Ulcerative colitis: symptoms, causes, treatment and which doctor to see
What ulcerative colitis is, the symptoms of a flare, how it is told apart from infections, the medicines that control it, and when urgent care is needed.
Also known as: Colitis; Colitis gravis; Distal colitis; Idiopathic proctocolitis; Inflammatory Bowel Disease; Inflammatory bowel disease, ulcerative colitis type and 3 more
Pancolitis; UC; Ulcerative proctitis
What ulcerative colitis is
Ulcerative colitis (UC) is a long-term condition in which the lining of the large intestine (colon) and rectum becomes inflamed and develops small sores, or ulcers. It is one of the two main types of inflammatory bowel disease (IBD); the other is Crohn's disease. UC always starts in the rectum and can extend continuously up part or all of the colon. When only the rectum is affected it is called ulcerative proctitis; when the whole colon is involved it is called pancolitis.
UC usually follows a pattern of flares, when symptoms are active, and remission, when they settle. It can start at any age but most often begins in teenagers and young adults. It is not the same as irritable bowel syndrome, which does not cause inflammation, ulcers or bleeding. With modern treatment most people with UC lead full lives, working, travelling and raising families.
Symptoms
Symptoms depend on how much of the colon is inflamed and how active the disease is. About half of people have mild symptoms. Common features of a flare are:
- Bloody diarrhoea, or blood and mucus (sometimes pus) in the stool
- Urgency — a sudden need to rush to the toilet — and frequent trips, including at night
- A feeling of not having fully emptied the bowel
- Abdominal pain or cramping, often in the lower left side, eased by passing stool
- Tiredness, often due to inflammation and anaemia from blood loss
- Weight loss and loss of appetite
- Fever in more severe flares
UC can also affect other parts of the body: joint pain or swelling, red and painful eyes, painful red lumps or ulcers on the skin, mouth ulcers and, less commonly, liver and bile duct problems. In children, it can slow growth.
Causes and risk factors
The exact cause is not known. UC appears to result from the immune system reacting inappropriately to the gut lining and the bacteria that normally live there, in people with a genetic tendency, influenced by environmental factors. It tends to run in families. It is not caused by stress or by a particular food, although both can affect how you feel. It is not contagious.
Inflammatory bowel disease was once thought to be rare in India, but it is now increasingly diagnosed, especially in cities. At the same time, bloody diarrhoea in India is often caused by infections such as amoebic dysentery or bacterial dysentery, and intestinal tuberculosis can mimic IBD. That is why careful testing is needed before the diagnosis is confirmed and long-term treatment begins.
How it is diagnosed
- Blood tests to check for anaemia, inflammation (such as CRP), and liver and kidney function
- Stool tests to rule out bacterial, amoebic and other infections, which must be excluded before diagnosing UC
- Faecal calprotectin — a stool test for a protein released by inflamed bowel; it helps tell IBD from irritable bowel syndrome and track activity
- Colonoscopy — a flexible camera passed through the back passage to look at the rectum and colon; a shorter sigmoidoscopy may be used in a severe flare
- Biopsy — small tissue samples taken during the scope to confirm the diagnosis under a microscope and look for other causes such as tuberculosis
- Imaging such as an X-ray or CT scan during a severe flare to check for complications
Treatment
There is no medicine that makes UC disappear for good, but treatment can settle flares, keep the disease in remission, and heal the bowel lining. The plan depends on how much of the colon is involved and how severe the inflammation is.
- Aminosalicylates (5-ASA medicines) — the usual first treatment for mild to moderate UC, taken by mouth and often also as suppositories or enemas for the rectum; usually continued to prevent flares
- Corticosteroids — to bring a moderate or severe flare under control quickly; used for short courses only, not for long-term maintenance, because of side effects
- Immunomodulators — medicines that dampen the immune response, used when steroids are needed too often; they require regular blood tests
- Biologic medicines and newer targeted tablets — for moderate to severe UC that does not respond to other treatment; you will be screened for tuberculosis and hepatitis before starting
- Surgery — removal of the colon (colectomy), sometimes with an internal pouch made from the small intestine, for disease that cannot be controlled with medicines, for a severe flare that does not respond, or for precancerous changes; removing the colon and rectum ends the disease in the bowel
A severe flare — many bloody stools a day with fever, a fast pulse or anaemia — needs hospital admission for intravenous treatment and close monitoring, with surgeons involved early. Take medicines even when you feel well, and do not stop them without talking to your gastroenterologist; stopping maintenance treatment is a common cause of flares.
Living with ulcerative colitis
- There is no single UC diet; eat a balanced diet, and during a flare your doctor or a dietitian may suggest temporary changes such as softer, lower-fibre foods
- Drink plenty of fluids during diarrhoea, and keep oral rehydration solution handy
- Avoid regular use of non-steroidal painkillers, which can trigger flares; ask your doctor what is safe
- Get your anaemia, vitamin D and bone health checked, particularly after steroid courses
- Keep vaccinations up to date, and ask which vaccines to have before starting immune-suppressing medicines
- Long-standing UC raises the risk of colorectal cancer, so your gastroenterologist will advise regular surveillance colonoscopies after some years
- Plan pregnancy with your doctor, as keeping UC in remission is important for mother and baby
- Look after your mental health; anxiety and low mood are common with any chronic illness, and talking about them helps
When it is an emergency
Call 112 or 108, or go to the nearest emergency department, if you have:
- Heavy bleeding from the back passage, or passing clots
- Severe abdominal pain, or a swollen, tense abdomen
- High fever with frequent bloody diarrhoea
- Signs of dehydration or blood loss — dizziness, fainting, a racing heart, very little urine
Contact your doctor promptly if a flare is not settling with your usual treatment, if you need to go to the toilet many more times a day than usual, or if you develop new joint, eye or skin symptoms. See also our guide to gastrointestinal bleeding.
Which doctor to see
A general physician can start investigations for ongoing diarrhoea or rectal bleeding, but UC should be diagnosed and managed by a gastroenterologist. A GI surgeon joins the team when surgery is considered, and a dietitian can help with nutrition. Children are best looked after by a paediatric gastroenterology team.
You can find gastroenterologists in Bengaluru or GI surgeons in Bengaluru on The Doctor Index, each with a registration you can check.
Common questions
Questions people ask
- What is the difference between ulcerative colitis and Crohn's disease?
- Both are inflammatory bowel diseases. Ulcerative colitis affects only the lining of the colon and rectum, in a continuous stretch starting from the rectum. Crohn's disease can affect any part of the gut, often in patches, and can involve the full thickness of the bowel wall.
- Can ulcerative colitis be cured?
- Medicines cannot remove the condition permanently, but they can control inflammation and keep many people in long remission. Surgery to remove the colon and rectum ends the disease in the bowel, but it is a major decision usually reserved for when medicines are not enough.
- What foods should I avoid with ulcerative colitis?
- No specific food causes UC, and there is no single diet that suits everyone. Some people notice certain foods worsen symptoms during a flare. Keeping a food and symptom diary and working with a dietitian helps you avoid unnecessary restrictions.
- Does ulcerative colitis increase the risk of cancer?
- Long-standing UC that affects much of the colon increases the risk of colorectal cancer over time. Keeping inflammation under control and having regular surveillance colonoscopies as your gastroenterologist advises helps find and treat early changes.
This condition is usually assessed by a gastroenterologist. Every profile shows the doctor’s registration and what has been checked.
Gastroenterologists in Bangalore
A few gastroenterologists listed on The Doctor Index. They are shown because of their speciality, not a stated interest in Ulcerative Colitis; ask the clinic whether the doctor sees it.
Related conditions
- Celiac Disease
- Constipation
- Crohn's Disease
- Diarrhea
- Diverticulosis and Diverticulitis
- Foodborne Illness
- Gallstones
- Gastroenteritis
All gastroenterology conditions →
Practical reading
All postsSources
- MedlinePlus, US National Library of Medicine — Ulcerative Colitis
- Government of India — Emergency Response Support System (112)
- MedlinePlus, National Library of Medicine — Ulcerative Colitis — Public-domain health-topic summary
- Human Phenotype Ontology Consortium — terminology definitions — HPO licence; definitions reproduced without alteration
Ulcerative colitis: symptoms, causes, treatment and which doctor to see is original text by The Doctor Index; the compiled source draft was used for research. Source: MedlinePlus, National Library of Medicine. Orphadata Science: Free access data from Orphanet. © INSERM 1999; July 2026 data, CC BY 4.0. This product uses the Human Phenotype Ontology (hp/releases/2026-09-01). Only sources listed for this article apply. Source material has been selected and arranged; HPO definitions are reproduced without alteration. No source organisation endorses this compilation. Köhler S et al. The Human Phenotype Ontology project: linking molecular biology and disease through phenotype data. Nucleic Acids Research 2014;42(D1):D966–D974. doi:10.1093/nar/gkt1026.
General information, not advice about your situation. Errors can be reported through the corrections process. Reference TDI-C-2380.