Ulcerative colitis

What is ulcerative colitis?

Ulcerative colitis is a chronic inflammatory bowel disease (IBD) that causes inflammation and ulceration of the inner lining of the large intestine (colon and rectum). The ulcers can bleed and produce mucus or pus, leading to discomfort and digestive issues.

If only the rectum is affected, the condition is known as proctitis.

Who is affected?

One in 500 people in the UK are affected by ulcerative colitis

Between 6,000 and 12,000 new cases are diagnosed each year

Men and women are equally affected

It is more common in white Europeans and less common in Asian populations

What causes ulcerative colitis?

The exact cause is unknown, but it is believed to be due to an abnormal immune response that leads to inflammation in the gut. Other contributing factors include:

Genetics – A family history increases the risk

Environmental factors – Diet and lifestyle may play a role

Symptoms of ulcerative colitis

Symptoms vary depending on the extent and severity of inflammation.

Common symptoms

Frequent loose stools (diarrhoea)

Rectal bleeding

Mucus in the stools

Constant urge to pass stools (tenesmus)

Abdominal pain and cramping

Unexplained weight loss

Fatigue and low energy

Dehydration in severe cases

Less common symptoms

Skin rashes

Eye inflammation and irritation

Joint pain and swelling

Ulcerative colitis is a long-term condition where symptoms may go into remission for long periods before flare-ups occur.

How is ulcerative colitis diagnosed?

A specialist consultation and tests are required to confirm the diagnosis, assess the extent of inflammation, and rule out other conditions.

Diagnostic tests include:

Blood tests – To check for anaemia and inflammation markers

Stool tests – To rule out infections that could mimic IBD

Rigid sigmoidoscopy – A quick examination of the rectum in the clinic

Flexible sigmoidoscopy – Examines the lower bowel for inflammation and allows biopsies to be taken

Colonoscopy – A detailed examination of the entire colon, often used to assess disease severity and take biopsies

MRI or CT scans – Used in specific cases to assess complications

Treatment for ulcerative colitis

Treatment aims to reduce inflammation, relieve symptoms, and prevent complications.

Medical treatments include:

5-ASA drugs – Anti-inflammatory medications for mild to moderate cases

Steroids – Used for short-term flare-ups

Immunosuppressants (e.g., azathioprine) – Help control inflammation by modifying the immune system

Biologic therapies (anti-TNF drugs like infliximab) – Target specific immune pathways to control inflammation

Topical treatments (suppositories and enemas) – Used when inflammation is limited to the rectum or lower bowel

Intravenous therapy – Some medications may be given via a drip in hospital for severe flare-ups

Surgical treatment for ulcerative colitis

Surgery is recommended when:

Medical treatment is ineffective

There are severe complications such as bowel perforation

There is a high risk of colorectal cancer

Surgical procedures include:

Pan-proctocolectomy – Removal of the colon and rectum, which cures ulcerative colitis

Ileostomy – Some patients opt for a permanent stoma (external bag for waste)

Ileal pouch surgery (J-pouch) – A pouch made from the small intestine is created to store stool, allowing normal bowel control

Most ulcerative colitis surgeries, including ileal pouch procedures, can be performed using minimally invasive (keyhole) techniques for faster recovery.