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Ulcerative Colitis

Dr Roger Henderson
Reviewed by Roger HendersonReviewed on 29.04.2024 | 4 minutes read

Ulcerative colitis (UC) is a condition where there is inflammation of the large bowel and rectum (the last part of the bowel where poo is stored). This inflammation can lead to serious problems including ulcers on the lining of the bowel. Those suffering complain of tummy pain and diarrhoea, and they often notice blood and mucus mixed in the stool.

Weight loss can occur as vital nutrients aren't absorbed and the body puts its resources into the inflammation process. You may also have a mild fever and feel easily fatigued, to the extent it's hard to get on with your daily tasks.

Symptoms can range from mild to severe, and there can be long periods of being symptom-free between flare-ups. How often you're opening your bowels can be a good marker of how bad the symptoms are. If you are opening your bowels more than six times a day this is a serious flare of symptoms.

Ulcerative colitis is a long-term condition and needs to be monitored and managed throughout your life. About 2 in 1,000 people in the UK develop ulcerative colitis and although it can develop at any age, it most commonly develops between the ages of 10 and 40. Only around 1 in 7 cases first develop it over the age of 60. Although it appears that non-smokers are slightly more likely than smokers to develop ulcerative colitis, the risk of smoking far outweighs any potential benefit here.

What causes ulcerative colitis?

Ulcerative colitis is an autoimmune condition, meaning the body starts attacking certain parts of itself as it recognises them as foreign, rather like it would with an infection which is a foreign invasion of viruses or bacteria.

The underlying cause is not known, but likely to be a complex mix of factors. Genetics plays a part – up to 1 in 5 people who develop UC have a close relative with it - and its course may be influenced by some aspects of diet and lifestyle, leading to the immune system acting inappropriately.

Treatment aims to reduce inflammation of the bowel with medications such as steroids, aminosalicylates and immunosuppressants. Some may need to stay on medications long term to control symptoms, and some may experience complications that require surgery to remove part of the bowel.

Other autoimmune or inflammatory conditions can be more common if you suffer from ulcerative colitis. It's common to get inflammation with the joints, especially those of the hand, eye problems, such as an inflammatory condition known as uveitis, skin problems, such as psoriasis, and a lower back problem called ankylosing spondylitis.

Ulcerative colitis is not contagious and cannot be passed on from person to person, but it may be inherited.

Is diet an important factor?

Ulcerative colitis is not linked to any kind of food intolerance, but there is some evidence that certain dietary changes may help symptoms - following a high-calorie diet or lactose-free diet are two examples. These may be recommended by your specialist team alongside medications to dampen down the inflammatory response.

There's some evidence that improving your gut microbiome balance could reduce inflammation and keep your condition under control. A recent study showed that Symprove, a probiotic supplement, reduced inflammatory markers in tests.

You could try anti-inflammatory foods such as those rich in omega 3, turmeric and Psyllium husk as soluble fibre. Vitamin C-rich foods and ginger may help protect the intestinal lining.

You are at risk of anaemia, so make sure you have enough iron-rich foods or you could try supplements, and seek out vitamin B foods or supplements to help with any fatigue.

Am I fit for work?

If you have a flare of ulcerative colitis, you are not fit to work. If your symptoms are manageable, you may be fit for work.

When should I see my doctor?

If you have diarrhoea with blood, mucus or abdominal pain, you should book an urgent appointment with your doctor. If the symptoms are severe or you are unwell, book an urgent doctor's appointment. If you are concerned, call 111 for urgent help over the phone.

The doctor will ask about your symptoms and, if necessary, examine you. Depending on the possible diagnosis, blood tests, urine or stool tests, or imaging (ultrasound, X-ray, CT scan) could be carried out, or you may be referred to a specialist department. The doctor may also prescribe some medication to help with your symptoms.

In the long term, it's likely you will have a hospital specialist team to monitor your condition and advise on treatment to best suit you. Once your ulcerative colitis is under good control, they may ask your doctor to take over care, but will be on hand for any future flare-ups.

Unfortunately, this condition also puts you at increased risk of bowel cancer. You will be under regular surveillance to monitor this, as symptoms of colitis and bowel cancer can appear similar, so it can be difficult to spot without regular tests.

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Dr Roger Henderson
Reviewed by Roger Henderson
Reviewed on 29.04.2024
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