Ulcerative Colitis

 National Digestive Diseases Information Clearinghouse 

U.S. Department 

of Health and 

Human Services 

NATIONAL 

INSTITUTES 

OF HEALTH 

What is ulcerative colitis? 

Ulcerative colitis is a disease that causes 

inflammation and sores, called ulcers, in 

the lining of the rectum and colon. Ulcers 

form where inflammation has killed the 

cells that usually line the colon, then 

bleed and produce pus. Inflammation in 

the colon also causes the colon to empty 

frequently, causing diarrhea. 

When the inflammation occurs in the rectum and lower part of the colon it is called 

ulcerative proctitis. If the entire colon is 

affected it is called pancolitis. If only the 

left side of the colon is affected it is called 

limited or distal colitis. 

Ulcerative colitis is an inflammatory 

bowel disease (IBD), the general name 

for diseases that cause inflammation in 

the small intestine and colon. It can be 

difficult to diagnose because its symptoms 

are similar to other intestinal disorders 

and to another type of IBD called Crohn’s 

disease. Crohn’s disease differs because 

it causes inflammation deeper within the 

intestinal wall and can occur in other parts 

of the digestive system including the small 

intestine, mouth, esophagus, and stomach. 

Ulcerative colitis can occur in people of 

any age, but it usually starts between the 

ages of 15 and 30, and less frequently 

between 50 and 70 years of age. It affects 

men and women equally and appears to run 

in families, with reports of up to 20 percent 

of people with ulcerative colitis having a 

family member or relative with ulcerative 

Stomach 

Large intestine 

(colon) 

Small 

intestine 

Rectum 

Anus Sigmoid colon 

colitis or Crohn’s disease. A higher incidence of ulcerative colitis is seen in Caucasians and people of Jewish descent. 

What are the symptoms of 

ulcerative colitis? 

The most common symptoms of ulcerative 

colitis are abdominal pain and bloody diarrhea. Patients also may experience 

•	 anemia

•	 fatigue

•	 weight loss

•	 loss of appetite

•	 rectal bleeding
 

	 	 	 	 	 	

	 	 	 	

 

 

 

 

 

 

 

 

 

 

•	 loss of body fluids and nutrients

•	 skin lesions

•	 joint pain

•	 growth failure (specifically in children)

About half of the people diagnosed with 

ulcerative colitis have mild symptoms. 

Others suffer frequent fevers, bloody 

diarrhea, nausea, and severe abdominal 

cramps. Ulcerative colitis may also cause 

problems such as arthritis, inflammation 

of the eye, liver disease, and osteoporosis. 

It is not known why these problems occur 

outside the colon. Scientists think these 

complications may be the result of inflammation triggered by the immune system. 

Some of these problems go away when 

the colitis is treated. 

What causes ulcerative 

colitis? 

Many theories exist about what causes 

ulcerative colitis. People with ulcerative 

colitis have abnormalities of the immune 

system, but doctors do not know whether 

these abnormalities are a cause or a result 

of the disease. The body’s immune system 

is believed to react abnormally to the bacteria in the digestive tract. 

Ulcerative colitis is not caused by emotional distress or sensitivity to certain foods or 

food products, but these factors may trigger 

symptoms in some people. The stress of 

living with ulcerative colitis may also contribute to a worsening of symptoms. 

How is ulcerative colitis 

diagnosed? 

Many tests are used to diagnose ulcerative colitis. A physical exam and medical 

history are usually the first step. 

Blood tests may be done to check for 

anemia, which could indicate 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, whose presence indicates ulcerative 

colitis or inflammatory disease. In addition, a stool sample allows the doctor to 

detect bleeding or infection in the colon 

or rectum caused by bacteria, a virus, or 

parasites. 

A colonoscopy or sigmoidoscopy are the 

most accurate methods 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. 

Sometimes x rays such as a barium enema 

or CT scans are also used to diagnose ulcerative colitis or its complications. 

2 Ulcerative Colitis 
 

	 	 	 	 	

 

What is the treatment for 

ulcerative colitis? 

Treatment for ulcerative colitis depends 

on the severity of the disease. Each person 

experiences ulcerative colitis differently, so 

treatment is adjusted for each individual.

Drug Therapy 

The goal of drug therapy is to induce and 

maintain remission, and to improve the 

quality of life for people with ulcerative 

colitis. Several types of drugs are available. 

•	 Aminosalicylates, drugs that contain 

5-aminosalicyclic acid (5-ASA), help 

control inflammation. Sulfasalazine 

is a combination of sulfapyridine and 

5-ASA. The sulfapyridine component 

carries the anti-inflammatory 5-ASA 

to the intestine. However, sulfapyridine may lead to side effects such as 

nausea, vomiting, heartburn, diarrhea, 

and headache. Other 5-ASA agents, 

such as olsalazine, mesalamine, and 

balsalazide, have a different carrier, 

fewer side effects, and may be used by 

people who cannot take sulfasalazine. 

5-ASAs are given orally, through an 

enema, or in a suppository, depending 

on the location of the inflammation in 

the colon. Most people with mild or 

moderate ulcerative colitis are treated 

with this group of drugs first. This 

class of drugs is also used in cases of 

relapse. 

•	 Corticosteroids, such as prednisone, 

methylprednisone, and hydrocortisone also reduce inflammation. They 

may be used by people who have 

moderate to severe ulcerative colitis or who do not respond to 5-ASA 

drugs. Corticosteroids, also known 

as steroids, can be given orally, intravenously, through an enema, or in a 

suppository, depending on the location 

of the inflammation. These drugs can 

cause side effects such as weight gain, 

acne, facial hair, hypertension, diabetes, mood swings, bone mass loss, and 

an increased risk of infection. For this 

reason, they are not recommended for 

long-term use, although they are considered very effective when prescribed 

for short-term use. 

•	 Immunomodulators such as azathioprine and 6-mercapto-purine (6-MP) 

reduce inflammation by affecting the 

immune system. These drugs are used 

for patients who have not responded 

to 5-ASAs or corticosteroids or who 

are dependent on corticosteroids. 

Immunomodulators are administered 

orally, however, they are slow-acting 

and it may take up to 6 months before 

the full benefit. Patients taking these 

drugs are monitored for complications including pancreatitis, hepatitis, 

a reduced white blood cell count, 

and an increased risk of infection. 

Cyclosporine A may be used with 

6-MP or azathioprine to treat active, 

severe ulcerative colitis in people 

who do not respond to intravenous 

corticosteroids. 

Other drugs may be given to relax the 

patient or to relieve pain, diarrhea, or 

infection. 

Some people have remissions—periods 

when the symptoms go away—that last 

for months or even years. However, most 

patients’ symptoms eventually return. 

3	 Ulcerative Colitis 
4 Ulcerative Colitis

Hospitalization

Occasionally, symptoms are severe enough 

that a person must be hospitalized. For 

example, a person may have severe bleeding or severe diarrhea that causes dehydration. In such cases the doctor will try 

to stop diarrhea and loss of blood, fluids, 

and mineral salts. The patient may need a 

special diet, feeding through a vein, medications, or sometimes surgery.

Surgery

About 25 to 40 percent of ulcerative colitis 

patients must eventually have their colons 

removed because of massive bleeding, 

severe illness, rupture of the colon, or 

risk of cancer. Sometimes the doctor will 

recommend removing the colon if medical treatment fails or if the side effects of 

 corticosteroids or other drugs threaten 

the patient’s health.

Surgery to remove the colon and rectum, 

known as proctocolectomy, is followed by 

one of the following:

• Ileostomy, in which the surgeon creates a small opening in the abdomen, 

called a stoma, and attaches the end of 

the small intestine, called the ileum, to 

it. Waste will travel through the small 

intestine and exit the body through the 

stoma. The stoma is about the size of 

a quarter and is usually located in the 

lower right part of the abdomen near 

the beltline. A pouch is worn over 

the opening to collect waste, and the 

patient empties the pouch as needed.

• Ileoanal anastomosis, or pull-through 

operation, which allows the patient 

to have normal bowel movements 

because it preserves part of the anus. 

In this operation, the surgeon removes 

the colon and the inside of the rectum, 

leaving the outer muscles of the rectum. The surgeon then attaches the 

ileum to the inside of the rectum and 

the anus, creating a pouch. Waste 

is stored in the pouch and passes 

through the anus in the usual manner. Bowel movements may be more 

 frequent and watery than before the 

procedure. Inflammation of the pouch 

(pouchitis) is a possible complication.

Not every operation is appropriate for 

every person. Which surgery to have 

depends on the severity of the disease 

and the patient’s needs, expectations, and 

lifestyle. People faced with this decision 

should get as much information as possible 

by talking to their doctors, to nurses who 

work with colon surgery patients (enterostomal therapists), and to other colon 

 surgery patients. Patient advocacy organizations can direct people to support groups 

and other information resources.

Is colon cancer a concern?

About 5 percent of people with ulcerative 

colitis develop colon cancer. The risk of 

cancer increases with the duration of the 

disease and how much the colon has been 

damaged. For example, if only the lower 

colon and rectum are involved, the risk of 

cancer is no higher than normal. However, 

if the entire colon is involved, the risk of 

cancer may be as much as 32 times the 

 normal rate.

Sometimes precancerous changes occur in 

the cells lining the colon. These changes 

are called dysplasia. People who have dysplasia are more likely to develop cancer 

than those who do not. Doctors look for 

signs of dysplasia when doing a colonoscopy or sigmoidoscopy and when examining 

 tissue removed during these tests.
 

 

According to the 2002 updated guidelines 

for colon cancer screening, people who 

have had IBD throughout their colon for 

at least 8 years and those who have had 

IBD in only the left colon for 12 to 15 years 

should have a colonoscopy with biopsies 

every 1 to 2 years to check for dysplasia. 

Such screening has not been proven to 

reduce the risk of colon cancer, but it may 

help identify cancer early. These guidelines 

were produced by an independent expert 

panel and endorsed by numerous organizations, including the American Cancer 

Society, the American College of Gastroenterology, the American Society of Colon 

and Rectal Surgeons, and the Crohn’s & 

Colitis Foundation of America. 

Hope through Research 

NIDDK, through the Division of Digestive Diseases and Nutrition, conducts and 

supports research into many kinds of digestive disorders, including ulcerative colitis. 

Researchers are studying how and why the 

immune system is activated, how it damages the colon, and the processes involved 

in healing. Through this increased understanding, new and more specific therapies 

can be developed. Currently, there are 

numerous clinical trials being conducted 

that are investigating ulcerative colitis. 

Participants in clinical trials can play a more 

active role in their own health care, gain 

access to new research treatments before 

they are widely available, and help others by 

contributing to medical research. For information about current studies, visit 

www.ClinicalTrials.gov. 

For More Information 

Crohn’s & Colitis Foundation of America 

386 Park Avenue South, 17th floor 

New York, NY 10016–8804 

Phone: 1–800–932–2423 or 212–685–3440 

Fax: 212–779–4098 

Email: info@ccfa.org 

Internet: www.ccfa.org 

Reach Out for Youth With Ileitis 

and Colitis 

84 Northgate Circle 

Melville, NY 11747 

Phone: 631–293–3102 

Fax: 631–293–3103 

Email: reachoutforyouth@ 

reachoutforyouth.org 

Internet: www.reachoutforyouth.org 

United Ostomy Associations of America, Inc. 

P.O. Box 66 

Fairview, TN 37062–0066 

Phone: 1–800–826–0826 

Email: info@uoaa.org 

Internet: www.uoaa.org 

Acknowledgments 

Publications produced by the Clearinghouse 

are carefully reviewed by both NIDDK scientists and outside experts. This fact sheet 

was reviewed by the Crohn’s & Colitis Foundation of America. 

5 Ulcerative Colitis 
 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

You may also find additional information about this 

topic by visiting MedlinePlus at www.medlineplus.gov.

This publication may contain information about 

medications. When prepared, this publication 

included the most current information available. 

For updates or for questions about any medications, 

contact the U.S. Food and Drug Administration 

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visit www.fda.gov. Consult your doctor for more 

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U.S. DEPARTMENT OF HEALTH 

AND HUMAN SERVICES 

National Institutes of Health 

NIH Publication No. 06–1597 

February 2006