How to control colitis?

6 Tips to Help Manage Ulcerative Colitis Flare-Ups

In addition to knowing how to manage flare-ups, it’s also helpful to recognize factors that can trigger your flare-ups.

Skipping or forgetting to take your medication

UC causes inflammation and ulcers in the colon. If left untreated, this condition can lead to life-threatening complications like a bowel perforation, colon cancer, and toxic megacolon.

Your doctor will likely prescribe a medication to reduce inflammation, such as an anti-inflammatory drug or an immunosuppressant drug.

These medications ease symptoms of UC, and can also function as maintenance therapy to keep you in remission. Symptoms could return if you don’t take your medication as directed.

At some point, your doctor may discuss slowly tapering you off the medication. But you should never decrease your dosage or stop taking your medication without talking to your doctor first.

Other medications

A medication you take for another condition can also trigger a flare-up. This might happen if you take an antibiotic to treat a bacterial infection. Antibiotics can sometimes disrupt the balance of intestinal bacteria in the gut and cause diarrhea.

Also, certain over-the-counter nonsteroidal anti-inflammatory drugs (NSAIDs) like aspirin and ibuprofen may irritate the colon and cause a flare. This doesn’t mean you should stop taking pain medications or antibiotics. But you should speak with your doctor before taking these drugs.

If you experience stomach pain after taking an NSAID, your doctor may suggest acetaminophen to reduce pain instead. If you take an antibiotic, you may also need a temporary anti-diarrheal medication to combat possible side effects.

Stress

Stress doesn’t cause UC, but it can exacerbate symptoms and trigger a flare-up.

When under stress, your body goes into fight-or-flight mode. It releases hormones that increase your heart rate and boost your adrenaline. These stress hormones also stimulate an inflammatory response.

In small doses, stress hormones are harmless. Chronic stress, on the other hand, can keep your body in an inflamed state and worsen UC symptoms.

Diet

The foods you eat can also worsen symptoms of UC. You may have a flare-up or notice that your symptoms get worse after consuming certain types of foods, such as:

  • dairy
  • raw fruits and vegetables
  • beans
  • spicy foods
  • artificial sweeteners
  • popcorn
  • meat
  • nuts and seeds
  • fatty foods

Troublesome beverages can include milk, alcohol, carbonated drinks, and caffeinated drinks.

Foods that trigger UC flare-ups vary from person to person. Also, the way your body responds to certain foods can change over time.

Ulcerative Colitis Treatment Options

The primary goal in treating ulcerative colitis is to help patients regulate their immune system better. While there is no known cure for ulcerative colitis and flare ups may recur, a combination of treatment options can help you stay in control of your disease and lead a full and rewarding life.

Treatment for ulcerative colitis is multifaceted and includes the use of medication, alterations in diet and nutrition, and sometimes surgical procedures to repair or remove affected portions of your GI tract.

Medication

Medication for ulcerative colitis can suppress the inflammation of the colon and allow for tissues to heal. Symptoms including diarrhea, bleeding, and abdominal pain can also be reduced and controlled with effective medication.

In addition to controlling and suppressing symptoms (inducing remission), medication can also be used to decrease the frequency of symptom flare ups (maintaining remission). With proper treatment over time, periods of remission can be extended and periods of symptom flare ups can be reduced. Several types of medication are being used to treat ulcerative colitis today.

Combination Therapy

In some circumstances, a health care provider may recommend adding an additional therapy that will work in combination with the initial therapy to increase its effectiveness. For example, combination therapy could include the addition of a biologic to an immunomodulator. As with all therapy, there are risks and benefits of combination therapy. Combining therapies can increase the effectiveness of IBD treatment, but there may also be an increased risk of additional side effects and toxicity. Your healthcare provider will identify the treatment option that is most effective for your individual health care needs.

Diet & Nutrition

While ulcerative colitis is not caused by the foods you eat, you may find that once you have the disease, particular foods can aggravate the symptoms. It’s important to maintain a healthy and soothing diet that helps reduce your symptoms, replace lost nutrients, and promote healing.

For people diagnosed with ulcerative colitis, it is essential to maintain good nutrition because the disease often reduces your appetite while increases your body’s energy needs. Additionally, common symptoms like diarrhea can reduce your body’s ability to absorb protein, fat, carbohydrates, as well as water, vitamins, and minerals.

Many people with ulcerative colitis find that soft, bland foods cause less discomfort than spicy or high-fiber foods. While your diet can remain flexible and should include a variety of foods from all food groups, your doctor will likely recommend restricting your intake of dairy foods if you are found to be lactose-intolerant.

Surgery

In one-quarter to one-third of patients with ulcerative colitis, medical therapy is not completely successful or complications arise. Under these circumstances, surgery may be considered. This operation involves the removal of the colon (colectomy).

Depending on a number of factors, including the extent of the disease and the patient’s age and overall health, one of two surgical approaches may be recommended. The first involves the removal of the entire colon and rectum, with the creation of an ileostomy or external stoma (an opening on the abdomen through which wastes are emptied into a pouch, which is attached to the skin with adhesive).

Today, many people are able to take advantage of new surgical techniques, which have been developed to offer another option. This procedure also calls for removal of the colon, but it avoids an ileostomy. By creating an internal pouch from the small bowel and attaching it to the anal sphincter muscle, the surgeon can preserve bowel integrity and eliminate the need for the patient to wear an external ostomy appliance.

Making Informed Decisions

If you’re confused about all the medications and therapies out there, you are not alone! IBD is extremely complex, and it is important to review the risks and benefits of all treatment options with your doctor. Learn more about available tools and resources that can help you make informed decisions about your care.

Ulcerative Colitis

On this page:

  • What is ulcerative colitis?
  • What is the large intestine?
  • What causes ulcerative colitis?
  • Who is more likely to develop ulcerative colitis?
  • What are the signs and symptoms of ulcerative colitis?
  • How is ulcerative colitis diagnosed?
  • How is ulcerative colitis treated?
  • Eating, Diet, and Nutrition
  • What are the complications of ulcerative colitis?
  • Ulcerative Colitis and Colon Cancer
  • Clinical Trials

What is ulcerative colitis?

Ulcerative colitis is a chronic, or long lasting, disease that causes inflammation—irritation or swelling—and sores called ulcers on the inner lining of the large intestine.

Ulcerative colitis is a chronic inflammatory disease of the gastrointestinal (GI) tract, called inflammatory bowel disease (IBD). Crohn’s disease and microscopic colitis are the other common IBDs.

Ulcerative colitis most often begins gradually and can become worse over time. Symptoms can be mild to severe. Most people have periods of remission—times when symptoms disappear—that can last for weeks or years. The goal of care is to keep people in remission long term.

Most people with ulcerative colitis receive care from a gastroenterologist, a doctor who specializes in digestive diseases.

What is the large intestine?

The large intestine is part of the GI tract, a series of hollow organs joined in a long, twisting tube from the mouth to the anus—an opening through which stool leaves the body. The last part of the GI tract, called the lower GI tract, consists of the large intestine—which includes the appendix, cecum, colon, and rectum—and anus. The intestines are sometimes called the bowel.

The large intestine is part of the GI tract.

The large intestine is about 5 feet long in adults and absorbs water and any remaining nutrients from partially digested food passed from the small intestine. The large intestine changes waste from liquid to a solid matter called stool. Stool passes from the colon to the rectum. The rectum is located between the lower, or sigmoid, colon and the anus. The rectum stores stool prior to a bowel movement, when stool moves from the rectum to the anus and out of a person’s body.

What causes ulcerative colitis?

The exact cause of ulcerative colitis is unknown. Researchers believe the following factors may play a role in causing ulcerative colitis:

  • overactive intestinal immune system
  • genes
  • environment

Overactive intestinal immune system. Scientists believe one cause of ulcerative colitis may be an abnormal immune reaction in the intestine. Normally, the immune system protects the body from infection by identifying and destroying bacteria, viruses, and other potentially harmful foreign substances. Researchers believe bacteria or viruses can mistakenly trigger the immune system to attack the inner lining of the large intestine. This immune system response causes the inflammation, leading to symptoms.

Genes. Ulcerative colitis sometimes runs in families. Research studies have shown that certain abnormal genes may appear in people with ulcerative colitis. However, researchers have not been able to show a clear link between the abnormal genes and ulcerative colitis.

Environment. Some studies suggest that certain things in the environment may increase the chance of a person getting ulcerative colitis, although the overall chance is low. Nonsteroidal anti-inflammatory drugs,1 antibiotics,1 and oral contraceptives2 may slightly increase the chance of developing ulcerative colitis. A high-fat diet may also slightly increase the chance of getting ulcerative colitis.3

Some people believe eating certain foods, stress, or emotional distress can cause ulcerative colitis. Emotional distress does not seem to cause ulcerative colitis. A few studies suggest that stress may increase a person’s chance of having a flare-up of ulcerative colitis. Also, some people may find that certain foods can trigger or worsen symptoms.

Who is more likely to develop ulcerative colitis?

Ulcerative colitis can occur in people of any age. However, it is more likely to develop in people

  • between the ages of 15 and 304
  • older than 601
  • who have a family member with IBD
  • of Jewish descent

What are the signs and symptoms of ulcerative colitis?

The most common signs and symptoms of ulcerative colitis are diarrhea with blood or pus and abdominal discomfort. Other signs and symptoms include

  • an urgent need to have a bowel movement
  • feeling tired
  • nausea or loss of appetite
  • weight loss
  • fever
  • anemia—a condition in which the body has fewer red blood cells than normal

Less common symptoms include

  • joint pain or soreness
  • eye irritation
  • certain rashes

The symptoms a person experiences can vary depending on the severity of the inflammation and where it occurs in the intestine. When symptoms first appear,

  • most people with ulcerative colitis have mild to moderate symptoms
  • about 10 percent of people can have severe symptoms, such as frequent, bloody bowel movements; fevers; and severe abdominal cramping1

How is ulcerative colitis diagnosed?

A health care provider diagnoses ulcerative colitis with the following:

  • medical and family history
  • physical exam
  • lab tests
  • endoscopies of the large intestine

The health care provider may perform a series of medical tests to rule out other bowel disorders, such as irritable bowel syndrome, Crohn’s disease, or celiac disease, that may cause symptoms similar to those of ulcerative colitis.

Medical and Family History

Taking a medical and family history can help the health care provider diagnose ulcerative colitis and understand a patient’s symptoms. The health care provider will also ask the patient about current and past medical conditions and medications.

Physical Exam

A physical exam may help diagnose ulcerative colitis. During a physical exam, the health care provider most often

  • checks for abdominal distension, or swelling
  • listens to sounds within the abdomen using a stethoscope
  • taps on the abdomen to check for tenderness and pain

Lab Tests

A health care provider may order lab tests to help diagnose ulcerative colitis, including blood and stool tests.

Blood tests. A blood test involves drawing blood at a health care provider’s office or a lab. A lab technologist will analyze the blood sample. A health care provider may use blood tests to look for

  • anemia
  • inflammation or infection somewhere in the body
  • markers that show ongoing inflammation
  • low albumin, or protein—common in patients with severe ulcerative colitis

Stool tests. A stool test is the analysis of a sample of stool. A health care provider will give the patient a container for catching and storing the stool at home. The patient returns the sample to the health care provider or to a lab. A lab technologist will analyze the stool sample. Health care providers commonly order stool tests to rule out other causes of GI diseases, such as infection.

Endoscopies of the Large Intestine

Endoscopies of the large intestine are the most accurate methods for diagnosing ulcerative colitis and ruling out other possible conditions, such as Crohn’s disease, diverticular disease, or cancer. Endoscopies of the large intestine include

Colonoscopy. Colonoscopy is a test that uses a long, flexible, narrow tube with a light and tiny camera on one end, called a colonoscope or scope, to look inside the rectum and entire colon. In most cases, light anesthesia and pain medication help patients relax for the test. The medical staff will monitor a patient’s vital signs and try to make him or her as comfortable as possible. A nurse or technician places an intravenous (IV) needle in a vein in the patient’s arm or hand to give anesthesia.

For the test, the patient will lie on a table or stretcher while the gastroenterologist inserts a colonoscope into the patient’s anus and slowly guides it through the rectum and into the colon. The scope inflates the large intestine with air to give the gastroenterologist a better view. The camera sends a video image of the intestinal lining to a monitor, allowing the gastroenterologist to carefully examine the tissues lining the colon and rectum. The gastroenterologist may move the patient several times and adjust the scope for better viewing. Once the scope has reached the opening to the small intestine, the gastroenterologist slowly withdraws it and examines the lining of the colon and rectum again.

A colonoscopy can show irritated and swollen tissue, ulcers, and abnormal growths such as polyps—extra pieces of tissue that grow on the inner lining of the intestine. If the gastroenterologist suspects ulcerative colitis, he or she will biopsy the patient’s colon and rectum. A biopsy is a procedure that involves taking small pieces of tissue for examination with a microscope.

A health care provider will give patients written bowel prep instructions to follow at home before the test. The health care provider will also give patients information about how to care for themselves following the procedure.

Flexible sigmoidoscopy. Flexible sigmoidoscopy is a test that uses a flexible, narrow tube with a light and tiny camera on one end, called a sigmoidoscope or scope, to look inside the rectum, the sigmoid colon, and sometimes the descending colon. In most cases, a patient does not need anesthesia.

For the test, the patient will lie on a table or stretcher while the health care provider inserts the sigmoidoscope into the patient’s anus and slowly guides it through the rectum, the sigmoid colon, and sometimes the descending colon. The scope inflates the large intestine with air to give the health care provider a better view. The camera sends a video image of the intestinal lining to a monitor, allowing the health care provider to examine the tissues lining the sigmoid colon and rectum. The health care provider may ask the patient to move several times and adjust the scope for better viewing. Once the scope reaches the end of the sigmoid colon, the health care provider slowly withdraws it while examining the lining of the colon and rectum again.

The health care provider will look for signs of bowel diseases and conditions such as irritated and swollen tissue, ulcers, and polyps.

If the health care provider suspects ulcerative colitis, he or she will biopsy the patient’s colon and rectum.

A health care provider will give patients written bowel prep instructions to follow at home before the test. The health care provider will also give patients information about how to care for themselves following the procedure.

How is ulcerative colitis treated?

A health care provider treats ulcerative colitis with

  • medications
  • surgery

Which treatment a person needs depends on the severity of the disease and the symptoms. Each person experiences ulcerative colitis differently, so health care providers adjust treatments to improve the person’s symptoms and induce, or bring about, remission.

Medications

While no medication cures ulcerative colitis, many can reduce symptoms. The goals of medication therapy are

  • inducing and maintaining remission
  • improving the person’s quality of life

Many people with ulcerative colitis require medication therapy indefinitely, unless they have their colon and rectum surgically removed.

Health care providers will prescribe the medications that best treat a person’s symptoms:

  • aminosalicylates
  • corticosteroids
  • immunomodulators
  • biologics, also called anti-TNF therapies
  • other medications

Depending on the location of the symptoms in the colon, health care providers may recommend a person take medications by

  • enema, which involves flushing liquid medication into the rectum using a special wash bottle. The medication directly treats inflammation of the large intestine.
  • rectal foam—a foamy substance the person puts into the rectum like an enema. The medication directly treats inflammation of the large intestine.
  • suppository—a solid medication the person inserts into the rectum to dissolve. The intestinal lining absorbs the medication.
  • mouth.
  • IV.

Aminosalicylates are medications that contain 5-aminosalicyclic acid (5-ASA), which helps control inflammation. Health care providers typically use aminosalicylates to treat people with mild or moderate symptoms or help people stay in remission. Aminosalicylates can be prescribed as an oral medication or a topical medication—by enema or suppository. Combination therapy—oral and rectal—is most effective, even in people with extensive ulcerative colitis.5 Aminosalicylates are generally well tolerated.

Aminosalicylates include

  • balsalazide
  • mesalamine
  • olsalazine
  • sulfasalazine—a combination of sulfapyridine and 5-ASA

Some of the common side effects of aminosalicylates include

  • abdominal pain
  • diarrhea
  • headaches
  • nausea

Health care providers may order routine blood tests for kidney function, as aminosalicylates can cause a rare allergic reaction in the kidneys.

Corticosteroids, also known as steroids, help reduce the activity of the immune system and decrease inflammation. Health care providers prescribe corticosteroids for people with more severe symptoms and people who do not respond to aminosalicylates. Health care providers do not typically prescribe corticosteroids for long-term use.

Corticosteroids are effective in bringing on remission; however, studies have not shown that the medications help maintain long-term remission. Corticosteroids include

  • budesonide
  • hydrocortisone
  • methylprednisone
  • prednisone

Side effects of corticosteroids include

  • acne
  • a higher chance of developing infections
  • bone mass loss
  • death of bone tissue
  • high blood glucose
  • high blood pressure
  • mood swings
  • weight gain

People who take budesonide may have fewer side effects than with other steroids.

Immunomodulators reduce immune system activity, resulting in less inflammation in the colon. These medications can take several weeks to 3 months to start working. Immunomodulators include

  • azathioprine
  • 6-mercaptopurine, or 6-MP

Health care providers prescribe these medications for people who do not respond to 5-ASAs. People taking these medications may have the following side effects:

  • abnormal liver tests
  • feeling tired
  • infection
  • low white blood cell count, which can lead to a higher chance of infection
  • nausea and vomiting
  • pancreatitis
  • slightly increased chance of lymphoma
  • slightly increased chance of nonmelanoma skin cancers

Health care providers routinely test blood counts and liver function of people taking immunomodulators. People taking these medications should also have yearly skin cancer exams.

People should talk with their health care provider about the risks and benefits of immunomodulators.

Biologics—including adalimumab, golimumab, and infliximab—are medications that target a protein made by the immune system called tumor necrosis factor (TNF). These medications decrease inflammation in the large intestine by neutralizing TNF. Anti-TNF therapies work quickly to bring on remission, especially in people who do not respond to other medications. Infliximab is given through an IV; adalimumab and golimumab are given by injection.

Health care providers will screen patients for tuberculosis and hepatitis B before starting treatment with anti-TNF medications.

Side effects of anti-TNF medications may include

  • a higher chance of developing infections—especially tuberculosis or fungal infection
  • skin cancer—melanoma
  • psoriasis

Doctors may treat patients with vedolizumab when they do not respond to or cannot tolerate other medicines. Vedolizumab works by blocking cells that cause inflammation.

Side effects of vedolizumab may include

  • infections—common cold, flu, bronchitis, throat infection, or sinus infection
  • headache
  • pain in the back, arms, legs, or joints
  • skin rash or itching

Other medications to treat symptoms or complications may include

  • acetaminophen for mild pain. People with ulcerative colitis should avoid using ibuprofen, naproxen, and aspirin since these medications can make symptoms worse.
  • antibiotics to prevent or treat infections.
  • loperamide to help slow or stop diarrhea. In most cases, people only take this medication for short periods of time since it can increase the chance of developing megacolon. People should check with a health care provider before taking loperamide, because those with significantly active ulcerative colitis should not take this medication.6
  • cyclosporine—health care providers prescribe this medication only for people with severe ulcerative colitis because of the side effects. People should talk with their health care provider about the risks and benefits of cyclosporine.

Some people will need surgery to treat their ulcerative colitis when they have

  • colon cancer
  • dysplasia, or precancerous cells in the colon
  • complications that are life threatening, such as megacolon or bleeding
  • no improvement in symptoms or condition despite treatment
  • continued dependency on steroids
  • side effects from medications that threaten their health

Removal of the entire colon, including the rectum, “cures” ulcerative colitis. A surgeon performs the procedure at a hospital. A surgeon can perform two different types of surgery to remove a patient’s colon and treat ulcerative colitis:

  • proctocolectomy and ileostomy
  • proctocolectomy and ileoanal reservoir

Full recovery from both operations may take 4 to 6 weeks.

Proctocolectomy and ileostomy. A proctocolectomy is surgery to remove a patient’s entire colon and rectum. An ileostomy is a stoma, or opening in the abdomen, that a surgeon creates from a part of the ileum—the last section of the small intestine. The surgeon brings the end of the ileum through an opening in the patient’s abdomen and attaches it to the skin, creating an opening outside of the patient’s body. The stoma most often is located in the lower part of the patient’s abdomen, just below the beltline.

A removable external collection pouch, called an ostomy pouch or ostomy appliance, connects to the stoma and collects intestinal contents outside the patient’s body. Intestinal contents pass through the stoma instead of passing through the anus. The stoma has no muscle, so it cannot control the flow of intestinal contents, and the flow occurs whenever peristalsis occurs. Peristalsis is the movement of the organ walls that propels food and liquid through the GI tract.

People who have this type of surgery will have the ileostomy for the rest of their lives.

Ileostomy

Proctocolectomy and ileoanal reservoir. An ileoanal reservior is an internal pouch made from the patient’s ileum. This surgery is a common alternative to an ileostomy and does not have a permanent stoma. Ileoanal reservoir is also known as a J-pouch, a pelvic pouch, or an ileoanal pouch anastamosis. The ileoanal reservior connects the ileum to the anus. The surgeon preserves the outer muscles of the patient’s rectum during the proctocolectomy. Next, the surgeon creates the ileal pouch and attaches it to the end of the rectum. Waste is stored in the pouch and passes through the anus.

After surgery, bowel movements may be more frequent and watery than before the procedure. People may have fecal incontinence—the accidental passing of solid or liquid stool or mucus from the rectum. Medications can be used to control pouch function. Women may be infertile following the surgery.

Many people develop pouchitis in the ileoanal reservoir. Pouchitis is an irritation or inflammation of the lining of the ileoanal reservoir. A health care provider treats pouchitis with antibiotics. Rarely, pouchitis can become chronic and require long-term antibiotics or other medications.

Ileoanal reservoir

The surgeon will recommend one of the operations based on a person’s symptoms, severity of disease, expectations, age, and lifestyle. Before making a decision, the person should get as much information as possible by talking with

  • health care providers
  • enterostomal therapists, nurses who work with colon-surgery patients
  • people who have had one of the surgeries

Patient-advocacy organizations can provide information about support groups and other resources.

Eating, Diet, and Nutrition

Researchers have not found that eating, diet, and nutrition play a role in causing ulcerative colitis symptoms. Good nutrition is important in the management of ulcerative colitis, however. Dietary changes can help reduce symptoms. A health care provider may recommend dietary changes such as

  • avoiding carbonated drinks
  • avoiding popcorn, vegetable skins, nuts, and other high-fiber foods while a person has symptoms
  • drinking more liquids
  • eating smaller meals more often
  • keeping a food diary to help identify troublesome foods

Health care providers may recommend nutritional supplements and vitamins for people who do not absorb enough nutrients.

To help ensure coordinated and safe care, people should discuss their use of complementary and alternative medical practices, including their use of dietary supplements and probiotics, with their health care provider. Read more at nccih.nih.gov/health/probiotics.

Depending on a person’s symptoms or medications, a health care provider may recommend a specific diet, such as a

  • high-calorie diet
  • lactose-free diet
  • low-fat diet
  • low-fiber diet
  • low-salt diet

People should speak with a health care provider about specific dietary recommendations and changes.

What are the complications of ulcerative colitis?

Complications of ulcerative colitis can include

  • rectal bleeding—when ulcers in the intestinal lining open and bleed. Rectal bleeding can cause anemia, which health care providers can treat with diet changes and iron supplements. People who have a large amount of bleeding in the intestine over a short period of time may require surgery to stop the bleeding. Severe bleeding is a rare complication of ulcerative colitis.
  • dehydration and malabsorbtion, which occur when the large intestine is unable to absorb fluids and nutrients because of diarrhea and inflammation. Some people may need IV fluids to replace lost nutrients and fluids.
  • changes in bones. Some corticosteroid medications taken to treat ulcerative colitis symptoms can cause
    • osteoporosis—the loss of bone
    • osteopenia—low bone density

Health care providers will monitor people for bone loss and can recommend calcium and vitamin D supplements and medications to help prevent or slow bone loss.

  • inflammation in other areas of the body. The immune system can trigger inflammation in the
    • joints
    • eyes
    • skin
    • liver

Health care providers can treat inflammation by adjusting medications or prescribing new medications.

  • megacolon—a serious complication that occurs when inflammation spreads to the deep tissue layers of the large intestine. The large intestine swells and stops working. Megacolon can be a life-threatening complication and most often requires surgery. Megacolon is a rare complication of ulcerative colitis.

Ulcerative Colitis and Colon Cancer

People with ulcerative colitis may be more likely to develop colon cancer when

  • ulcerative colitis affects the entire colon
  • a person has ulcerative colitis for at least 8 years
  • inflammation is ongoing
  • people also have primary sclerosing cholangitis, a condition that affects the liver
  • a person is male

People who receive ongoing treatment and remain in remission may reduce their chances of developing colon cancer.

People with ulcerative colitis should talk with their health care provider about how often they should get screened for colon cancer. Screening can include colonoscopy with biopsies or a special dye spray called chromoendoscopy.

Health care providers may recommend colonoscopy every 1 to 3 years for people with ulcerative colitis who have

  • the disease in one-third or more or of their colon
  • had ulcerative colitis for 8 years

Such screening does not reduce a person’s chances of developing colon cancer. Instead, screening can help diagnose cancer early and improve chances for recovery.

Surgery to remove the entire colon eliminates the risk of colon cancer.

Clinical Trials

The National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK) and other components of the National Institutes of Health (NIH) conduct and support research into many diseases and conditions.

What are clinical trials, and are they right for you?

Clinical trials are part of clinical research and at the heart of all medical advances. Clinical trials look at new ways to prevent, detect, or treat disease. Researchers also use clinical trials to look at other aspects of care, such as improving the quality of life for people with chronic illnesses. Find out if clinical trials are right for you.

What clinical trials are open?

Clinical trials that are currently open and are recruiting can be viewed at www.ClinicalTrials.gov.

Daily Life With Ulcerative Colitis

Explaining ulcerative colitis

Having a chronic disease means that you may have chronic symptoms—and may have to deal with some aspect of your condition frequently. That’s why it’s beneficial for friends and family members to understand ulcerative colitis and what you’re going through, since it will be helpful to have their support. Similarly, depending on your situation, you might want to be mindful about informing your co-workers, classmates, and supervisors or teachers of what having UC can be like, so they can prepare to be flexible in case you have to stay home. You might also want to be mindful about letting teachers and supervisors know what your rights are as someone with a chronic disease.

Talking to others about your needs up front is a helpful way to manage expectations if your symptoms flare up.

Use these tips to help explain ulcerative colitis—and make advocating for yourself easier:

  • Learn about UC. Knowing as much about UC as you can is helpful for you to be able to share the basics of the disease and how it can affect you.
  • Know where to get information. Your teacher, co-worker, friend or family member can benefit from having a copy of Ulcerative Colitis 101. You can also direct them to this site to learn about ulcerative colitis.
  • Know your rights. There may be means to access reasonable accommodations at school and at work through laws such as the Individuals with Disabilities Education Act (IDEA), the Americans with Disabilities Act (ADA), and Section 504 of the Rehabilitation Act of 1973. It may be helpful to explore these means about guidelines and eligibility requirements for potential services and accommodations.

It shows up gradually and become worse over time. It can be mild or severe. It comes and goes. There are times when it may disappear and others when its around for weeks or even years. Ulcerative colitis is an unpredictable and difficult disease. While there is no known cure, there are natural treatments and lifestyle changes that can reduce the signs and symptoms and aid in long-term remission.

Ulcerative colitis is defined by its continual inflammation of the lining of the colon. Its sometimes called the left-sided disease because its located in the descending colon. The most common symptoms are stomach pain, diarrhea, and blood in bowel movements. There is a risk of intense bleeding, chronic illness, damage to the colon, and cancer. Due to these severe symptoms, about 25% of people suffering from ulcerative colitis eventually require surgery.

Conventional treatment

Some traditional remedies can help bring ulcerative colitis into remission. It’s important to work with a physician to find the best treatment options. Some treatment options include drugs, including medication and surgery.

Anti-inflammatory medications, such as corticosteroids, are typically the first line of action to treat ulcerative colitis. Immune system suppressors also help to reduce inflammation by reducing the action of the immune system response that triggers the inflammation. A blend of other medications may be used to manage other associated symptoms such as anti-diarrheal medications, antibiotics, and pain relievers.

Surgery

Surgery can be helpful but also poses dangers. In some cases, it involves removing the entire colon. Many surgery situations call for an opening to be created in the abdomen in which stool can be passed, in other surgeries such as an ileal pouch, the need to wear a bag can be eliminated.

Natural treatments for ulcerative colitis

It can be overwhelming and difficult to deal with intense symptoms and treatments. Nori understands this and can help empower a sense of control over symptoms through diet and lifestyle change. The goal will be to create more time between flare-ups and increase symptom management, to reduce the need for surgery and coincide with medication recommended by a physician.

Food

Certain foods and drinks can aggravate symptoms, particularly during a flare-up. Research shows that more westernized populations are at higher risk for ulcerative colitis so there may be a link between processed diets, however, there has been no specific and definitive link between a food and ulcerative. One of the best ways to discover which foods cause discomfort is to keep a journal to discover which foods are causing symptoms to worsen and how to substitute or remove them.

Common ulcerative colitis problematic foods:

  • Too much fiber: fiber can be difficult to digest. Beware of too many fruits, vegetables, whole grains, and nuts. Avoid raw versions as needed and cook thoroughly, to help kick-start the digestion process.
  • Dairy and gluten: these tend to be the top culprits of digestive problems such as gas, pain, and diarrhea. Gluten and dairy sensitivity is personal. If gluten is causing inflammation, avoid it, if dairy is the problem, either avoid it or consider taking Lactaid.
  • Irritating foods and beverages (spicy, caffeine, alcohol): these irritate the lining of the gut and can increase inflammation. Track what foods cause symptoms and limit according to symptoms.

Stress management

There is a strong relationship between the gut and the mind. Shifting the nervous system away from fight or flight mode, into a rest and digest place, will help improve digestive function. People with ulcerative colitis are twice as likely to suffer from depression and stress. It creates a cyclical pattern of stress, flare-up, depression/anxiety, worsening of symptoms, increased depression/anxiety, difficulty managing the flare-up and performing daily tasks of living.

Decrease stress by practicing these activities:

  • Exercise: activity is helpful in managing many symptoms and complications associated with ulcerative colitis, including poor immunity, stress and mental health, and weight. Calmer and slower exercises such as yoga and thai chi promote relaxation in the digestive system and healing of the body and mind.
  • Meditation: Meditation includes techniques such as deep breathing and progressive muscle relaxation. Simply taking a few minutes out of the busy day will help activate the parasympathetic system.
  • Therapy: working with a therapist can help control ulcerative colitis symptoms. Cognitive behavioral therapy can help process skills to cope with pain and stress associated with flare-ups. It can ease abdominal pain and assist in controlling some body processes such as muscle relaxation.

Probiotics and natural treatment

Probiotic foods and natural supplements can be a perfect addition to medical treatment. Note that the FDA doesn’t regulate supplements. Before purchasing them, check the label and research the company.

  • Probiotics: healthy bacteria in the gut support health and digestion. These helpful “bugs” are also associated with an improved immune function which can help ulcerative colitis. On the contrary, too many of the unhealthy bacteria can make ulcerative colitis symptoms worse. Balance is the key.
  • Herbs and supplements: Ginseng may reduce symptoms of ulcerative colitis. It has been shown to possibly lower inflammation and prevent DNA damage. Omega-3 fatty acids (fatty fish, flax oil, walnut oil) has shown to decrease inflammation which as a result may decrease ulcerative colitis symptoms.

Next level nourishment

Remember that stress is one of the main causes of flare-ups. If this information is overwhelming, no stress! We compiled a few easy habit changes that will help nourish your body and step you in the right direction towards decreasing your flare-ups and feeling better.

  • Drink plenty of water – aim for electrolyte drinks particularly when flare-ups and diarrhea is present
  • Eat small meals throughout the day instead of large, less frequent ones – these are easier to digest
  • Focus on eating enough – aim for wholesome foods, however, any calories are helpful when it comes to ulcerative colitis
  • Aim for lower fiber diet
  • Avoid fried, spicy, and dairy filled foods

This article has been written by Lisa Booth, registered dietician and nutritionist, and co-founder of Nori Health. Content is based on her professional knowledge, and our collection of 100+ scientific research study papers.

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