What is ulcerative
Ulcerative colitis is a disease that causes inflammation (pain, sores
and swelling) in the inside lining of the colon (large intestine) or
rectum. This causes urgent and bloody diarrhoea, and tiredness. The
effects of the disease vary depending on how much of the colon is
affected, and symptoms change over time with periods called flare-ups in
between symptom-free periods called remission. (For an illustration and
details on the different types of ulcerative colitis and the areas they
affect, see the previous section,
Digestive System and IBD)
Ulcerative colitis can be difficult to diagnose because its symptoms are
similar to other intestinal disorders and to another type of
Inflammatory Bowel Disease (IBD) called Crohn's disease. Crohn's disease
differs from ulcerative colitis because it causes inflammation deeper
within the intestinal wall and can occur in other parts of the digestive
system, including the small intestine, mouth, oesophagus and stomach.
What are the symptoms?
most common symptoms of ulcerative colitis are abdominal pain and
bloody diarrhoea. Other symptoms include loss of appetite, weight
loss, fever, tiredness, joint pain, anaemia (low levels of red blood
cells in the blood, causing dizziness, faintness or tiredness), or
loss of body fluids and nutrients.
How is ulcerative
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Many different tests are used to diagnose ulcerative colitis. A
physical examination and medical history
are usually the first step. Blood tests may also be done to check
for anaemia, which could suggest bleeding in the colon or rectum, or
they may uncover a high white blood cell count, which is a sign of
inflammation somewhere in the body.
A stool sample can also reveal white
blood cells, which might be an indication of ulcerative colitis or
inflammatory disease. A stool sample also allows the doctor to
detect bleeding or infection in the colon or rectum caused by
bacteria, a virus or parasites. Ruling out these causes can be
useful in diagnosing ulcerative colitis.
A colonoscopy or sigmoidoscopy is the
most commonly used method for making a diagnosis of ulcerative
colitis and ruling out other possible conditions, such as Crohn's
disease, diverticular disease or cancer. For both tests, the doctor
inserts an endoscope - a long, flexible, lighted tube connected to a
computer and TV monitor - into the anus to see the inside of the
colon and rectum. The doctor will be able to see any inflammation,
bleeding or ulcers on the colon wall. During the exam, the doctor
may do a biopsy, which involves taking a sample of tissue from the
lining of the colon to view with a microscope.
Before the examination, you will need to drink a special preparation
which will make you go to the toilet often. This is to clear the
digestive system, so the camera can move about, and clearly see the
walls of the bowel. Although the examination may be uncomfortable,
it shouldn't be painful. Your doctor can discuss options for pain
relief with you. If a biopsy is taken, usually this doesn't cause
Sometimes X-rays such as a barium enema
are also used to diagnose ulcerative colitis. A specially prepared
enema containing barium is taken before the test. Barium coats the
lining of the gut and shows up as white on X-ray films. The patterns
on the films show the doctor which parts of the gut are affected by
CT and MRI
scans can also be used to obtain detailed pictures of the digestive
system, to help to identify any problems. In about 10% of people
with IBD, it is difficult to determine whether they have ulcerative
colitis or Crohn's disease, due to similar or overlapping symptoms.
parts of the body be affected also?
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Other parts of the body may also be affected in some people with
ulcerative colitis, such as the joints, eyes or liver. Some of these
problems go away when the ulcerative colitis is treated, but some
need specific treatment as well.
Who gets ulcerative colitis?
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About 1.2 million people in Europe have ulcerative colitis. That is
about 1 in 1,500 people. It can develop at any age, but most
commonly starts between the ages of 15 and 40. Slightly more men
than women are affected.
What causes ulcerative
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The cause of ulcerative colitis is not yet known, although a
combination of factors are believed to play a role, including
viruses, bacteria, genetics and smoking. It does tend to run in
families. One theory is that a bacteria or virus may trigger the
immune system to cause inflammation in parts of the digestive system
in people who are genetically prone to develop the disease.
How does ulcerative
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Ulcerative colitis is a chronic (ongoing) disease, with times when
symptoms flare up (relapse) and times when there are few or no
symptoms (remission). The severity of symptoms, and how often they
occur, varies from one person to the next. About half of people with
ulcerative colitis have mild symptoms. A few people have frequent
and/or severe flare ups. Usually, however, with treatment and
medical care, symptoms can be managed well and it still possible to
follow your ambitions and live life to the full.
Should cancer be a concern?
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People with ulcerative colitis have a small increased risk of colon
cancer compared to the risk of the general population. The risk of
cancer is different depending on how long the person has had the
disease and how much of the colon is affected. Your doctor will look
for signs of abnormal cells when doing a colonoscopy, sigmoidoscopy
or biopsy. If you are concerned about your risk, speak with your
Will I need surgery?
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Most people with mild or moderate disease are able to manage their
symptoms with medication. However, surgery may be needed in people
with more severe disease if, for example, there is a complication.
After surgery, however, people with ulcerative colitis can usually
expect a good quality of life.
Choosing which surgery to have depends on the severity of the
disease and your needs, expectations and lifestyle. Not every
operation is appropriate for every person. Your doctor will discuss
the options with you, including which surgery is right for you and
the best time to have it. If you are faced with this decision, get
as much information as possible by talking to your doctors, to
nurses who work with colon surgery patients and to other ulcerative
colitis surgery patients. Patient support groups can also direct you
to other helpful resources and give you the opportunity to meet with
other people who are considering similar options, or who have had
similar experiences in the past.
For tips on talking to your doctor about your concerns, see
Your IBD Consultation.
For more information on treatment and surgery for ulcerative
colitis, please see,
Treatment Plan for ulcerative colitis.
What can I do to
help manage my illness?
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Your role in managing your illness is very important. Here are some
of the most important things you can do to stay in control of
Be involved in the proactive management of your own health every
Know when and how to take care of your general health
Follow your management plan and take your medication
Ask questions if you are concerned, and seek help if a problem
arises in between doctor visits. It is important that you follow
your treatment plan and know what to do should a problem arise.
If you have any of these problems, contact your doctor as soon
Blood in your stool
Change in bowel habits that last for more than 10 days
Severe abdominal cramps or pain
Severe diarrhoea or bloody diarrhoea
Weight loss with no known reason
Unexplained fever lasting more than 3-4 days
Loss of appetite
Nausea or vomiting for unknown reasons
everyone will have these problems; in mild disease, it is less likely
that other parts of the body will be affected.
Here are a few examples of possible 'extraintestinal manifestations' of
Peripheral arthropathy or arthritis - mainly soreness in the large
and medium-size joints during a flare. The spine and lower back may
be affected as well. Sometimes the arthritis can flare up even when
the inflammatory disease is under control. Typical treatment may
include analgesics (for pain relief).
Pyoderma gangrenosum - ulcers (open sores) over the lower part of
the legs. This is more common in ulcerative colitis than in Crohn's
disease, and usually improves with treatment for the inflammatory
disease. Treatment may include corticosteroids, immunosuppressants
Primary sclerosing cholangitis (PSC) - inflammation of the bile
ducts, which can lead to liver disease.
Episcleritis - a painless inflammation of the white part of the eye
and surrounding tissue, often mistaken for pink eye. Treatment may
include chilled artificial tears, corticosteroid eye drops or
Uveitis - inflammation of the iris (coloured part of the eye), which
can be very painful and can be associated with visual changes and
sensitivity to light. If untreated, uveitis can progress to
blindness, so it is important to treat this condition if it
develops. Treatment may include eye drops (steroids or pupil
dilators) to help reduce the inflammation and pain.
possible complications of ulcerative colitis will vary depending on the
extent of inflammation in the rectum and the colon. Not everyone will
have these problems, but here are a few examples of what could happen,
usually in more severe cases:
Abdominal distension - a sudden and severe expansion of the colon
which can lead to a condition called toxic megacolon, in which case
the colon is at risk of rupturing (when small tears or holes form).
Surgery may be needed to prevent rupture of the bowel.
Perforation - A small hole that forms in the wall of the gut. The
contents of the gut can leak out and cause infection or an abscess
inside the abdomen. This can be serious and life-threatening.
Severe bleeding - this can become quite serious and require
treatment on its own.
do need to have surgery, rest assured that you are not alone: about 25
to 40 percent of people with ulcerative colitis will eventually need to
have surgery. Sometimes the doctor will suggest removing the colon if
medical treatment fails, or if the side effects of medication are
causing problems. After surgery, however, most people with ulcerative
colitis can usually expect a good quality of life.
have severe disease, learn to listen to your body and if you think
something may be wrong, it is best to take action and check with your
doctor. If something is wrong, you will catch it early. If nothing is
seriously wrong, at least you will be reassured.
In severe cases
severe ulcerative colitis there may be inflammation and pain in the
joints (arthritis); inflammation of the eye (uveitis); liver disease; or
bone mineral density loss (osteoporosis) Doctors call these