What is Ulcerative colitis?

Ulcerative colitis is a chronic condition that causes inflammation of the inner lining of the large bowel (colon and rectum). It is a form of inflammatory bowel disease. The cause remains unknown, although it can tend to run in families.


The main symptoms include loose watery stools (diarrhoea), with associated rectal bleeding, mucus or pus. In addition, abdominal pain, weight loss and incontinence to stool may occur. Occasionally, other areas of the body may show signs of inflammation, including skin rashes, pain/irritation around the eyes or painful and swollen joints.


Symptoms of colitis can be investigated with blood tests, stool tests, rigid sigmoidoscopy and biopsy in the outpatient clinic, or colonoscopy, where a flexible camera is used to investigate the lower bowel and potentially take biopsies to help with diagnosis. There are a number of different causes of colitis, such as Crohn’s disease, and it is important to be as sure as possible which is the one responsible so the correct treatment can be started.


Generally, initial treatments will be aimed at controlling inflammation with medication (including steroids, 5-ASA drugs, immunosuppressive drugs such as azathioprine, methotrexate and 6-MP, or biologic anti-TNF agents such as Infliximab and Humira). These treatments may be given by mouth (tablets), suppositories/enemas or injections. If the medication is not sufficient, if side-effects develop or if pre-cancerous or cancerous changes occur in the large bowel, surgery may be required.

Ulcerative colitis can be cured with surgery. Options will include removal of the entire colon, rectum and anus (panproctocolectomy) with a permanent stoma, known as an ileostomy, or an initial removal of the colon (subtotal colectomy) with formation of an ileostomy. Subsequently, the rectum and anus could be removed with the ileostomy being permanent, or the rectum could be removed and an ileoanal pouch performed. The idea of an ileoanal pouch is to form a reservoir to store stool. This restores the ability to go to the toilet using the anus again, and therefore living without an ileostomy/stoma. Your surgeon will discuss this procedure with you in more detail, if appropriate. All of these procedures can be carried out using laparoscopic (keyhole) or traditional open surgery.

Those patients with extensive ulcerative colitis for more than 10 years have a higher risk of developing bowel cancer. If this is the case, your consultant will discuss regular examination of the bowel by colonoscopy with you.