Ulcerative colitis is a type of inflammatory bowel disease that affects the large intestine and rectum.

The cause of ulcerative colitis is unknown. It may affect any age group, although there are peaks at ages 15 - 30 and then again at ages 50 - 70.

The disease usually begins in the rectal area and may eventually extend through the entire large intestine. Repeated swelling (inflammation) leads to thickening of the wall of the intestine and rectum with scar tissue. Death of colon tissue or sepsis may occur with severe disease.

The symptoms vary in severity and may start slowly or suddenly. Many factors can lead to attacks, including respiratory infections or physical stress.

Risk factors include a family history of ulcerative colitis, or Jewish ancestry. The incidence is 10 to 15 out of 100,000 people.

• Abdominal pain and cramping that usually disappears after a bowel movement
• Abdominal sounds (a gurgling or splashing sound heard over the intestine)
• Diarrhea, from only a few episodes to very often throughout the day (blood and mucus may be present)
• Fever
• Tenesmus
• Weight loss

Other symptoms that may occur with ulcerative colitis include the following:

• Gastrointestinal bleeding
• Joint pain
• Nausea and vomiting

• Barium enema
• Colonoscopy with biopsy

Your doctor may also order the following blood tests:

• Complete blood count (CBC)
• C-reactive protein (CRP)
• Sedimentation rate (ESR)

The goals of treatment are to:

• Control the acute attacks
• Prevent repeated attacks
• Help the colon heal

Hospitalization is often required for severe attacks. Your doctor may prescribe corticosteroids to reduce inflammation.

Medications that may be used to decrease the number of attacks include:

• 5-aminosalicylates such as mesalamine
• Immunomodulators such as azathioprine and 6-mercaptopurine

An intravenous medicine called infliximab has also been shown to improve symptoms of ulcerative colitis.

Surgery to remove the colon will cure ulcerative colitis and removes the threat of colon cancer. Patients may need an ostomy (a surgical opening in the abdominal wall), or a procedure that connects the small intestine to the anus to help the patient gain more normal bowel function.

Surgery is usually for patients who have colitis that does not respond to complete medical therapy, or patients who have serious complications such as:

• Rupture (perforation) of the colon
• Severe bleeding (hemorrhage)
• Toxic megacolon

Social support can often help with the stress of dealing with illness, and support group members may also have useful tips for finding the best treatment and coping with the condition.

For more information visit the Crohn's and Colitis Foundation of America (CCFA) web site at www.ccfa.org.

The course of the disease generally varies. Ulcerative colitis may be inactive and then get worse over a period of years. Sometimes ulcerative colitis can progress quickly. A permanent and complete cure is unusual.

The risk of colon cancer increases in each decade after ulcerative colitis is diagnosed.

• Ankylosing spondylitis
• Cancer
• Colon narrowing
• Complications of corticosteroid therapy
• Impaired growth and sexual development in children
• Inflammation of the joints
• Lesions in the eye
• Liver disease
• Massive bleeding in the colon
• Mouth ulcers
• Pyoderma gangrenosum (skin ulcer)
• Tears or holes (perforation) in the colon

Call your health care provider if you develop persistent abdominal pain, new or increased bleeding, persistent fever, or other symptoms of ulcerative colitis.

Call your health care provider if you have ulcerative colitis and your symptoms worsen or do not improve with treatment, or if new symptoms develop.

Because the cause is unknown, prevention is also unknown.

Nonsteroidal anti-inflammatory drugs (NSAIDs) may make symptoms worse.

Due to the risk of colon cancer associated with ulcerative colitis, screening with colonoscopy is recommended.

The American Cancer Society recommends having your first screening:

• 8 years after you are diagnosed with severe disease, or when most of, or the entire, large intestine is involved
• 12 - 15 years after diagnosis when only the left side of the large intestine is involved

Have follow-up examinations every 1 - 2 years.

Graham L. AGA reviews the use of corticosteroids, immunomodulators, and infliximab in IBD. Am Fam Physician. 2007;75:410-412.

Moyer MS. Chronic ulcerative colitis in childhood. J Pediatr. 2006;148:325.

Langan RC. Ulcerative colitis: diagnosis and treatment. Am Fam Physician. 2007;76:1323-1330.