Ulcerative colitis Ulcerative colitis is a long-term inflammatory disorder that causes ulceration of the rectum and the colon.

In this article

Symptoms

Causes and risk factors

Treatment and recovery

The symptoms are intermittent, often not occurring for months or years. During mild attacks, symptoms may develop over a few days and include diarrhoea (sometimes with blood, pus and mucus), an urgent need to go to the toilet, tiredness, nausea, abdominal pain and poor appetite.

In severe attacks, the symptoms come on suddenly and may include severe diarrhoea many times a day, passing of blood and mucus, fever, abdominal pain and swelling, and weight loss.

A potentially fatal complication of ulcerative colitis is inflammation and extreme distension of the colon, called toxic megacolon, which may result in bowel perforation.

Ulcerative colitis affecting most or all of the colon for several years increases the risk of bowel cancer

Ulcerative colitis affecting most or all of the colon for several years increases the risk of bowel cancer.

People with ulcerative colitis may also have an associated inflammatory arthritis, eye disorders (episcleriitis/ uveitis) and erythema nodosum.

Its exact cause is unknown, making prevention difficult, but triggers which set off an episode include bouts of gastroenteritis or taking medication, such as non-steroidal anti-inflammatories.

Ulcerative colitis affects approximately one in 1,000 people and is more common than Crohn's disease, another inflammatory bowel disease. It most often occurs in Caucasians, particularly those of Jewish descent

Symptoms usually first appear between the ages of 15 and 35, but can appear later in life. It can also run in families and is more common in non-smokers and ex-smokers

Treatments include dietary advice and medication such as steroids and aminosalicylate anti-inflammatory drugs such as mesalazine to control an attack, stop diarrhoea and reduce inflammation. Immune suppressants are then used to prevent further attacks.

Leukapheresis, a blood treatment which removes some of the white cells which may be responsible for the inflammation, has now been approved by NICE for ulcerative colitis.

Routine inspection of the bowel, by colonoscopy, every two to three years is used to detect bowel cancer.

Probiotics may have a potential use in the future.

Surgery may be needed to remove severely diseased parts of bowel, if there is perforation or if cancer has developed. A quarter of people with long term ulcerative colitis will eventually need to have the colon removed.

This article was last medically reviewed by Dr Gill Jenkins in April 2009.