A condition that causes inflammation and ulceration of the lining of the colon and the rectum, ulcerative colitis is thought to affect around one in 420 people in the UK, which according to the NHS amounts to about 146,000 people. It’s one of two main types of disorders that are grouped together under the term inflammatory bowel disease, the other being Crohn’s disease.
Ulcerative colitis affects both sexes equally, but it’s more common in urban rather than rural areas. It’s also more common in developed countries than in developing nations – though the number of cases in these countries are starting to increase too. White people of European descent – particularly those who originated from Ashkenazi Jewish communities – are more likely to develop ulcerative colitis than those from other ethnic groups.
You’re also more likely to develop ulcerative colitis in your younger years, as in most cases the condition is thought to start between the ages of 10 and 40, with many people first noticing symptoms between the ages of 15 and 25 (just one in seven cases first develop in the over 60s). Perhaps most surprising, however, is that ulcerative colitis is more common in non-smokers than smokers – though health experts strongly discourage smoking in people with or without ulcerative colitis, as the risks heavily outweigh any benefits it may have in terms of preventing the condition.
What are the symptoms?
Like many other conditions, the symptoms of ulcerative colitis vary from one person to the next, and range from mild to severe. These symptoms often flare up at times, and can be very mild or non-existent between flare-ups. Some people have remission periods – that is, when they’re not having a flare-up – that last for weeks, months or even years, while others have them more frequently. When you do have a flare-up, the main symptoms include the following:
Recurring diarrhoea, often with blood, mucus and pus.
Abdominal pain, including severe cramps.
Frequent bowel movements.
Other symptoms can include tiredness and fatigue, which can be caused by a lack of sleep if your symptoms are keeping you up at night or nutritional deficiencies such as anaemia (see Complications of ulcerative colitis, below), as well as feeling generally unwell. Some people can lose their appetite and lose weight during a flare-up too, as well as symptoms such as joint pain, eye irritation, mouth ulcers and swollen skin.
If you have severe ulcerative colitis, you may also be affected by more symptoms such as a fast or irregular heartbeat, shortness of breath and a high temperature.
There are also different types of ulcerative colitis, depending on how much of the colon is affected. These include proctitis, which is where only the rectum is inflamed; left-sided (distal) colitis, where inflammation affects the rectum as well as the left side of the colon; and extensive or total colitis (pancolitis), which is where most or all of the colon is affected.
What causes it?
Nobody really knows what causes ulcerative colitis exactly, but many experts believe it has something to do with a problem with the immune system – though the cause is widely believed to be a combination of immune system problems, genetics and environmental triggers.
Immune system problems
Ulcerative is considered by many to be an autoimmune condition, which is when your immune system attacks healthy tissue for some unknown reason. This causes the inflammation in the colon and rectum, though experts don’t know why this happens in some people and not in others.
According to the NHS, studies suggest more than one in four people with ulcerative colitis has a family history of the condition. The fact that it’s more common in certain ethnic groups also suggests genetics may play a part, and several genes have been identified that may make you more likely to develop it (some of these genes are involved in the immune system).
Since where you live can increase your risk of developing ulcerative colitis, experts also believe your environment may be to blame. However, while a number of environmental factors have been linked to ulcerative colitis – including viruses, bacteria, diet, stress, air pollution and medication – there’s still no definite evidence that any one causes it. According to the NHS, people living in countries with improved sanitation are more likely to develop ulcerative colitis, which suggests that reduced exposure to bacteria may be linked with the condition.
Complications of ulcerative colitis
Very severe flare-ups of ulcerative colitis can cause serious problems, as part of the colon can puncture or there may be severe bleeding. Other problems that can develop as a result of having ulcerative colitis include the following:
A common complication of inflammatory bowel disease, anaemia can cause tiredness, shortness of breath, headache, palpitations and general weakness. In most ulcerative colitis cases it’s usually caused by a lack of iron, either because of diet deficiencies or because of nutrient absorption problems. Ongoing blood loss can also cause anaemia, as can some of the medicines used to treat ulcerative colitis.
If you have ulcerative colitis your risk of developing bowel cancer is higher than normal, especially if you have severe symptoms or extensive/total colitis. The symptoms of bowel cancer are similar to those of ulcerative colitis, which means some people with ulcerative colitis don’t realise they may have bowel cancer. Since the risk of developing bowel cancer increases the longer you have ulcerative colitis, those who have had the condition for about 10 years usually have regular bowel cancer check-ups.
Two things can increase your risk of developing brittle bones – or osteoporosis – if you have ulcerative colitis. Some of the medicines used to treat ulcerative colitis can affect bone health (see corticosteroids, below); and if you avoid eating dairy foods because you believe they trigger your symptoms, you may not be getting enough calcium and vitamin D in your diet – which can have a negative effect on the strength of your bones. Indeed, some people with ulcerative colitis are advised to take vitamin D and calcium supplements to try to prevent bone health problems.
Primary schlerosing cholangitis
This is a condition that causes inflammation of the bile ducts of the liver. There is no cure, and those with severe symptoms may need a liver transplant. It is, however, a rare complication of ulcerative colitis.
Another rare but serious complication of severe ulcerative colitis, toxic megacolon can make the colon enlarged and swollen, making it more susceptible to splitting and causing septicaemia (blood infection).
Children and young people with ulcerative colitis may be affected by poor growth and development problems, including delayed puberty.
A type of arthritis affecting the spine, ankylosing spondylitis can also develop as a result of having ulcerative colitis.
Treatments for ulcerative colitis
If you suspect you have the symptoms of ulcerative colitis, it’s important to see your GP for a diagnosis. There are several tests carried out in hospitals that can diagnosed the condition, such as x-rays and scans, or you may need a procedure where a tube is inserted into your rectum, such as a sigmoidoscopy or a colonoscopy.
Once diagnosed, ulcerative colitis can be treated in different ways, depending on how severe your symptoms are and how often they flare up. Treatment usually involves taking one or more types of medicines, though some people may need surgery.
Often the first treatment option for mild or moderate ulcerative colitis, these drugs – such as sulphasalazine and mesalazine – can be used in the short term to treat flare-ups or in the long term to maintain remission from your symptoms. They’re available as tablets, suppositories or enemas, and are generally well tolerated with few side effects.
If aminosalicylates don’t control your symptoms you may be prescribed a steroid medicine to reduce the inflammation in your colon. These are only used to treat flare-ups, as long-term use can increase the risk of side effects, such as osteoporosis and cataracts.
Learn to relax
Medicines that reduce the activity of the immune system, immunosuppressants can be used to treat flare-ups as well as to maintain remission where aminosalicylates have proved ineffective. However they can make you more susceptible to infections as well as anaemia. Severe flare-ups are usually managed in hospital, and may include a type of steroid or immunosuppressant medicine along with intravenous fluids to help prevent dehydration.
This may be recommended if you have frequent flare-ups that affect your day-to-day life significantly or if you have a very severe flare-up that doesn’t respond to medication. The operation, called a colectomy, removes the colon permanently. This means you’ll no longer have any symptoms, but you may have to use a stoma bag, which is a bag fitted on the outside of your abdomen that collects waste from the small intestine that would have previously gone into the colon. Alternatively you may have surgery to remove the colon and create an ileo-anal pouch, where part of your small intestine is used to create an internal pouch that’s connected to your anus.
How diet and lifestyle helps
If you have ulcerative colitis, there are a few things you can do yourself to manage your symptoms and reduce your risk of complications.
Experts believe diet isn’t to blame for the development of ulcerative colitis, and that those who are affected should eat a normal healthy diet, which includes at least five portions of fruit and vegetables a day. Eating smaller, more frequent meals rather than three larger meals a day may be helpful, as will making sure you drink plenty of fluids (with ulcerative colitis you can lose a lot of fluid through diarrhoea).
Some foods, however, may make your symptoms worse, such as spicy foods, alcohol and caffeine. Try to identify which foods are among your triggers by keeping a food and symptoms diary. However, don’t eliminate entire food groups from your diet without your GP’s or specialist’s advice (some people with ulcerative colitis believe dairy foods trigger their symptoms, though there’s no evidence to suggest they are any more likely to be lactose intolerant than the general population).
Meanwhile, when you’re having a flare-up it may be a good idea to eat a low-fibre diet, as fibre can make diarrhoea worse. According to the NHS this means eating foods such as white bread, white rice, white pasta, cooked vegetables without the peel, seeds or stalks, eggs and lean meat and fish.
On the other hand if you’re affected by ulcerative colitis in the rectum only (proctitis), you may need to increase your fibre intake to help avoid constipation.
Supplement your diet
People with ulcerative colitis may not be able to absorb all the nutrients they need in their diet, so experts often recommend nutritional supplements. Speak to your GP or specialist about which supplements you may need.
Reduce your stress levels
The lower your level of stress, the less frequent your ulcerative colitis symptoms may become. Try relaxation techniques such as meditation, yoga or breathing exercises, and try to do some gentle exercise whenever you can, as it’s widely thought to help reduce stress and boost mood.
The anxiety and stress of having ulcerative colitis can also lead to low mood and depression. If you think you’re affected, speak to your GP.
Get some support
Living with a long-term illness can be difficult, but talking about it with others who know what you’re going through can help. The inflammatory bowel disease charity Crohn’s & Colitis offers telephone emotional support to anyone who needs to talk about their condition, whether they’ve recently been diagnosed with ulcerative colitis or they’ve had the condition for many years. Call 0121 737 9931 between 1 - 3pm and 6.30 - 9pm Monday to Friday or visit www.crohnsandcolitis.org.uk to find out more.
Natural support for ulcerative colitis
Nutritional supplements are often helpful for people with ulcerative colitis, as they can develop deficiencies in several nutrients for several reasons, such as absorption problems, poor appetite, diet restrictions and blood loss. Taking a good-quality daily multivitamin and mineral supplement may be useful as a way of making sure your body gets the nutrients it needs. It’s also a good idea to speak to your GP or specialist about identifying which nutrients you may be deficient in, and to find out if the nutritional supplements you’re taking are helping.
Meanwhile, other natural supplements that may be useful include the following:
There is some evidence that the essential fatty acids found in oily fish such as salmon, pilchards and sardines may help when you’re having a flare-up of ulcerative colitis (i), but researchers have yet to prove that they can prevent flare-ups in people whose ulcerative colitis has gone into remission. Some researchers also believe the essential fatty acids found in fish oils may help reduce inflammation caused by autoimmune disease (ii).
Thought to help promote a healthy intestinal bacterial environment, products containing live (or ‘friendly’) bacteria such as L acidophilus may be helpful for those who have ulcerative colitis. One study suggests supplementing with one type of live bacteria may be as effective as the aminosalicylate drug mesalazine in controlling the symptoms of ulcerative colitis and preventing flare-ups (iii). Other studies have produced similarly positive findings, with one also suggesting using live bacteria products may help maintain remission of ulcerative colitis symptoms (iv). There’s also some evidence that live bacteria may relieve joint pain associated with inflammatory bowel disease (v).
The active ingredient in turmeric – called curcumin – has been much studied in connection with a number of conditions, and is widely believed to have an anti-inflammatory effect. One study also suggests it may help prevent flare-ups in people with ulcerative colitis, with volunteers taking a curcumin supplement having significantly fewer relapses over a six-month period compared to those taking a placebo (vi).
An amino acid derived from glutamic acid (which is also an amino acid), glutamine is involved in immune health, as well as other bodily functions. Experts believe glutamine is needed by cells of the intestine for fuel, and there is some evidence to suggest it may help relieve the symptoms of inflammatory bowel disease (vii).
A collection of protein-digesting enzymes called proteolytic enzymes, bromelain is found in pineapple juice as well as in the stems of pineapple plants. It’s commonly used as a digestive enzyme, and is thought to help those with digestion problems. One animal study suggests bromelain may reduce the inflammation associated with inflammatory bowel disease (viii). An in vitro study has similarly found that bromelain may be a novel therapy for inflammatory bowel disease (ix).
Substances such as fructo-oligiosaccharides (FOS) are types of soluble fibre thought to improve the intestinal environment by helping to feed live bacteria in the gut. There is some evidence that fermentable fibre – including FOS – may have an intestinal anti-inflammatory action (x).
Setting up a treatment and management plan should help experience fewer flare-ups, and following the tips above can help you do this. To find more information about tips to help manage common health conditions, you can read the articles in our health library.
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Onken. JE, et al. Bromelain Treatment Decreases Secretion of Pro-Inflammatory Cytokines and Chemokines by Colon Biopsies In Vitro. Clin Immunol. 2008 Mar; 126(3): 345–352.
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Disclaimer: The information presented by Nature's Best is for informational purposes only. It is based on scientific studies (human, animal, or in vitro), clinical experience, or traditional usage as cited in each article. The results reported may not necessarily occur in all individuals. Self-treatment is not recommended for life-threatening conditions that require medical treatment under a doctor's care. For many of the conditions discussed, treatment with prescription or over the counter medication is also available. Consult your doctor, practitioner, and/or pharmacist for any health problem and before using any supplements or before making any changes in prescribed medications.
Christine Morgan has been a freelance health and wellbeing journalist for almost 20 years, having written for numerous publications including the Daily Mirror, S Magazine, Top Sante, Healthy, Woman & Home, Zest, Allergy, Healthy Times and Pregnancy & Birth; she has also edited several titles such as Women’ Health, Shine’s Real Health & Beauty and All About Health.