Whether you're newly diagnosed with ulcerative colitis or continuously learning to manage your symptoms and get better, you need scientifically accurate information. In this article, we'll help you separate fact from fiction about ulcerative colitis. We’ll cover what ulcerative colitis is, what typical symptoms and triggers are, and what your options are for treatment and management.

What Is Ulcerative Colitis?

Ulcerative colitis is a chronic inflammatory bowel disease. Inflammation of intestinal mucosa is seen in the rectum and segments of the colon near the rectum. Ulcerative colitis follows a cycle of relapse and remission of mucosal inflammation. Prevalence rates of ulcerative colitis are highest in Europe, Canada, and the United States. Disease onset peaks between the ages of 30 and 40 years. (Source) While ulcerative colitis cannot be cured, it can be well managed.

Signs and Symptoms

• bloody diarrhea (especially in people with proctitis, inflammation of the rectal lining)
• a sensation of incomplete evacuation
• urgency
• incontinence
• fatigue
• increased frequency of bowel movements
• nocturnal defecations
• abdominal discomfort, such as cramps
• fevers and weight loss, in severe cases

(Source)

Causes and Triggers of Ulcerative Colitis

It is known that ulcerative colitis results from a dysregulated immune system. Still, no exact cause has been identified. Your ulcerative colitis may have one or multiple causes, such as an abnormal immune response, genetics, an unbalanced microbiome, or environmental factors such as medicine, diet, and air pollution. (Source)

During the flare-up period, ulcerative colitis symptoms and inflammation will come back. These symptoms patients experience affect the digestive system, such as diarrhea, bloody stools, and abdominal pain. Some patients may also experience pain and swelling in joints, rashes in the skin, mouth ulcers, and irritated eyes. (Source)

Ulcerative Colitis Flares

Flares are the return of symptoms after a period of remission. If you feel you have no control over relapse, we encourage you to be aware of your diet, lifestyle, and stress levels. Even changing little things can have an effect on your disease's progression. (Source)

Ulcerative Colitis Flare Triggers

• not taking prescribed medication doses. Missing or incorrect medication doses without your provider’s approval can result in flare-ups.
• nonsteroidal anti-inflammatory drugs (NSAIDs). Ulcerative colitis patients shouldn't take NSAIDs such as aspirin, ibuprofen, or naproxen, as they can cause flares. Other suitable painkillers, including acetaminophen, may be used.
• antibiotics. Try to avoid use of antibiotics unless necessary for bacterial infections, as in some cases antibiotics cause flares and symptoms.
• infections. Infections of the gastrointestinal tract such as Clostridium difficile (often called C. diff) infection can cause flares. Stool tests may be used to detect the cause of infection.
• foods that irritate your gastrointestinal system
• stress

(Source)

Ulcerative Colitis Flare Treatments

Mild to moderate flare-ups are usually treatable at home. You should seek medical care for severe symptoms of flare-ups to avoid the risk of dehydration and serious complications. Corticosteroids, immunosuppressants, and biologic medicines are the treatments you could be given. (Source)

Ulcerative Colitis Risk Factors

• having a family history of inflammatory bowel diseases
• genetic predisposition
• cigarette smoking
• drugs including oral contraceptives, hormone replacement therapy, nonsteroidal anti-inflammatory drugs
• a history of infectious gastroenteritis
• exposure to air pollution

(Source)

How Is Ulcerative Colitis Diagnosed?

Ulcerative colitis diagnosis is based on the patient's medical history, symptoms, physical exam, medical tests, and the absence of other possible diagnoses.

Ulcerative Colitis’s Lab Tests

• blood tests. A complete blood count includes both white blood cells, which may reveal infection and inflammation markers, and red blood cells to detect anemia.
• serology tests. These specialized tests on serum, or the fluid left after all blood cells and clotting factors have been removed, can’t diagnose IBD but can help differentiate between ulcerative colitis and Crohn's disease.
• stool tests. Stool cultures test for the presence of microbes such as bacteria, viruses, or parasites that could be causing symptoms. Biomarker proteins such as calprotectin and lactoferrin in the stool confirm there is an ongoing inflammatory process.
• endoscopy. A lighted tube is inserted through the rectum during endoscopy, which is a procedure that allows your health care provider to see the colon and rectum. In ulcerative colitis testing, two types of endoscopy are used:
• Total colonoscopy examines the entire colon.
• Sigmoidoscopy visualizes the scale of inflammation in the lower colon and rectum. ‍
• biopsy. Microscopic examination of tissue removed during endoscopy can help differentiate between Crohn’s and ulcerative colitis.

(Source, Source)

Prognosis of Ulcerative Colitis

The severity of the disease and extent of inflammation provide insight into the progression of ulcerative colitis. Severity is determined by clinical symptoms and diagnostic tests, including blood, stool, endoscopy, and imaging. In 40% percent of newly diagnosed patients, ulcerative colitis is limited to the rectum. Twenty percent to 30% of patients have total colonic involvement, putting them at higher risk of colon cancer and the need for surgical intervention. (Source)

Potential Complications of Ulcerative Colitis

Potential complications of ulcerative colitis include:

• One in 3 people with ulcerative colitis experience inflammation-related complications in other parts of the body, including severe pain, swelling, stiffness in joints, tender bumps in the skin, mouth ulcers, redness, irritation, and itchiness in the eyes.
• Osteoporosis risk increases in people with ulcerative colitis. Steroid medications, dietary restrictions, and problems in nutrient absorption lead to nutrient deficiencies that can affect bone health.
• Children and teens may experience delays in growth and development.
• Primary sclerosing cholangitis (PSC) is a digestive condition characterized by inflamed and damaged bile ducts, small tubes that carry bile from the liver. Symptoms of PSC include fatigue, diarrhea, weight loss, yellowing skin, itchy skin, and chills.
• Toxic megacolon is a rare complication of ulcerative colitis. This severe complication occurs when the colon is enlarged and swollen due to trapped gas. Abdominal pain, a rapid heart rate, and high temperature are some of the symptoms.
• People with ulcerative colitis have a higher risk of developing bowel cancer. Symptoms include blood in stool, diarrhea, and abdominal pain. Because symptoms of bowel cancer are similar to common ulcerative colitis symptoms, diagnosis may be delayed. In order to reduce risk, it is recommended to eat a healthy and balanced diet, maintain a healthy weight, avoid smoking and alcohol, and get regular exercise.

(Source)

Treatment of Ulcerative Colitis

The treatment goal is to reach and maintain remission. Treatments used depend on the severity of disease.

• Aminosalicylates (5-ASAs) are medications that are used to heal damaged tissue by reducing inflammation. They are used as a short-term treatment in mild to moderate ulcerative colitis to ease flare-ups and as a long-term treatment to maintain remission.
• Corticosteroids are used to reduce inflammation. Sometimes 5-ASA therapy and corticosteroids are combined to treat flare-ups if one treatment is ineffective. Corticosteroids are not for long-term use due to their serious side effects, such as osteoporosis and cataracts.
• Immunosuppressants reduce immune system activity. They are given to treat mild to moderate flare-ups. They are also used to maintain remission in case symptoms do not go away with other medications. The downside is increased risk of infections because of suppressed immunity. Anemia is a risk, too.
• Biological therapies are used to ease inflammation resulting in remission, especially if the patient has not responded to other treatments. Examples of biological therapies:

• tumor necrosis factor (TNF) antagonists such as infliximab, certolizumab
• integrin receptor antagonists such as vedolizumab
• interleukin (IL) 12 and IL-23 antagonists such as ustekinumab

• Antibiotics and painkillers may be given to patients with ulcerative colitis, and diarrhea medications may be used to slow or stop severe diarrhea.

(Source, Source)

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Ulcerative Colitis Diet

There is no established diet that benefits all patients with ulcerative colitis, but some modifications in your diet can help with symptoms. Keeping a food diary helps you distinguish foods that trigger or reduce your symptoms. (Source)

Tracking your nutrition helps you identify foods that worsen symptoms and trigger flare-ups. Some foods and drinks generally worsen symptoms, including high sugar and high fat foods, carbonated beverages, and alcohol.

Temporarily eating a low-fiber diet improves symptoms during a flare-up in some patients. Low fiber or low residue foods include cooked vegetables (except for peel, seeds, or stalks), eggs, lean meat, fish, and white rice. Consult your care team before trying a low residue diet. (Source) If you’re unsure what nutritional approach is right for you and your ulcerative colitis, WellTheory’s Care Team Practitioners can create a personalized care plan inclusive of nutrition and supplementation.

General Diet Guidance: What You Can Eat in Remission

Proper nutrition is crucial if you have ulcerative colitis because you may be prone to nutrient deficiencies, weight loss, and malnutrition. In remission, you may benefit from the general diet guidance below; however, you should work with your health care provider, dietitian, or WellTheory Care Team to develop a suitable nutrition plan.

• Eat smaller portions of meals for better digestion.
• Eat probiotic foods such as yogurt, miso, kimchi, and tempeh.
• Include calcium-rich foods such as collard greens, kefir, and yogurt.
• Eat enough protein, such as lean meats, fish, eggs, and tofu.
• Eat fiber rich foods unless your health care provider advises otherwise.
• Stay well hydrated.
• Drink slowly and avoid using a straw, which may cause you to ingest air.
• Replace nutrients that are lacking in your diet with your health care provider’s guidance.
• Foods ulcerative colitis patients generally tolerate well include low fiber foods, lean protein, and refined grains, including gluten free bread, white pasta, white rice, and oatmeal.

Ulcerative colitis patients generally can't tolerate fruits with skin and seeds, raw green vegetables, whole grains, lactose, non-absorbable sugars such as sorbitol, sugary and high-fat foods, alcohol, caffeinated drinks, and spicy foods. (Source)

Holistic Approach to Ulcerative Colitis Management

Physical, mental, and social well-being are equally important for health, especially for complex diseases such as ulcerative colitis. Let's look at the research behind holistic approaches to ulcerative colitis.

A systematic literature review published in the Journal of Crohn's and Colitis investigated the effects of complementary and alternative medicines (CAM) on ulcerative colitis and Crohn's disease. Investigated CAM were herbal medicines, acupuncture, and mind/body interventions such as lifestyle modifications and mindfulness. Analysis of studies concluded that CAM therapies may be effective, but strong evidence is lacking. You should consult your health care provider before following specific treatments. (Source)

Diet is a huge part of a healthy digestive tract. Nutrients, especially vitamins and minerals, regulate physiological processes. Nutrient deficiency due to low absorption or low intake results in health problems. Always check with your health care provider before starting supplements to confirm they’re right for you and your condition. (Source)

When Should I Seek Medical Care for Ulcerative Colitis?

It is helpful to see get medical care for your ulcerative colitis when:

• Your symptoms come back, and you start feeling unwell. Signs of a flare-up you may experience include, but are not limited to, going to the toilet frequently (more than what is typical for you), diarrhea, bloody stool, abdominal pain, fatigue, lack of appetite, and weight loss
• You missed, skipped, or took the wrong dose of medication, or you're worried about the side effects you're experiencing from your medication.

(Source)

Where Can I Find the Best Resources About Ulcerative Colitis?

Outside of WellTheory’s Ultimate Guide to Ulcerative Colitis, we recommend looking at:

• Crohn's & Colitis Foundation
• IBD Support Foundation
• American Gastroenterological Foundation
• American College of Gastroenterology

The Bottom Line on Ulcerative Colitis

If you're newly diagnosed with ulcerative colitis or learning to manage your symptoms, you’re not alone. Getting support from friends, family, and people on similar paths is hugely important, along with sticking to a personalized care plan that takes your symptoms, nutrient status, and lifestyle into consideration.

Adopting a suitable diet, staying hydrated, getting good sleep, and prioritizing emotional health and mental well-being are a few things that help you manage the symptoms of ulcerative colitis.