Diagnosis

Your doctor will likely diagnose ulcerative colitis after ruling out other possible causes for your signs and symptoms. To help confirm a diagnosis of ulcerative colitis, you may have one or more of the following tests and procedures:

  • Blood tests. Your doctor may suggest blood tests to check for anemia — a condition in which there aren't enough red blood cells to carry adequate oxygen to your tissues — or to check for signs of infection.
  • Stool sample. White blood cells in your stool can indicate ulcerative colitis. A stool sample can also help rule out other disorders, such as infections caused by bacteria, viruses and parasites.
  • Colonoscopy. This exam allows your doctor to view your entire colon using a thin, flexible, lighted tube with an attached camera. During the procedure, your doctor can also take small samples of tissue (biopsy) for laboratory analysis. Sometimes a tissue sample can help confirm a diagnosis.
  • Flexible sigmoidoscopy. Your doctor uses a slender, flexible, lighted tube to examine the rectum and sigmoid, the last portion of your colon. If your colon is severely inflamed, your doctor may perform this test instead of a full colonoscopy.
  • X-ray. If you have severe symptoms, your doctor may use a standard X-ray of your abdominal area to rule out serious complications, such as a perforated colon.
  • CT scan. A CT scan of your abdomen or pelvis may be performed if your doctor suspects a complication from ulcerative colitis. A CT scan may also reveal how much of the colon is inflamed.
  • Computerized tomography (CT) enterography and magnetic resonance (MR) enterography. Your doctor may recommend one of these noninvasive tests if he or she wants to exclude any inflammation in the small intestine. These tests are more sensitive for finding inflammation in the bowel than are conventional imaging tests. MR enterography is a radiation-free alternative.

Treatment

Ulcerative colitis treatment usually involves either drug therapy or surgery.

Several categories of drugs may be effective in treating ulcerative colitis. The type you take will depend on the severity of your condition. The drugs that work well for some people may not work for others, so it may take time to find a medication that helps you. In addition, because some drugs have serious side effects, you'll need to weigh the benefits and risks of any treatment.

Anti-inflammatory drugs

Anti-inflammatory drugs are often the first step in the treatment of ulcerative colitis. They include:

  • 5-aminosalicylates. Examples of this type of medication include sulfasalazine (Azulfidine), mesalamine (Asacol HD, Delzicol, others), balsalazide (Colazal) and olsalazine (Dipentum). Which one you take, and whether it is taken by mouth or as an enema or suppository, depends on the area of your colon that's affected.
  • Corticosteroids. These drugs, which include prednisone and hydrocortisone, are generally reserved for moderate to severe ulcerative colitis that doesn't respond to other treatments. Due to the side effects, they are not usually given long term.

Immune system suppressors

These drugs also reduce inflammation, but they do so by suppressing the immune system response that starts the process of inflammation. For some people, a combination of these drugs works better than one drug alone.

Immunosuppressant drugs include:

  • Azathioprine (Azasan, Imuran) and mercaptopurine (Purinethol, Purixan). These are the most widely used immunosuppressants for treatment of inflammatory bowel disease. Taking them requires that you follow up closely with your doctor and have your blood checked regularly to look for side effects, including effects on the liver and pancreas.
  • Cyclosporine (Gengraf, Neoral, Sandimmune). This drug is normally reserved for people who haven't responded well to other medications. Cyclosporine has the potential for serious side effects and is not for long-term use.
  • Infliximab (Remicade), adalimumab (Humira) and golimumab (Simponi). These drugs, called tumor necrosis factor (TNF) inhibitors, or biologics, work by neutralizing a protein produced by your immune system. They are for people with severe ulcerative colitis who don't respond to or can't tolerate other treatments.
  • Vedolizumab (Entyvio). This medication was recently approved for treatment of ulcerative colitis for people who don't respond to or can't tolerate other treatments. It works by blocking inflammatory cells from getting to the site of inflammation.

Other medications

You may need additional medications to manage specific symptoms of ulcerative colitis. Always talk with your doctor before using over-the-counter medications. He or she may recommend one or more of the following.

  • Antibiotics. People with ulcerative colitis who run fevers will likely take antibiotics to help prevent or control infection.
  • Anti-diarrheal medications. For severe diarrhea, loperamide (Imodium) may be effective. Use anti-diarrheal medications with great caution and after talking with your doctor, because they may increase the risk of toxic megacolon (enlarged colon).
  • Pain relievers. For mild pain, your doctor may recommend acetaminophen (Tylenol, others) — but not ibuprofen (Advil, Motrin IB, others), naproxen sodium (Aleve), and diclofenac sodium (Voltaren), which can worsen symptoms and increase the severity of disease.
  • Iron supplements. If you have chronic intestinal bleeding, you may develop iron deficiency anemia and be given iron supplements.

Surgery

Surgery can often eliminate ulcerative colitis. But that usually means removing your entire colon and rectum (proctocolectomy).

In most cases, this involves a procedure called ileal pouch anal anastomosis. This procedure eliminates the need to wear a bag to collect stool. Your surgeon constructs a pouch from the end of your small intestine. The pouch is then attached directly to your anus, allowing you to expel waste relatively normally.

In some cases a pouch is not possible. Instead, surgeons create a permanent opening in your abdomen (ileal stoma) through which stool is passed for collection in an attached bag.

Cancer surveillance

You will need more-frequent screening for colon cancer because of your increased risk. The recommended schedule will depend on the location of your disease and how long you have had it.

If your disease involves more than your rectum, you will require a surveillance colonoscopy every one to two years. You will need a surveillance colonoscopy beginning as soon as eight years after diagnosis if the majority of your colon is involved, or 15 years if only the left side of your colon is involved.

Clinical trials

Explore Mayo Clinic studies testing new treatments, interventions and tests as a means to prevent, detect, treat or manage this disease.

Lifestyle and home remedies

Sometimes you may feel helpless when facing ulcerative colitis. But changes in your diet and lifestyle may help control your symptoms and lengthen the time between flare-ups.

There's no firm evidence that what you eat actually causes inflammatory bowel disease. But certain foods and beverages can aggravate your signs and symptoms, especially during a flare-up.

It can be helpful to keep a food diary to keep track of what you're eating, as well as how you feel. If you discover that some foods are causing your symptoms to flare, you can try eliminating them. Here are some suggestions that may help:

Foods to limit or avoid

  • Limit dairy products. Many people with inflammatory bowel disease find that problems such as diarrhea, abdominal pain and gas improve by limiting or eliminating dairy products. You may be lactose intolerant — that is, your body can't digest the milk sugar (lactose) in dairy foods. Using an enzyme product such as Lactaid may help as well.
  • Limit fiber, if it's a problem food. If you have inflammatory bowel disease, high-fiber foods, such as fresh fruits and vegetables and whole grains, may make your symptoms worse. If raw fruits and vegetables bother you, try steaming, baking or stewing them.

    In general, you may have more problems with foods in the cabbage family, such as broccoli and cauliflower, and nuts, seeds, corn and popcorn.

  • Avoid other problem foods. Spicy foods, alcohol and caffeine may make your signs and symptoms worse.

Other dietary measures

  • Eat small meals. You may find you feel better eating five or six small meals a day rather than two or three larger ones.
  • Drink plenty of liquids. Try to drink plenty of fluids daily. Water is best. Alcohol and beverages that contain caffeine stimulate your intestines and can make diarrhea worse, while carbonated drinks frequently produce gas.
  • Talk to a dietitian. If you begin to lose weight or your diet has become very limited, talk to a registered dietitian.

Stress

Although stress doesn't cause inflammatory bowel disease, it can make your signs and symptoms worse and may trigger flare-ups.

To help control stress, try:

  • Exercise. Even mild exercise can help reduce stress, relieve depression and normalize bowel function. Talk to your doctor about an exercise plan that's right for you.
  • Biofeedback. This stress-reduction technique helps you reduce muscle tension and slow your heart rate with the help of a feedback machine. The goal is to help you enter a relaxed state so that you can cope more easily with stress.
  • Regular relaxation and breathing exercises. An effective way to cope with stress is to perform relaxation and breathing exercises. You can take classes in yoga and meditation or practice at home using books, CDs or DVDs.

Alternative medicine

Many people with digestive disorders have used some form of complementary and alternative (CAM) therapy.

Some commonly used therapies include:

  • Herbal and nutritional supplements. The majority of alternative therapies aren't regulated by the FDA. Manufacturers can claim that their therapies are safe and effective but don't need to prove it. What's more, even natural herbs and supplements can have side effects and cause dangerous interactions. Tell your doctor if you decide to try any herbal supplement.
  • Probiotics. Researchers suspect that adding more of the beneficial bacteria (probiotics) that are normally found in the digestive tract might help combat the disease. Although research is limited, there is some evidence that adding probiotics along with other medications may be helpful, but this has not been proved.
  • Fish oil. Fish oil acts as an anti-inflammatory, and there is some evidence that adding fish oil to aminosalicylates may be helpful, but this has not been proved.
  • Aloe vera. Aloe vera gel may have an anti-inflammatory effect for people with ulcerative colitis, but it can also cause diarrhea.
  • Acupuncture. Only one clinical trial has been conducted regarding its benefit. The procedure involves the insertion of fine needles into the skin, which may stimulate the release of the body's natural painkillers.
  • Turmeric. Curcumin, a compound found in the spice turmeric, has been combined with standard ulcerative colitis therapies in clinical trials. There is some evidence of benefit, but more research is needed.

Preparing for your appointment

Symptoms of ulcerative colitis may first prompt you to visit your family doctor or general practitioner. Your doctor may recommend you see a specialist who treats digestive diseases (gastroenterologist).

Because appointments can be brief, and there's often a lot of information to discuss, it's a good idea to be well-prepared. Here's some information to help you get ready, and what to expect from your doctor.

What you can do

  • Be aware of any pre-appointment restrictions. At the time you make the appointment, be sure to ask if there's anything you need to do in advance, such as restrict your diet.
  • Write down any symptoms you're experiencing, including any that may seem unrelated to the reason for which you scheduled the appointment.
  • Write down key personal information, including any major stresses or recent life changes.
  • Make a list of all medications, vitamins or supplements that you're taking. Be sure to let your doctor know if you're taking any herbal preparations, as well.
  • Ask a family member or friend to come with you. Sometimes it can be difficult to remember all the information provided to you during an appointment. Someone who accompanies you may remember something that you missed or forgot.
  • Write down questions to ask your doctor.

Your time with your doctor is limited, so preparing a list of questions ahead of time can help you make the most of your time. List your questions from most important to least important in case time runs out. For ulcerative colitis, some basic questions to ask your doctor include:

  • What's the most likely cause of my symptoms?
  • Are there other possible causes for my symptoms?
  • What kinds of tests do I need? Do these tests require any special preparation?
  • Is this condition temporary or long lasting?
  • What treatments are available, and which do you recommend?
  • What types of side effects can I expect from treatment?
  • Are there any prescription or over-the-counter medications I need to avoid?
  • What sort of follow-up care do I need? How often do I need a colonoscopy?
  • Are there any alternatives to the primary approach that you're suggesting?
  • I have other health conditions. How can I best manage them together?
  • Are there certain foods I can't eat anymore?
  • Will I be able to keep working?
  • Can I have children?
  • Is there a generic alternative to the medicine you're prescribing me?
  • Are there any brochures or other printed material that I can take with me? What websites do you recommend?

What to expect from your doctor

Your doctor is likely to ask you a number of questions. Being ready to answer them may reserve time to go over points you want to spend more time on. Your doctor may ask:

  • When did you first begin experiencing symptoms?
  • Have your symptoms been continuous or occasional?
  • How severe are your symptoms?
  • Do you have abdominal pain?
  • Have you had diarrhea? How often?
  • Have you recently lost any weight unintentionally?
  • Does anything seem to improve your symptoms?
  • What, if anything, appears to worsen your symptoms?
  • Have you ever experienced liver problems, hepatitis or jaundice?
  • Have you had any problems with your joints, eyes, skin rashes or sores, or had sores in your mouth?
  • Do you awaken from sleep during the night because of diarrhea?
  • Have you recently traveled? If so, where?
  • Is anyone else in your home sick with diarrhea?
  • Have you taken antibiotics recently?
  • Do you regularly take nonsteroidal anti-inflammatory drugs, such as ibuprofen (Advil, Motrin IB, others) or naproxen sodium (Aleve)?

Ulcerative colitis care at Mayo Clinic

July 28, 2017
References
  1. Goldman L, et al., eds. Inflammatory bowel disease. In: Goldman-Cecil Medicine. 25th ed. Philadelphia, Pa.: Saunders Elsevier; 2016. https://www.clinicalkey.com. Accessed May 10, 2017.
  2. Feldman M, et al. Ulcerative colitis. In: Sleisenger and Fordtran's Gastrointestinal and Liver Disease: Pathophysiology, Diagnosis, Management. 10th ed. Philadelphia, Pa.: Saunders Elsevier; 2016. https://www.clinicalkey.com. Accessed June 20, 2017.
  3. What is ulcerative colitis? Crohn's and Colitis Foundation of America. http://www.crohnscolitisfoundation.org/what-are-crohns-and-colitis/what-is-ulcerative-colitis/. Accessed June 20, 2017.
  4. Ulcerative colitis. National Institute of Diabetes and Digestive and Kidney Diseases. https://www.niddk.nih.gov/health-information/digestive-diseases/ulcerative-colitis. Accessed June 20, 2017.
  5. Ungaro R, et al. Ulcerative colitis. The Lancet. 2017;389:1756.
  6. MacDermott RP. Management of mild to moderate ulcerative colitis in adults. https://www.uptodate.com/contents/search. Accessed June 20, 2017.
  7. Peppercorn MA, et al. Clinical manifestations, diagnosis, and prognosis of ulcerative colitis in adults. https://www.uptodate.com/contents/search. Accessed June 20, 2017.
  8. Ferri FF. Ulcerative colitis. In: Ferri's Clinical Advisor 2018. Philadelphia, Pa.: Elsevier; 2018. https://www.clinicalkey.com. Accessed June 20, 2017.
  9. AskMayoExpert. Chronic ulcerative colitis. Rochester, Minn.: Mayo Foundation for Medical Education and Research; 2017.
  10. Complementary and alternative medicine (CAM). Crohn's and Colitis Foundation. http://www.crohnscolitisfoundation.org/resources/complementary-alternative.html. Accessed June 21, 2017.
  11. Inflammatory bowel disease. Natural Medicines. https://naturalmedicines.therapeuticresearch.com. Accessed June 21, 2017.
  12. Yanai H, et al. Complementary therapies in inflammatory bowel diseases. Current Gastroenterology Reports. 2016;18:62.
  13. Diet, nutrition, and inflammatory bowel disease. Crohn's and Colitis Foundation of America. http://www.crohnscolitisfoundation.org/. Accessed May 15, 2017.
  14. Brown A. Allscripts EPSi. Mayo Clinic, Rochester, Minn. April 3, 2017.
  15. Rajan E (expert opinion). Mayo Clinic, Rochester, Minn. July 4, 2017.