Ulcerative colitis
Also called: UC, Inflammatory bowel disease
Long-term inflammation and ulceration of the inner lining of the large bowel, always starting in the rectum and spreading continuously upward. It causes bloody diarrhoea and urgency.
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Causes
- Immune dysregulation in genetically susceptible people
Risk factors
- Family history
- Age 15–30
- Ex-smokers (smoking paradoxically lowers risk)
Symptoms
- Bloody diarrhoea with mucus
- Urgency and frequent stools
- Cramping abdominal pain
- Tiredness and weight loss in severe flares
Diagnosis — tests and examinations
- Stool tests to exclude infection; faecal calprotectin
- Colonoscopy with biopsies
- Blood tests
Treatment
Medicines and medical treatment
- Mesalazine (5-ASA) tablets and suppositories
- Steroids for flares
- Thiopurines
- Biologics (infliximab, vedolizumab, ustekinumab) and small molecules (tofacitinib, ozanimod)
- Intravenous steroids in hospital for acute severe colitis
Operations and procedures
- Colectomy, often with ileal pouch–anal anastomosis — curative for the bowel disease
Self-care, home remedies and lifestyle
- Take maintenance treatment even when well
- Regular colonoscopic cancer surveillance
Possible complications
- Acute severe colitis and toxic megacolon
- Colorectal cancer
- Primary sclerosing cholangitis
- Anaemia
Prevention
- No known prevention
Outlook
Most people achieve remission; surgery cures intestinal disease if medicines fail.
When to see a doctor
See a doctor for blood in stools or diarrhoea lasting weeks; seek urgent care for more than 6 bloody stools a day with fever or fast pulse.
Sources and further reading
These sources cover this condition. They have not been checked against every statement on this page.
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