Ulcerative Colitis

Author, Frank W. Jackson MD
Updated 2014


The colon is also known as the large bowel. It is the last segment of the intestine just above the rectum. Ulcerative colitis is a recurrent inflammation of the colon. When the inflammation just involves the rectum, it is known as ulcerative proctitis. When it involves the entire colon, it is called pan colitis. In most cases, the inflammation is somewhere in between proctitis and pancolitis. 

What Causes the Inflammation?

Medical experts don’t know the cause of this disorder. Genetics is likely important. The body’s immune system also seems to be important as there is an overreaction of certain immune factors. There is no evidence that any specific food is a cause. Finally, there are more than a thousand different types of bacteria that normally live in the colon and provide health benefits to the colon and the body. Some experts feel that these bacteria in some way may be a factor. One bacteria makes a toxic gas called hydrogen sulfide. There is some research to implicate this gas as contributing to inflammation.

Anything Else?

Ulcerative colitis seems to be a disease of developed countries. However, in America, the incidence is falling. This disorder can strike anyone at almost any age. Commonly, it seems to occur in younger people in their 20?s and 30?s. It develops in Caucasians and Jewish-Europeans more often than African-Americans. There is also a family history of the disease with various members in a family being involved or having any one of a variety of immune type disorders. It is more common in those who live in an urban setting, developed country, and the Northern climate.

The bottom line is that there are likely multiple factors going on here. The medical experts just have not been able to figure it all out yet, which means that while the disease may wax and wane, there is no cure except to surgically remove the colon.

What Do I Feel and What Do I See?

Rectal bleeding is usually the first and often the only sign you will see. Intermittent abdominal crampy discomfort is common. So is diarrhea, especially at night. When you have had the disorder for awhile, fatigue, weakness and even fever can occur.

Most importantly, these symptoms wax and wane. Even so and especially if rectal bleeding has occurred, medical attention should always be sought immediately.


While the physician may be suspicious of ulcerative colitis just by the medical history, a colonoscopy will almost always be required to make the diagnosis. When this is done, the physician will see a characteristic pattern of minute bleeding points, each of which is a tiny ulcer. Inflammation will also be present visually and confirmed when a biopsy is taken. Blood tests are needed to evaluate the effect of the disorder on your general health. A barium x-ray exam of the colon may occasionally be indicated.

What Complications Can Occur?

It is reassuring that most people with ulcerative colitis do just fine. They respond to medication and go about their lives as before with few problems. However, there are certain more serious things that can occur.

  • An attack may be very severe and sudden, requiring hospitalization, bowel rest and intravenous medications to get the disorder under control. It can even reach a point where the colon becomes very weak and dilated. This is a surgical emergency.
  • Colon leakage or perforation – This complication is rare but serious. It results in peritonitis and requires surgery.
  • Diseases of the liver and/or bile ducts – In a small group of people with ulcerative colitis, disorders of the liver and/or inflammation of the bile ducts can occur.

Colon Cancer

This is a special consideration for everyone with ulcerative colitis. Some 8-10 years after the onset, the cells that line the colon may become increasingly disorganized and the first indications of approaching cancer may occur. This is why regular surveillance exams by colonoscopy are required to perform multiple biopsies of the colon in order to detect any such change. The frustrating thing for patients and physicians alike is that cancer can occur even when the disorder is under good control.


There is a great deal that can be done to treat ulcerative colitis. Medications fall into four main categories:

  • Prednisone, Steroids, cortisone – These drugs are often used initially when the disorder is most severe. The physician will usually reduce the dose in a gradual manner until a low maintenance dose
    is satisfactory. More often, these medications will be stopped entirely.
  • Mesalamine type anti-inflammatory drugs – These medications induce an anti-inflammatory response in the colon. They can usually be used safely long term. They are given by pill form or by enemas. The trade names include Azulfidine, Dipentum, Asacol, Pentasa, Rowasa, and Lialdia.
  • Immune suppressors – Since the immune system is clearly implicated in ulcerative colitis, certain drugs that can dampen the immune response in the body can be useful. Imuran, 6-MP, Neoral, and methotrexate belong in this group.
  • Inflammation cascade blockers – The inflammation of ulcerative colitis begins with a series of chemical changes leading finally to inflammation. Remicade is an intravenous drug that has been shown to block this domino-like cascade of factors that leads to tissue damage. This drug is usually given every 4-8 weeks, frequently for a prolonged period of time.


There are instances, fortunately not very often, where all medical treatments are ineffective. When this happens, the entire colon is surgically removed and this, in effect, cures the disease. In most instances, the surgeon will create a pouch from the small intestine and so avoid a bag on the abdominal wall. The pouch is attached to the rectum. Patients handle this type of surgery and the presence of a pouch very well.

Dietary Therapy

For the most current detailed recommendations on diet, go to Ulcerative Colitis Dietary Therapy. It is a fact that ulcerative colitis occurs in a part of the intestine where food fiber and waste end up. It is certainly reasonable to think that foods in some way or another effect the disorder. Despite a lot of research, no cause and effect has been found with any specific food. However, there is much you should know about diet.

Colon Bacteria

The colon is home to tens of trillions of bacteria. One would think that surely, somehow, there must be a role played by these bacteria. To date, however, there has been nothing specific demonstrated, although the gas, hydrogen sulfide, which is produced by certain bacteria in the colon, is suspected by some researchers to be a factor. Again, you are referred to Ulcerative Colitis Dietary Therapy for further considerations of this aspect of the disease.


A prebiotic is a special type of food fiber that is not digested by the body but rather is used by certain colon bacteria as a food source. Measurable beneficial changes may then occur within the colon itself and for the body as well. By increasing the acidity in the colon by the use of prebiotics, the bacteria that make hydrogen sulfide will not grow. As noted, there is new evidence that this gas is particularly damaging to the colon of ulcerative colitis patients, and may even play a role in causing Ulcerative Colitis.


Probiotics are bacteria that are taken with the hope that they will take up residence in the colon and produce good results. A few of these have been studied on patients with ulcerative colitis. Ask your physician about probiotics. VSL#3 is one such probiotic that has had some encouraging early reports in ulcerative colitis patients.


For the patient with ulcerative colitis, there is a lot to be learned by medical researchers.  A close working relationship with a physician knowledgeable about this disease is needed. Most people with this disorder do very well and are able to exercise, eat, marry and raise a family. There are many avenues of promising research being explored even now.