Ulcerative Colitis

Ulcerative colitis is a chronic condition where the colon and the rectum become inflamed. It leads to the formation of ulcers which can leak mucus and bleed when they are irritated.

  1. Symptoms include diarrhoea, rectal bleeding and abdominal pain
  2. Treatment varies depending on severity
  3. Cause is unknown, but thought to be an autoimmune condition

If you have symptoms of ulcerative colitis and would like to discuss them with a doctor, or have been diagnosed with the condition and need to speak to a healthcare professional online, our video consultation can help.

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What is ulcerative colitis?

Ulcerative colitis (UC) is a type of inflammatory bowel disease that affects the large intestine, including the colon and rectum. It causes ulcers to form on the surface of the large intestine. Unlike in Crohn’s disease, the inflammation associated with UC is limited to the large bowel, and does not occur in the small bowel as well. It is a chronic condition that's often characterised by its intermittency, meaning that relapses can often occur.

What causes ulcerative colitis?

Ulcerative colitis is considered an autoimmune disease (more specifically, the immune system attacking the bowel), although it is possible that environmental factors may have an impact, as well as genetics. It is not fully understood what the exact nature of the disease is, but around 20% of people in the US have a blood relative who has an inflammatory bowel disease (IBD).

Of the two main forms of IBD (Crohn’s being the other), ulcerative colitis is the more common in the UK. The diagnosis rate is around 10 per 100,000 each year, and in general there are 240 people thought to be living with ulcerative colitis per 100,000 (so in total there is likely to be in excess of 100,000 people with the condition in the UK). The age demographic for which the disease is most commonly diagnosed is between 15 and 25, and the second most common age range is 55-65.

Someone’s quality of life in the home, work or educational setting can be affected by the condition. 

Can ulcerative colitis lead to complications?

UC can in some cases lead to further health issues. Colorectal cancer is one possible complication. The risk of developing it increases exponentially with age, to the point where after 30 years with ulcerative colitis, the risk is around 18%. According to NICE guidelines, colorectal cancer accounts for around 33% of all deaths related to ulcerative colitis. Prolonged use of steroid treatment in UC can also result in the development of osteoporosis in some.

What symptoms does ulcerative colitis cause?

The condition causes rectal bleeding, a mucus discharge from the rectum and a frequent need to pass stools. Severity of symptoms can vary significantly. Definitions vary, but symptoms may be considered mild if someone is having around 4 loose stools a day with some abdominal pain, moderate if someone is having between 4-6 loose stools (which may be bloody with more prominent abdominal pain) and severe if someone is having more than 6 bloody stools accompanied with a fever. A very severe case would entail passing more than 10 bloody stools, with abdominal pain and a high fever.

Generally, you should see a doctor if you haven’t been diagnosed with IBD and are going to the toilet more than four or five times per day, or are passing any blood or mucus. If you’re going more than eight times a day and passing blood or mucus, you should seek medical advice urgently. 

It is also possible to have inflammation outside of the large intestine, which usually manifests in the eyes, skin or joints.

If you have symptoms of ulcerative colitis and would like to speak to a doctor online, you can consult one of our UK prescribers using our confidential video service. Book an appointment at a time that suits you. Our doctors can renew your prescription for ulcerative colitis treatment if you have one, or issue advice if you are developing symptoms for the first time. 

Page last reviewed:  12/06/2020
Diagnosis and treatment

How is ulcerative colitis diagnosed?

Ulcerative colitis can be confused with other conditions such as Crohn’s, and less frequently, irritable bowel syndrome, because of the similar symptoms that it presents (unpredictable bowel movements and abdominal pain). 

Therefore, if a doctor suspects ulcerative colitis because of symptoms, such as persistent bloody diarrhoea, abdominal pain and a frequent faecal urge, there are several tests that they will need to perform.

Will I need tests?

To confirm a diagnosis of ulcerative colitis, tests are required. A blood test can look for a higher concentration of C-reactive protein (CRP) which would suggest inflammation. A stool test can examine the level of calciprotein, which is also an indicator of inflammation, and a sigmoidoscopy can inspect the lining of the rectum. In some cases, a colonoscopy (which inspects the full length of the bowel) may be recommended.

Ultrasound, MRI and CT scans may also be used to produce an image of the inside of the bowel.

What will a doctor normally advise?

If a doctor suspects that you have ulcerative colitis, you will most likely be referred to a consultant gastroenterologist for a diagnosis. It is very important to follow the treatment plan that you are given by them, as this decreases the possibility of flare-ups and increases the likelihood of remission.

Even though there is no specific diet that will prevent flare-ups, it helps to get the right nutrition and avoid a few items which may exacerbate symptoms, such as spicy food, foods high in fibre, and caffeine. However, it’s important to note that certain foods may impact differently on an individual basis.

You’ll need to see your specialist consultant on a regular basis (normally once a year at the very least), so that they can monitor your treatment and keep an eye on your disease. 

What treatments are there for ulcerative colitis?

There are various types of treatments that can be used to treat ulcerative colitis, depending on the severity of the condition. 

There are four main categories of treatments: corticosteroids, such as prednisolone, (used to suppress inflammation), aminosalicylates or 5-ASAs, such as Pentasa  (which decrease inflammation in the lining of the intestines), immune modifiers (which suppress the immune response of the body) and biologics (a newer type of therapy also used in immune suppression).

If these treatments aren’t effective, surgery for ulcerative colitis may be an option.

Page last reviewed:  12/06/2020
Questions and Answers

How is ulcerative colitis treated?

There are a variety of treatment options that can help you to manage the symptoms, depending on how severe the condition is. Common triggers for ulcerative colitis flare-ups can revolve around dietary choices and also environmental factors such as stress, so it is important to isolate what impacts your symptoms. 

What treatments are there?

Most of the treatments available for ulcerative colitis work by suppressing the immune system. There are four categories of medication that can be used to increase the remission period. 

Oral corticosteroids are often used to control a flare-up when it occurs. 5-ASAs can reduce the inflammation in the bowel once the steroids have settled the initial symptoms. Treatments such as Azathioprine and Mercaptopurine can help to reduce the activity of the immune system, and maintain remission. Biologic treatments such as adalimumab or infliximab can be given to more severe cases of ulcerative colitis and block the activity of the TNF alpha protein, which again reduces inflammation.

If the body responds poorly to any of these treatments over a sustained period, a doctor may recommend surgery. This typically involves removing some or all of the colon.

Can I consult a doctor about ulcerative colitis online?

Yes. Our UK doctors are available to consult about ulcerative colitis through our online video consultation service. You will be able to speak to them about renewing a prescription for existing treatment, or what to do if you think you may be experiencing symptoms of ulcerative colitis for the first time. 

Page last reviewed:  12/06/2020

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