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Digestive health centre

Ulcerative colitis

What is ulcerative colitis?

Ulcerative colitis is a long-term inflammatory bowel disease causing inflammation of the colon and rectum.

The main symptoms of ulcerative colitis are frequent diarrhoea, abdominal pain and needing to empty the bowels often.

Small ulcers and abscesses in the lining of the colon can cause bleeding and the discharge of pus.

There may be periods where symptoms of ulcerative colitis go away, but return with uncomfortable flare-ups.

What are the symptoms of ulcerative colitis?

Symptoms of ulcerative colitis include:

Ulcerative colitis may also be associated with weight loss, skin disorders, joint pain or soreness, eye problems, anaemia (a deficiency of red blood cells), blood clots and an increased risk of colon cancer.

What causes ulcerative colitis?

The cause of ulcerative colitis remains unknown, but it is likely caused by an abnormal response of the immune system. Food or bacteria in the intestines, or even the lining of the bowel may cause the uncontrolled response of the immune system associated with ulcerative colitis.

Who gets ulcerative colitis?

Ulcerative colitis can be inherited. Up to 20% of people with inflammatory bowel disease have a first-degree relative (mother, father, brother, sister) with the disease.

The disease is most common in the US and northern Europe and in people of Jewish (Ashkenazi) descent. Around 146,000 people in the UK have ulcerative colitis.

How is ulcerative colitis diagnosed?

A variety of diagnostic procedures and laboratory tests are used to distinguish ulcerative colitis from other conditions. First your doctor will review your medical history and perform a complete physical examination. One or more of the following tests may be arranged:

How is ulcerative colitis treated?

Treatment can include drug therapy, dietary modifications and/or surgery. Though treatments not involving surgery cannot cure ulcerative colitis, they can help most people lead normal lives.

It is important for you to seek treatment as soon as you start having symptoms. If you have severe diarrhoea and bleeding, hospital admission may be necessary to prevent or treat dehydration, reduce your symptoms and ensure that you receive correct nutrition.


Several medications - including aminosalicylate drugs, corticosteroids, immunosuppressive agents and antibiotics - are used to reduce inflammation of the bowel tissue, allowing it to heal and relieve symptoms.

  • Aminosalicylates. Mesalazine and sulfasalazine are principal medications in the treatment of ulcerative colitis.
  • Corticosteroids. These anti-inflammatory medications can be used when aminosalicylates are ineffective. Corticosteroids are also used to treat people who have more severe disease. The use of corticosteroids is limited by side effects and the potential of long-term complications. In general, corticosteroids are used for short periods of time to cause remission. Remission is maintained with an aminosalicylate medication.
  • Immunosuppressants. If corticosteroids or aminosalicylates are not effective, immunosupressants such as azathioprine may be prescribed.
  • Biologicals. These include TNF-alpha inhibitors, for example infliximab, adalimumab or golimumab that may be recommended if other treatments have not been effective, and the monoclonal antibody vedolizumab.

WebMD Medical Reference

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