Digestive Health

Understand ulcerative colitis and gain control of your gut

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Understand ulcerative colitis symptoms and change your gut health so you can feel better.


By Scott Estabrook, MD, Medical Director, Gastroenterology, Nuvance Health

The importance of gut health has proven to be a critical topic over the past few years. A healthy gut helps control your weight, keeps your blood sugar and fats in check and calms down inflammation in your body. Gut health can also impact how you feel and might even affect how you think and remember things. 


When your gut isn’t feeling great, you may notice changes in your stool and how often you need to use the bathroom. Although irregular bowel movements are common, anyone who has had a case of diarrhea knows just how uncomfortable the feeling can be. But when is diarrhea a problem and what should you do about it?


A short-term case of diarrhea usually goes away after a day or two and may be the result of a virus or bacterial infection.


Diarrhea can become a problem when you experience frequent bouts with it. Having diarrhea frequently over the period of several weeks, especially diarrhea with blood, could mean you’re experiencing a serious chronic issue such as inflammatory bowel disease or ulcerative colitis.


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What is inflammatory bowel disease or IBD?

Inflammatory bowel disease or (IBD) is the chronic inflammation of the gastrointestinal tract and is a broad term used to describe two conditions; both ulcerative colitis and Crohn’s disease. Longer periods of inflammation could indicate a more chronic condition such as ulcerative colitis.


Ulcerative colitis can develop at any age, but most commonly occurs in people between 15 and 30. Ulcerative colitis happens when the immune system attacks the digestive tract, but its exact cause is unknown. Ulcerative colitis occurs only in your large intestine when ulcers form continuously on the inner walls of your gut and up through your colon.


Ulcerative colitis is a chronic disease where symptoms become active and then inactive meaning the symptoms could go away for months or even years, but then suddenly reappear out of nowhere. Although there is no cure for ulcerative colitis, it can be managed with medicine, lifestyle changes and surgery. 


Learn more about inflammatory bowel disease.


What are the symptoms of ulcerative colitis?


Ulcerative colitis symptoms vary from person to person, but the most common symptoms include:

  • Diarrhea, which changes stool consistency to be more loose or watery. Diarrhea could be accompanied by abdominal bloating. Diarrhea often comes with the feeling of having to go to the bathroom urgently, nausea, vomiting or dehydration.
  • Bloody diarrhea may be more serious if blood is present. The stool may appear to have mucus mixed in. Your diarrhea may look black-colored or tarry. Contact your doctor if you experience blood in your diarrhea. 
  • Abdominal pain is common in people who have ulcerative colitis. Contact your doctor if you are experiencing severe abdominal pain.
  • Fatigue can make you feel tired or worn down and keep you in a constant state of exhaustion. Fatigue may be compared to the feeling of missing sleep or feeling like you have the flu.
  • Tenesmus is a frequent and sudden urge to move your bowels. Despite the sensation, sometimes very little bowel movement occurs.
  • Weight loss is a symptom of ulcerative colitis because it can affect your appetite. Eating can also worsen symptoms. Eating less can lead to nutrition deficiencies.
  • Anemia is a serious symptom of ulcerative colitis that can result from chronic blood loss or nutrient deficiencies. Anemia reduces oxygen flow to the body’s organs and may cause dizziness, fatigue, shortness of breath or a fast heartbeat.
  • Extraintestinal manifestations. Ulcerative colitis is also associated with conditions that affect the joints, eyes, liver, kidney and skin. People with untreated ulcerative colitis are also at an increased risk of colon cancer.


Related content: What you need to know about colorectal cancer screenings, prevention and risk


How is ulcerative colitis diagnosed?


If you think you are experiencing symptoms, make an appointment to see your doctor. The only way to know if your symptoms are related to ulcerative colitis is to get tested.


Inflammatory bowel disease testing

Your doctor will assess how severe your IBD is and what procedures may be necessary to further evaluate your condition. Your doctor will most likely test your blood and stool first. Ulcerative colitis is ultimately diagnosed with a procedure called a colonoscopy. A long thin tube with a camera at the tip is used to check for inflammation inside the colon. 


Related content: Is someone being a pain in the butt about colonoscopy screenings? Here is what to say to them.

What to expect when you visit a gastroenterologist because of ulcerative colitis symptoms 


Expect your gastroenterologist to ask many questions and get a detailed history of your symptoms. Depending on your answers, your doctor may perform a physical exam and order additional ulcerative colitis tests, including a colonoscopy.


Learn more about colonoscopies in this video: See what it’s like to get a colonoscopy screening


You and your doctor will work together to develop a care plan that meets your concerns and needs, and most importantly, helps you feel better. Specifically trained gastrointestinal nurses will answer your questions between appointments, obtain insurance approvals and help with disability paperwork, if necessary.


How is ulcerative colitis treated?


Although there is no cure for ulcerative colitis, it can be put in remission. Many people can manage symptoms and prevent future flare-ups with medications, lifestyle changes and surgery. Living with IBD can raise your risk for other health issues, including common illnesses, like the flu and certain cancers. Your gastroenterologist will recommend the proper vaccines and screening tests that are right for your needs, which often include a screening colonoscopy for colorectal cancer.


Ulcerative colitis treatment options


Your gastroenterologist may suggest medications to reduce inflammation in your bowel, such as 5-ASA agents, corticosteroids or biologic agents. Surgery may also be an option for you.


Some ulcerative colitis treatments might need different medicines. Your doctor may suggest medicine to help with inflammation, and other medicine to calm down your immune system if it is too active. You get some of these medicines through a tube in your vein, which delivers a lot of medicine at once. You can get these treatments at special places called infusion centers.


5-ASA agents for ulcerative colitis


5-ASA agents are also known as mesalamine. They are anti-inflammatory and work in the lining of the colon. They come in a variety of oral and rectal forms.


Corticosteroids for ulcerative colitis


Corticosteroids are medicines that copy the effects of certain hormones. These hormones do important jobs in your body, like controlling inflammation, fighting off sickness, managing how you use energy, and balancing salt and water. People often take corticosteroids to treat inflammation caused by IBD. These medicines work by calming down your immune system’s response to inflammation. These agents also come in oral and rectal forms.


Biologic agents for ulcerative colitis


Current therapy for more severe cases of ulcerative colitis includes newer biological agents. These agents target different triggers of inflammation involving the colon. The choice of these agents depends on a variety of individual factors and are part of a treatment plan between you and your doctor.


Lifestyle changes to help treat ulcerative colitis


At Nuvance Health, your gastroenterology team includes doctors specializing in the unique nutritional needs of people with IBD. They provide diet recommendations that can minimize flares, such as lean meat, fish, poultry, healthy fats, and nutrient dense fruit and vegetables.


Related content: Exercise and nutrition facts about colorectal cancer risk


Surgery for ulcerative colitis


In severe cases, surgery may be necessary to remove diseased tissue and repair the colon. Nowadays, surgeons frequently use minimally invasive techniques that use smaller incisions and preserve healthy tissue.


Surgery for ulcerative colitis may help you improve your quality of life. In some cases, surgery can be lifesaving. For ulcerative colitis, surgeons offer the J-pouch surgery, which restores bowel function, avoiding the need for a permanent ostomy (waste collection pouch outside the body).


The bottom line: Ulcerative colitis is an inflammatory bowel disease that occurs in your large intestine when ulcers form continuously on the inner walls of your gut and up through your colon. Ulcerative colitis symptoms that are common in most people include diarrhea, bloody diarrhea and abdominal pain. Ulcerative colitis may be treated in a variety of ways such as with inflammation reducing medicines or surgery. Certain changes to your diet such as consuming lean meat, fish, poultry, healthy fats, and nutrient dense fruit and vegetables can also help manage ulcerative colitis symptoms.


Learn more about ulcerative colitis at the Nuvance Health Digestive Health Institute. Our digestive health doctors use research-based methods and a compassionate approach to diagnose, treat, and manage a broad range of conditions. Understand inflammatory bowel disease so you can recognize the symptoms of ulcerative colitis, how it’s diagnosed, and what treatment options are available to you.