Ulcerative colitis is a chronic autoimmune disease that affects the large intestine and rectum. Ulcerative colitis is a form of inflammatory bowel disease (IBD). Although it can begin at any age, it often starts in young adulthood, most commonly appearing in people between the ages of 15 to 30. Ulcerative colitis is characterized by ulcers (sores) in the large intestine, which includes the colon and rectum (anus).

There is no cure for ulcerative colitis. If you are diagnosed with ulcerative colitis, you will likely have periods of flare-ups, when your symptoms are worse. You will likely also have periods of remission, when your symptoms are reduced or gone and don’t interfere with your daily life. With treatment, most patients can be symptom-free for long periods of time, ranging from several weeks to several years.

Left untreated, patients may need to be hospitalized for severe flare-ups and are at risk for developing complications of ulcerative colitis, which may include:

• Severe bleeding
• Perforation (holes) in the colon
• Severe dehydration
• Anemia, a blood disorder where you don’t have enough red blood cells to carry oxygen throughout your body
• Osteoporosis, or loss of bone density
• Colorectal cancer. Your risk of developing colorectal cancer increases the longer you’ve had untreated ulcerative colitis.
• Toxic megacolon, a rare complication of ulcerative colitis where so much inflammation causes your colon to stop working

Ulcerative Colitis vs. Crohn's Disease

Ulcerative colitis and Crohn's disease are not the same. They are two types of inflammatory bowel disease that cause similar symptoms, but ulcerative colitis impacts only the large intestine, whereas Crohn's disease impacts the entire digestive tract, often presenting in the small intestine. People with Crohn's disease may have healthy areas of their digestive tract between inflamed areas. People with ulcerative colitis have continuous inflammation along their large intestine.

Symptoms unique to Crohn's disease include:

• Mouth sores
• Anal ulcers, tears or fistulas, which are openings that can lead to infections
• Blockages due to strictures, or scar tissue that builds up over time from repeated and ongoing inflammation

How is ulcerative colitis diagnosed?

Ulcerative colitis is typically diagnosed through a colonoscopy with a biopsy, where a physician uses a flexible tube with a camera to look at your large intestine and colon and takes a sample of your tissue to test for the disease. Other tests, like blood tests and stool samples, may help your care team rule out other diagnoses, but can’t definitively diagnose ulcerative colitis alone. If you think that you may have ulcerative colitis or a related issue, talk to your primary care team for the next steps.

What are common ulcerative colitis risk factors?

• Early life exposure to antibiotics.
• Regularly eating ultra-processed foods.
• Race and ethnicity. White people, especially of Ashkenazi Jewish descent, are at greater risk of developing ulcerative colitis.
• Family history. Having a first degree (parent or sibling) relative with ulcerative colitis increases your risk of developing it.

Treatment options for ulcerative colitis include:

• Using medication to reduce pain and inflammation, control immune system response or fight infection. Acetaminophen (Tylenol) is typically recommended to manage daily pain associated with ulcerative colitis because it doesn’t impact the lining of the digestive tract. Other over-the-counter painkillers like aspirin and non-steroidal anti-inflammatory drugs (NSAIDs), which include ibuprofen and naproxen, irritate the lining of the digestive tract and can cause ulcers, making symptoms of ulcerative colitis worse.
• Monitoring diet. There is no singular diet to manage symptoms of ulcerative colitis. You may opt to work with a dietitian to help determine which foods may trigger your symptoms. Sometimes people with ulcerative colitis benefit from eating smaller, more frequent meals as well. It’s also important to drink plenty of water to stay hydrated.
• Managing stress through exercise, lifestyle changes and relaxation practices.
• Biologic medications, which target specific parts of the immune system to keep inflammation under control.
• Undergoing surgery to remove all or part of the colon and rectum that have been severely damaged.
• Hyperbaric oxygen therapy is an emerging therapy for ulcerative colitis that involves delivering pressurized oxygen to the tissues of the large intestine and colon to help heal them. Watch a video on hyperbaric oxygen therapy.

Your care team will help come up with a treatment plan unique to your needs.

Learn more about ulcerative colitis.