Ulcerative Colitis

Written by A/Prof Viraj Kariyawasam, Gastroenterologist

1. What is Ulcerative Colitis?

Ulcerative colitis is a chronic inflammatory bowel disease that causes inflammation and ulceration of the inner lining of the large bowel (colon) and rectum. Unlike Crohn’s disease, ulcerative colitis affects only the colon and does not involve the small intestine. The inflammation usually starts in the rectum and may extend continuously through part or all of the colon.

Ulcerative colitis can affect people of any age, but it commonly begins in adolescence or early adulthood, with a second smaller peak later in life. It is a lifelong condition characterised by periods of flare-ups and remission.

2. Causes & Risk Factors

The exact cause of ulcerative colitis is not known. It is believed to result from an abnormal immune response to normal gut bacteria in people with a genetic predisposition.

Having a close family member with ulcerative colitis or Crohn’s disease increases risk. The condition is more common in developed countries, including Australia. Certain medications, such as non-steroidal anti-inflammatory drugs, may worsen symptoms or trigger flares.

3. Symptoms & How It May Present

Symptoms depend on the extent and severity of inflammation. Common symptoms include diarrhoea containing blood or mucus, urgency to open the bowels, abdominal cramping, and the sensation of incomplete bowel emptying.

Other symptoms may include fatigue, weight loss, fever, and anaemia. Some people experience symptoms outside the bowel, such as joint pain, skin rashes, eye inflammation, or mouth ulcers.

4. How Is It Diagnosed?

Diagnosis is based on symptoms, examination, and investigations. Blood tests may show inflammation or anaemia, and stool tests are used to exclude infection.

Colonoscopy is the key diagnostic test, allowing direct visualisation of the colon and biopsy sampling. Flexible sigmoidoscopy may be used in severe flares. Imaging such as CT or MRI scans may be required to assess complications.

5. Treatment & Management Options

Treatment aims to control inflammation, achieve remission, and prevent flare-ups. Management is individualised based on disease severity and extent.

Medications may include anti-inflammatory drugs, corticosteroids for short-term control, immune-modifying therapies, and biologic or targeted treatments. In severe or treatment-resistant cases, surgery to remove the colon may be required, which can be curative for ulcerative colitis.

6. Living With / Managing Ulcerative Colitis

With appropriate treatment, many people with ulcerative colitis lead full and active lives. Long-term management focuses on maintaining remission and monitoring for complications.

Taking medications consistently, attending regular follow-up, maintaining good nutrition, and managing stress are important. People with long-standing ulcerative colitis usually require regular colonoscopy to screen for bowel cancer.

7. Prevention & Risk Reduction

There is no proven way to prevent ulcerative colitis. However, early diagnosis and appropriate treatment reduce complications and improve long-term outcomes.

For people with ulcerative colitis, adherence to treatment and routine surveillance colonoscopy are key to reducing cancer risk.

8. When to Seek Medical Advice

Medical review is recommended if symptoms worsen, do not respond to usual treatment, or new symptoms develop.

Urgent medical attention is required for severe abdominal pain, heavy bleeding, fever, dehydration, or signs of severe colitis such as rapid heart rate or severe weakness.