What is Ulcerative Colitis?
Ulcerative colitis is a chronic inflammatory bowel disease (IBD) that causes inflammation and ulcers in the lining of the large intestine (colon) and rectum. Symptoms can come and go, with periods of flare and remission.
Symptoms/Complications
Common symptoms include diarrhoea, rectal bleeding or blood in the stool, abdominal cramping or pain, urgency, and sometimes mucus or pus in the stool. More severe disease can also cause fatigue, fever, nausea, vomiting, and weight loss. Possible complications include anaemia, dehydration, bone problems, colorectal cancer risk over time, severe bleeding, toxic megacolon, and perforation. Some people can also develop inflammation affecting the joints, skin, eyes, liver, or bile ducts.
Diagnosis
Doctors diagnose ulcerative colitis using your medical history, physical examination, and tests such as blood tests, stool tests, and endoscopy of the large intestine with biopsies. These tests help confirm the diagnosis, assess severity, and rule out other conditions.
Management
Treatment aims to reduce inflammation, control symptoms, bring on remission, and keep remission going. Many patients need long-term treatment, and some may need surgery if medicines do not work well enough or if complications develop.
- Dietary Lifestyle Modifications
There is no single ulcerative colitis diet that works for everyone. Many patients do best by eating a balanced diet, staying well hydrated, keeping a food diary to identify personal triggers, and working with their care team or dietitian if eating becomes difficult during flares. - Symptomatic Medication Therapy
Medicines may be used to help control symptoms such as diarrhoea or pain, but they should be used carefully. For example, anti-diarrhoea medicines should only be used with medical advice, especially if there is fever or bloody diarrhoea, and NSAIDs such as ibuprofen can worsen symptoms in some people with IBD. - Anti-inflammatory Medication Therapy
Anti-inflammatory treatment commonly includes 5-ASAs (aminosalicylates) for mild to moderate disease, corticosteroids for flare control, and for some patients immunosuppressants, biologics, or newer targeted medicines. The exact treatment depends on how severe the disease is and how much of the colon is affected. - Surgery
Surgery may be recommended if symptoms do not improve with medicines, if severe complications occur, or if the disease is difficult to control safely over time. Surgery for ulcerative colitis usually involves removing the colon and rectum
What is a Flare?
A flare is a period when ulcerative colitis symptoms return or get worse after a period of remission. Common flare symptoms include more frequent or urgent bowel movements, diarrhoea, bleeding, abdominal pain, and sometimes fatigue or weight loss.
- When to get treatment
Patients should contact their doctor promptly if they have worsening bleeding, uncontrolled diarrhoea, ongoing abdominal pain, fever, vomiting, or trouble staying hydrated. Severe symptoms can require hospital treatment. - Flare Treatment Options
Flare treatment may involve adjusting current medicines, starting or increasing 5- ASAs, using steroids, or in more serious cases using hospital-based treatment such as IV medicines and fluids. The right option depends on symptom severity and disease location. - Oral vs. Rectal Treatments
Some ulcerative colitis medicines are taken orally as tablets or capsules, while others are given rectally as suppositories, enemas, or rectal foam. Rectal treatments are especially useful when the rectum or lower colon is affected, and they are often used for mild to moderate disease. - Administering Rectal Therapies
Rectal medicines are placed into the rectum. Depending on the product, patients are usually advised to go to the toilet first, follow the product instructions carefully, and in the case of some enemas, use them at bedtime for comfort and retention. - Is it important to treat a flare early or is it ok to wait a bit?
It is generally better not to wait if symptoms are clearly worsening. Early contact with your GI team can help adjust treatment sooner, and severe flares can lead to dehydration, heavy bleeding, or other serious complications if not managed properly.
Outlook
Ulcerative colitis is usually a lifelong condition, but many people do well with the right treatment and follow-up. The goal is to control inflammation, reduce flares, and maintain remission for as long as possible.