What is ulcerative colitis?

Ulcerative colitis (UC) is an inflammatory bowel disease and a type of colitis, however it’s sometimes referred to simply as 'colitis'.

UC causes inflammation in your large bowel and rectum. This can lead to symptoms such as abdominal pain and diarrhoea, which may contain blood.

Inflammatory bowel disease can develop at any age, but usually first appears in people aged in their 20s and 30s.

What are the symptoms of ulcerative colitis?

Symptoms of UC can include:

• diarrhoea
• mucus and blood in your stool (poo)
• abdominal (tummy) pain
• the need to open your bowels (do a poo) urgently
• fatigue
• reduced appetite
• weight loss

Symptoms tend to vary between people. Symptoms also come and go over time, as the inflammation flares up then eases again (known as ‘remission’).

What causes ulcerative colitis?

The exact cause of UC isn’t known, but it is known that genetics, infections and other environmental factors are important. Research is ongoing into the potential causes and risk factors for UC.

What is the difference between ulcerative colitis and Crohn's disease?

Crohn's disease is also an inflammatory bowel disease (IBD). These 2 diseases affect the digestive tract differently, although their symptoms can overlap.

• Ulcerative colitis only affects your large bowel (colon and/or rectum), and inflammation is only in the surface layers of your bowel lining. It causes ulcers (tiny, open sores) to form in the lining of your bowel.
• Crohn's disease can affect any part of your digestive tract, from your mouth to your anus (back passage). Inflammation can extend through the entire thickness of your bowel wall. Inflammation caused by Crohn’s disease may also affect other parts of your body, such as your eyes or joints.

In some cases, it may not be clear if you have UC or Crohn’s disease.

When should I see my doctor?

See your doctor if you have symptoms of UC. Your doctor may refer you to a gastroenterologist (specialist doctor) for diagnosis and treatment.

If you have UC, it’s recommended to see your doctor for a checkup at least every 6 months.

How is ulcerative colitis diagnosed?

Your doctor will ask about your symptoms and general health. They will also examine you.

Your doctor or specialist may recommend some of the following tests to help diagnose UC.

• Blood tests can show inflammation, any vitamin or mineral deficiencies and rule out other potential causes of your symptoms, such as coeliac disease.
• A stool sample may be used to test for faecal calprotectin. This shows if there is inflammation in your bowel. Stool samples are often tested for infection as well.
• A colonoscopy (or sigmoidoscopy) uses a thin, flexible tube containing a tiny camera looks inside your bowel for inflammation.
• Biopsies are small samples of tissue may be taken from inside your bowel during a colonoscopy. These are examined under a microscope to look for signs of disease.
• Imaging tests such as x-ray, CT scan or MRI scan, may also be recommended.

How is ulcerative colitis treated?

Treatment for UC aims to:

• treat your symptoms
• reduce your inflammation
• prevent complications

Medicines

Medicines commonly used to control inflammation in UC include:

• 5-aminosalicylates (5-ASA medicines)
• corticosteroids
• medicines that suppress (reduce) your immune system's response to the inflammation caused by UC (known as immunomodulators)
• biologic medicines — that target specific cells or proteins in your body to reduce inflammation
• antibiotics

Nutrition

In general, it’s recommended that most people with inflammatory bowel diseases follow the Australian Guide to Healthy Eating without any changes. Research is ongoing into whether special diets might worsen or improve symptoms of inflammatory bowel diseases.

Some people with inflammatory bowel diseases develop nutritional deficiencies. Ask your doctor or dietitian if you should take any dietary supplements, such as those to boost your levels of:

• iron
• calcium
• some vitamins

Your doctor or dietitian may have specific dietary advice based on your situation.

Surgery

If your UC is severe or doesn’t respond to medicines, your doctor may recommend surgery to remove your colon (known as a total colectomy). A 'pouch' is then created inside your body using the end of your small intestine (known as an ‘ileal pouch’). This pouch is connected directly to your anus.

Another option is to create a temporary or permanent stoma. This is an artificial opening in your abdominal wall (tummy) that diverts faeces (poo) into a bag. It's normal to feel uneasy about the idea of living with a stoma, but many people find it greatly improves their quality of life.

As UC only affects the colon, it is considered ‘cured’ after the colon is removed, but you are still likely to need regular medical follow-up to manage your ileal pouch or stoma.

Living with ulcerative colitis

Seeing your GP or specialist for regular follow-ups can reduce your symptoms and treat any flare-ups early. Your doctor can also help you manage medicine side effects and advise you if you experience other problems that affect your health or quality of life.

Here are some other things you can do to help maintain your health and wellbeing while managing UC:

• Quit smoking.
• Avoid excessive alcohol intake.
• Be vaccinated as recommended by your doctor, especially if you take medicines that affect lower your immune system.
• Exercise regularly to improve your general health, lift your mood and help relieve stress. Regular weight-bearing exercise can also help reduce your chance of developing osteoporosis.
• Maintain a balanced diet.

Living with a chronic condition can affect your quality of life and mental health. If you are struggling, seek help from your doctor or a mental health professional.

Learn more about living with a chronic condition.

Can ulcerative colitis be prevented?

While you can’t prevent UC, you can reduce your chance of flare-ups and complications by taking your medicines as prescribed and maintaining a healthy lifestyle.

What are the complications of ulcerative colitis?

Risk of bowel cancer

In the long-term, UC is associated with an increased risk of developing bowel cancer. Your doctor will recommend bowel cancer screening with regular colonoscopies.

Dietary deficiencies

It is possible to become vitamin or mineral deficient or become malnourished. Your doctor or dietitian can advise you how to manage these.

Risk of osteoporosis

People with inflammatory bowel diseases often have many risk factors for developing osteoporosis, including:

• poor nutrition
• low BMI (Body mass index)
• chronic inflammation
• treatment with corticosteroids

To manage your risk, your doctor may recommend screening for osteoporosis with regular bone density scans.

Resources and support

Speak with your doctor or gastroenterologist to learn more about your condition.

For information and support, visit Crohn's & Colitis Australia or call the IBD helpline on 1800 138 029.

The Gastroenterological Society of Australia (GESA) also has resources on ulcerative colitis.

For more information about living with a stoma, visit the Australian Council of Stoma Associations.

To find an accredited practising dietitian, visit the Dietitians Association of Australia.

You can also call the healthdirect helpline on 1800 022 222 (known as NURSE-ON-CALL in Victoria). A registered nurse is available to speak with you 24 hours a day, 7 days a week.

Other languages

Crohn’s & Colitis Australia has information about Crohn’s disease in a variety of community languages.