pancreas, gallbladder and liver.

Enemas

A procedure in which fluid or gas is injected into the rectum for cleansing, diagnostic or therapeutic purposes.

Full blood count

A blood test that examines the blood, either by using a microscope or an automated machine, to determine the number of red blood cells, white blood cells and platelets.

Infection

Entry into the body of microorganisms that can reproduce and cause disease.

Inflammation

A body’s protective immune response to injury or infection. The accumulation of fluid, cells and proteins at the site of an infection or physical injury, resulting in swelling, heat, redness, pain and loss of function.

1. Inflammatory bowel disease (Crohn's & Colitis). GESA- Gastroenterological society of Australia. Accessed 25 July 2014 from

External link

Types of treatment

The treatment offered will depend on the severity of your symptoms and the part of your bowel affected by ulcerative colitis. Medications are the main form of treatment. Surgery is rarely needed and used only if the symptoms become unmanageable or there is a life-threatening complication.

Medication

Anti-inflammatory medications

The main medications used in ulcerative colitis aim to reduce inflammation in the bowel. The can be taken as a tablet, rectal suppository or enema, or occasionally, administered intravenously. These include:

  • 5-aminosalicyclic acid agents (5-ASA), such as sulfasalazine;
  • Corticosteroids, such as prednisolone, and;
  • Biological therapies, such as infliximab, which are medications that contain antibodies that target specific chemicals involved in the inflammatory process. 

Antibiotics

Antibiotics may be prescribed, in certain cases, where there is suggestion that an infection of the digestive system is also present. 

Other medications

Anti-diarrhoeal medications, probiotics and iron supplements can also be prescribed, where needed. 

Surgery

Surgery can be used to remove the affected part or all of your bowel and rectum. This may be necessary if the disease cannot be controlled sufficiently with medications, if there are precancerous or cancerous changes in the bowels, or if there are certain severe symptoms that develop outside the bowel (see Potential complications). Removing the entire bowel and rectum can potentially cure a person from ulcerative colitis; however, this procedure carries a significant risk and in most cases the condition can be sufficiently controlled through medications. 

Emergency surgery

Occasionally, emergency surgery may be needed to remove the affected part or all of the bowel, if a patient is admitted with certain complications. Complications can include severe bleeding from the bowel, bowel obstruction or toxic colitis (see Potential complications), which are life-threatening and generally do not improve with medications only.

Ileostomy

If your colon and rectum are removed (proctocolectomy), a special opening (stoma) can be created in your abdomen, which connects to a bag that collects your waste matter. A specially trained stoma nurse can teach you how to care for your stoma.

Ileo-anal pouch

If you have had surgery to remove your colon and rectum, a further operation may be an option to allow you to pass stools without needing a stoma. In this procedure, part of your small intestine is used to create a pouch within your abdominal cavity, which is then attached to your anus. This helps to collect the stools and allows you to control when you go to the toilet. 

This is a major surgical procedure with potential complications. Recovery in hospital can take least a week. You may not entirely regain full control of your bowels and it takes time to adapt to the new physiology.

Self care

  • Living with ulcerative colitis can be difficult and may sometimes make you feel depressed. Finding a local or online support group (see link) to connect with others who are experiencing similar issues can be useful;
  • Talk to your doctor or dietitian about foods that may be better during flare-ups, such as low-fibre foods;
  • Keeping a food diary may help you to keep track of any items that aggravate your bowels;
  • Eating small meals often may help, such as six small meals each day instead of three larger ones;
  • Visiting a dietitian may help address any dietary issues you have, and;
  • Find ways to relax, as lowering stress may reduce the incidence of flare-ups.

Abdomen

The part of the body that lies between the chest and the pelvis.

Antibiotics

Chemical substances that kill or suppress the growth of bacteria.

Antibodies

A protein molecule produced by the immune system. Antibodies bind specifically to foreign substances to neutralise them or target them for destruction.

Anus

The opening at the end of the anal canal, between the buttocks, through which faecal matter and intestinal gas exits the body.

Corticosteroids

A medication that resembles the cortisol hormone produced in the brain. It is used as an anti-inflammatory medication.

Digestive system

The series of organs within the body that contribute to the digestion of food. It begins at the mouth and ends at the anus, and includes the stomach, small and large intestines as well as the pancreas, gallbladder and liver.

Enema

A procedure in which fluid or gas is injected into the rectum for cleansing, diagnostic or therapeutic purposes.

Infection

Entry into the body of microorganisms that can reproduce and cause disease.

Inflammation

A body’s protective immune response to injury or infection. The accumulation of fluid, cells and proteins at the site of an infection or physical injury, resulting in swelling, heat, redness, pain and loss of function.

Intravenously

Within a vein.

Iron

An essential mineral required by the body. Iron is part of a protein in the blood called haemoglobin, which carries oxygen around the body.

Rectum

The final part of the large intestine, leading to the anus.

Stoma

A mouth-like opening from the body to the outside environment. Stomas are created surgically, such as a colostomy, in which the end of the large intestine is rerouted to an incision made in the abdominal wall.

Stress

The word ‘stress’ can have a variety of meanings, but generally describes the physical and mental responses of the body to a demand placed upon it. Often used to describe conditions where the demand is high or unable to be resolved and creates anxiety and tension.

Probiotics

Bacteria that have health benefits to the human body, such as Lactobacillus bacteria, which is added to yoghurt to improve digestion.

Rectal

Relating to the rectum, the final part of the large intestine leading to the anus.

Suppository

A form of medication that is inserted into the rectum or vagina for either local action or absorption into the bloodstream.

1. Inflammatory bowel disease (Crohn's & Colitis). GESA- Gastroenterological society of Australia. Accessed 25 July 2014 from

External link

Potential complications

Bleeding

Internal bleeding due to ulcers can lead to anaemia. Sudden heavy bleeding can be life-threatening and if this happens, you are advised to straight to hospital.

Toxic colitis

This is a potentially life-threatening condition in which the inflammation in the bowel is so extensive that the whole bowel wall is involved. This causes the bowels to stop and distend (bloating). The distension can be so severe that the bowel perforates, releasing its contents throughout the abdomen, which may lead to blood poisoning (sepsis). Symptoms of toxic colitis include severe abdominal pain, fever and a racing heart. Immediate surgery may be required to repair the bowel and remove any leaked bowel contents from the abdominal cavity.

Blood clotting

You have a slightly higher risk of developing blood clots (deep vein thrombosis), but this is rare.

Bowel cancer

If you have ulcerative colitis, there is an increased risk of developing bowel cancer. The longer you have had ulcerative colitis and the more severe it is, the greater your chances become. Your doctor may suggest that you have regular check-ups with a colonoscopy to detect any early changes that may be bowel cancer.

Disorders outside the colon

In a small number of people with ulcerative colitis, the inflammation can also affect other areas of the body. Some of these include:

  • Eyes - inflammation that causes a red, sore eye;
  • Skin - there are conditions that cause ulcers on the skin or small painful nodules on the legs;
  • Joints - joint pain is commonly reported and can affect your lower back, hips, knees and other joints;
  • Liver - inflammation of the bile ducts within your liver that can cause liver failure, and;
  • Bones - osteoporosis due to long-term corticosteroid use.

Abdomen

The part of the body that lies between the chest and the pelvis.

Anaemia

A deficiency in red blood cells or haemoglobin in the body.

Bile

A fluid made in the liver and stored in the gall bladder.

Corticosteroid

A medication that resembles the cortisol hormone produced in the brain. It is used as an anti-inflammatory medication.

Fever

An increase in body temperature above the normal temperature range. Fever is often caused by the body's immune reaction to infection.

Inflammation

A body’s protective immune response to injury or infection. The accumulation of fluid, cells and proteins at the site of an infection or physical injury, resulting in swelling, heat, redness, pain and loss of function.

Joints

A connecting surface or tissue between two bones.

Liver

A large, internal organ of the body, located on the upper right-hand side of the abdomen. The liver has hundreds of distinct functions, including producing bile, regulating the body's metabolism and detoxifying the blood.

Nodules

A small growth or lump of tissue.

Ulcers

An open sore in the skin or mucous membranes such as those of the stomach lining, intestine or mouth.

Clots

The thickened or solid mass formed from a liquid, such as blood. Blood clots normally form at an injury site to prevent further blood loss.

1. Inflammatory bowel disease (Crohn's & Colitis). GESA- Gastroenterological society of Australia. Accessed 25 July 2014 from

External link

Prognosis

Ulcerative colitis is a lifelong condition with periods of remission that can vary in length, followed by flare-ups. There is a greater risk than normal of developing bowel cancer, usually after 7-10 years with ulcerative colitis, so regular check-ups are essential.

Remission

A partial or complete reversal of the course of illness, such as cancer or a chronic disease. Remission can be spontaneous or the result of therapy.

1. Inflammatory bowel disease (Crohn's & Colitis). GESA- Gastroenterological society of Australia. Accessed 25 July 2014 from

External link

Prevention

There are lifestyle measures you can take that may reduce flare-ups of ulcerative colitis, such as:

  • Eating a healthy diet and drinking lots of water to stay hydrated;
  • Eating small, regular meals to reduce stress on the digestive system;
  • Undertaking regular exercise, and;
  • Keeping a food diary to record what foods or drinks you cannot tolerate. 

Digestive system

The series of organs within the body that contribute to the digestion of food. It begins at the mouth and ends at the anus, and includes the stomach, small and large intestines as well as the pancreas, gallbladder and liver.

Stress

The word ‘stress’ can have a variety of meanings, but generally describes the physical and mental responses of the body to a demand placed upon it. Often used to describe conditions where the demand is high or unable to be resolved and creates anxiety and tension.

1. Inflammatory bowel disease (Crohn's & Colitis). GESA- Gastroenterological society of Australia. Accessed 25 July 2014 from

External link