Digestive Disorders > IBD > Ulcerative Colitis

Ulcerative colitis: All you need to know

Dr. med. Andre Sommer

Dr. med. Andre Sommer

Ulcerative colitis is a chronic inflammatory bowel disease (IBD) of the colon. It leads to severe diarrhea in those affected. The disease often occurs in young adulthood (between the ages of 20 and 35 years). Thanks to medication, many sufferers can lead a largely symptom-free life.

How does ulcerative colitis develop?

The cause of the onset of chronic inflammation of the colon has not yet been definitively clarified, but experts suspect genetic and environmental factors interact, here. The risk of getting ulcerative colitis is the same for both men and women.

Experts do agree that ulcerative colitis disturbs the natural barrier function of the large intestine. The gut can no longer successfully fend off certain bacteria and other unwanted pathogens. This leads to a persistent inflammatory reaction for the person concerned.

What are the symptoms of ulcerative colitis?

Ulcerative colitis causes inflammation of the large intestine (colitis) with damage to the intestinal mucosa (ulcerations). This inflammation leads to the following symptoms:

  • Bloody-slimy diarrhea
  • Greatly increased stool frequency (more than five times per day)
  • Painful bowel urgency (Tenesmen)
  • Abdominal pain, often left-sided
  • Partial fever, often severe

Does ulcerative colitis only affect the intestine?

Although ulcerative colitis mainly affects the large intestine, the disease can spread to other organs. Doctors speak of a so-called “extraintestinal manifestation” here. In 2-4 percent of those affected, this leads to an inflammation of the liver and the bile ducts (this disease is called primary sclerosing cholangitis). In rare cases, the skin, eyes, or joints can be affected.

Ulcerative colitis can lead to these complaints:

  • Painful joints
  • Aphthae in the oral mucosa
  • Painful and inflammatory rashes
  • Inflammation of the eyes

In 10-20 percent of those affected, there is also a return of intestinal content from the colon back into the end of the small intestine (terminal ileum). This also causes an inflammatory reaction there.

Inflammation in the small intestine can lead to the following symptoms:

  • Weight loss
  • Bile acid deficiency
  • Vitamin B-12 deficiency

Where does the inflammation occur with ulcerative colitis?

Inflammation is essentially confined to the colon. The disease begins in the rectum, the last section of the large intestine before the anus. From there, it spreads continuously in the large intestine (up the intestine). Only rarely does the inflammation spread from the large intestine to the small intestine (terminal ileum). Depending on the spread of inflammation, ulcerative colitis is divided into proctitis (inflammation of the rectum), left-sided colitis (inflammation to the bowel curve), or extensive colitis.

The tissue in the colon is made up of different layers. In ulcerative colitis, the inflammatory response and resulting damage (ulcers) are limited to the superficial mucosal layers.

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What is the course of ulcerative colitis?

The course of ulcerative colitis varies individually. In most cases, however, phases in which symptoms develop alternate with symptom-free intervals (chronic intermittent form). The time span in which typical symptoms such as bloody-slimy diarrhea and pain occur is also called thrust. The symptom-free phase is called remission. The remission can be achieved by medication. About 60 percent of those affected experience a milder course of the disease.

Remission is the aim of treatment of ulcerative colitis as it is a chronic disease that is usually not curable. In some cases, healing can be achieved by complete removal of the inflamed colon.

The table shows an overview of the different forms of ulcerative colitis. However, the shapes can merge, so the frequencies can vary slightly.

Course form Description Frequency
Chronic-intermittent Disease outbreak and complete remission alternating 80%
Chronic-continuous Disease intensity varies but no complete remission 10-15%
Acute-fulminant Sudden onset of symptoms with particular severity 5%

How is ulcerative colitis diagnosed?

In addition to the typical symptoms of ulcerative colitis (including bloody-slimy diarrhea), the doctor makes the diagnosis using various examination methods. The most important diagnostic method is a colonoscopy. The doctor can look at the affected large intestine mucosa and remove tissue samples. These samples are examined in the laboratory to determine if ulcerative colitis is present.

Examination Findings with ulcerative colitis
Blood test - Signs of inflammation

Further testing:

- Iron test

- Kidney function

- Liver values (transaminases and cholestasis)

Stool examination - Exclusion of infection by microbiological examination

- Proof of mucosal inflammation

Sonography and other imaging techniques - Thickening of the colon wall

- Only the large intestine affected

Colonoscopy - Reddened mucous membrane

- Bleeding on contact

- Mucous-membrane ulcers

- Change in mucosal structure

- Only colon affected

Biopsy - Inflammatory cells in the mucosa

How is ulcerative colitis treated?

Ulcerative colitis is primarily treated by medication. Which drug is chosen depends on the severity of the episode and its course. In addition, how the colon is affected (infestation pattern) plays a role. Generally, a distinction is made between acute therapy in the thrust and a remission-preserving therapy.

Surgical removal of the inflamed colon sections is one treatment option with ulcerative colitis. However, this only comes into question if a drug therapy was unsuccessful or not possible.

Ulcerative colitis can be a very debilitating condition for sufferers. Visiting a self-help group can provide important support here. In some cases, psychotherapy is also advisable. This is especially true for sufferers who additionally suffer from an eating disorder such as anorexia (anorexia nervosa).

What nutritional recommendations are there for ulcerative colitis?

There are no specific nutritional recommendations for ulcerative colitis in medical guidelines. In general, however, people should eat foods that are well tolerated and pay attention to a balanced diet. In case of a severe attack, a low-fiber diet may be necessary.

There is also evidence that excessive consumption of soft drinks and a generally unhealthy diet style promotes the disease. No such influence has been proven with coffee. Subjective compatibility differs among individuals: 20 percent of respondents said they feel that consuming coffee would aggravate discomfort.

Generally, patients with ulcerative colitis have an increased risk of malnutrition. Dietary supplements can be helpful if there is a deficiency; however, a generic dietary supplement is not recommended.

Does ulcerative colitis increase the risk of other diseases?

Due to persistent inflammatory processes in the colon, there is a long-term danger that large intestinal cells will degenerate. Therefore, sufferers have an increased risk of colorectal cancer (colorectal carcinoma). Since colorectal cancer has a very serious course, regular check-ups are particularly important. Depending on one’s risk profile, doctors may recommend that a colonoscopy be performed as often as once per year.


Ulcerative colitis can be treated well through a variety of treatment options. The life expectancy of patients does not decrease with a normal course of the disease.


Trying to have children: What do you need to consider?

Since the disease occurs between the age of 20 and 30 years, this question is important for many patients. There is a genetic component to ulcerative colitis, but children of those affected are healthy in 95 percent of the cases.

Drug therapy usually does not limit fertility in men. Women should have a discussion with their gynecologist and gastroenterologist if they want to have children to ensure optimal therapy during pregnancy.

Nie J-Y, Zhao Q. Beverage consumption and risk of ulcerative colitis: Systematic review and meta-analysis of epidemiological studies. Medicine (Baltimore). 2017;96(49):e9070. doi:10.1097/MD.0000000000009070

Hou J, Abraham B, El-Serag H. Dietary Intake and Risk of Developing Inflammatory Bowel Disease: A Systematic Review of the Literature. American Journal of Gastroenterology. 2011;106(4):563-573. doi:10.1038/ajg.2011.44

Rashvand S, Behrooz M, Samsamikor M, Jacobson K, Hekmatdoost A. Dietary patterns and risk of ulcerative colitis: a case-control study. J Hum Nutr Diet. 2018;31(3):408-412. doi:10.1111/jhn.12544

Packer N, Hoffman-Goetz L, Ward G. Does physical activity affect quality of life, disease symptoms and immune measures in patients with inflammatory bowel disease? A systematic review. J Sports Med Phys Fitness. 2010;50(1):1-18.

Nowarski R, Jackson R, Gagliani N, et al. Epithelial IL-18 Equilibrium Controls Barrier Function in Colitis. Cell. 2015;163(6):1444-1456. doi:10.1016/j.cell.2015.10.072

Barthel C, Wiegand S, Scharl S, et al. Patients’ perceptions on the impact of coffee consumption in inflammatory bowel disease: friend or foe?--a patient survey. Nutr J. 2015;14:78. doi:10.1186/s12937-015-0070-8

Langhorst J, Wulfert H, Lauche R, et al. Systematic Review of Complementary and Alternative Medicine Treatments in Inflammatory Bowel Diseases. J Crohns Colitis. 2015;9(1):86-106. doi:10.1093/ecco-jcc/jju007

Rossi R, Whyand T, Murray C, Hamilton M, Conte D, Caplin M. The role of dietary supplements in inflammatory bowel disease: a systematic review. European Journal of Gastroenterology & Hepatology. 2016;28(12):1357-1364. doi:10.1097/MEG.0000000000000728

[Updated S3-Guideline Colitis ulcerosa. German Society for Digestive and Metabolic Diseases (DGVS) - AWMF Registry 021/009]. Z Gastroenterol. 2018;56(9):1087-1169. doi:10.1055/a-0651-8174

Dr. med. Andre Sommer

Dr. med. Andre Sommer

I’m André, a medical doctor from Berlin. Together with a team of medical doctors, nutritionists and data scientists we empower people to understand digestive issues with our app Cara.

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