Navigating Life with Ulcerative Colitis

What Causes Ulcerative Colitis?

Ulcerative colitis develops when the immune system triggers ongoing inflammation in the colon. Instead of protecting you from infection, the immune system mistakenly attacks the lining of the large intestine. Researchers do not yet know the exact cause of ulcerative colitis. Most experts believe it develops from a combination of factors.

Immune System Response

Researchers believe an abnormal immune response plays a major role. Your body may react to normal bacteria in the colon as if they pose a threat. That reaction leads to swelling, ulcers and bleeding.

Genetics and Risk Factors

Researchers believe genetics plays a role in ulcerative colitis. Family history increases risk, especially if a parent, sibling or child has inflammatory bowel disease. Ulcerative colitis also appears more often in people of Ashkenazi Jewish descent.

Environmental Triggers

Stress and certain foods do not cause ulcerative colitis. However, they can trigger a flare. Learning your personal triggers can help reduce the intensity of your symptoms over time. Keep in mind that everyone’s triggers are different. Common examples include spicy foods, alcohol, caffeine, and NSAIDs such as ibuprofen.

Symptoms of Ulcerative Colitis

Ulcerative colitis symptoms can be mild and can also be severe at times. Some people experience only occasional discomfort. Others face frequent flares that affect them daily.

Common signs of ulcerative colitis include:

• Abdominal pain and cramping
• Anemia due to loss of blood cells
• Diarrhea, often with blood or pus
• Fatigue
• Rectal bleeding
• Urgent bowel movements
• Weight loss

Ongoing blood loss may reduce healthy blood cells and lead to anemia. When inflammation becomes more severe, symptoms may intensify and require urgent care.

If you notice diarrhea that will not go away, rectal bleeding or unexplained low energy, schedule a visit with your physician. Early evaluation can help prevent complications.

Ulcerative Colitis Diagnosis

Getting a diagnosis of ulcerative colitis usually takes a few steps. We start by ruling out infection and other digestive conditions that can look similar. From there, we choose the tests that give you clear answers. Our specialists use several diagnostic tools to determine if ulcerative colitis is present. They may include:

• Colonoscopy — allows direct view of the colon and rectum lining
• Flexible sigmoidoscopy — evaluates the lower part of the large intestine
• Stool tests — check for infection and inflammation
• Blood tests — look for anemia and inflammation markers
• CT scan — assesses complications or the extent of inflammation

During the colonoscopy, your specialist may take small tissue samples to confirm inflammation patterns that are usually consistent with a diagnosis of ulcerative colitis.

Potential Complications

When ulcerative colitis symptoms flare, it can make you feel like the hardest part is simply getting through the day. But ulcerative colitis can also affect your health in ways you may not see right away. Staying on treatment and keeping follow-up appointments will help protect you now and in the years to come. There are several possible short-term complications you may experience:

• Blood clots
• Dehydration
• Severe bleeding

In rare cases, ulcerative colitis can lead to toxic megacolon. This happens when the colon swells quickly and cannot function as it should. Toxic megacolon is a medical emergency and needs immediate treatment. Call 911 or go to the nearest emergency department if you have severe abdominal pain, a swollen or tender abdomen, fever, rapid heart rate or feel suddenly very ill.

Over time, ongoing inflammation can also raise colon cancer risk. Because of that, many people with ulcerative colitis need colonoscopy screening earlier and more often than someone at average risk. Regular monitoring helps detect precancerous changes early, when they are easier to treat.

Ulcerative Colitis Treatment Options

Ulcerative colitis treatment focuses on reducing inflammation, controlling symptoms and preventing long-term complications. Your specialist will talk with you about a plan specific to you. Your plan will depend on how severe the disease is, how much of the colon is involved and how often you experience flares.

Medications

Medication is often the first step in treating ulcerative colitis.

• Anti-inflammatory drugs (aminosalicylates) — These medicines reduce swelling in the lining of the colon and rectum. Physicians may prescribe them for mild disease and for long-term maintenance.
• Biologics and immunomodulators — These medicines target specific parts of the immune system. Physicians often use them for mild to moderate or moderate to severe ulcerative colitis and when other treatments do not provide enough relief.
• Corticosteroids — Steroids may help during a severe flare. However, long-term steroid use can cause side effects such as bone loss, weight gain, increased infection risk and elevated blood sugar. For that reason, physicians use them for short periods whenever possible.

“The goal is to calm inflammation without exposing you to unnecessary risk,” said Dr. Yang. “Medications work well for many people, but may require adjustments and monitoring. Sometimes, when medications stop working, you may need to see a colorectal surgeon for your next step in treatment.”

Diet and Lifestyle

Diet does not cause ulcerative colitis, but certain foods can trigger symptoms during a flare. If symptoms flare, you can still take steps that support your body. You may feel better when you:

• Identify and avoid personal trigger foods
• Eat smaller meals during active symptoms
• Stay hydrated when diarrhea increases
• Work with a dietitian to prevent nutrient deficiencies

Stress management may also help reduce the frequency of flares. Try to get consistent sleep and make sure to schedule regular follow-up visits with your physician.

Surgery

When medication no longer controls inflammation or complications develop, surgery may become necessary.

Surgery to remove the entire colon and rectum, called proctocolectomy, may be considered a cure because ulcerative colitis affects only the large intestine. After surgery, symptoms related to colon inflammation stop.

Surgery may also lower long-term colon cancer risk in people with severe or long-standing disease.

Your gastroenterologist and colorectal surgeon will discuss whether surgery is appropriate for your condition, lifestyle and goals.

Long-term Outlook and Screening Vigilance

Ulcerative colitis requires lifelong monitoring. Even during remission, inflammation may continue at a low level. Regular visits with a gastroenterologist can help you stay ahead of flares, adjust treatment and protect your long-term colon health.

Routine colonoscopy helps track disease and detect early signs of colon cancer. Your physician will recommend a personalized screening schedule based on how long you have lived with ulcerative colitis and the extent of your inflammation.

If you experience ulcerative colitis symptoms or need ongoing management, schedule a visit with your primary care physician or gastroenterologist to review your symptoms and family history and determine a screening plan that makes sense for you.