Ulcerative Colitis (UC) and Crohn’s Disease Image of Woman Suffering Stomach Pains

What Is Ulcerative Colitis?

Ulcerative Colitis (UC) is an inflammatory bowel disease that causes inflammation and tiny open sores (ulcers) in the digestive tract (mainly in the large intestine). As a result, the ulcers that form produce pus and mucous- which can cause abdominal pain and the constant need to empty your colon.

Where Does Ulcerative Colitis Occur?

UC generally affects the innermost lining of the large intestine (colon) and rectum. However, inflammation can spread where it affects only a portion of your entire colon. Inflammation that is limited to the rectum is often referred to as ulcerative proctitis. This condition usually affects less than six inches of the rectum and is not associated with increased risks of cancer. If it is your entire colon, then it is called extensive colitis. Limited/distal colitis affects the left side of the colon. Continuous inflammation occurs in the rectum and can extend far into the colon. Proctosigmoiditis (which affects the rectum and lower colon) also falls under this type of UC.

What Are the Symptoms of Ulcerative Colitis?

For most individuals, UC tends to get worse over time. Some common symptoms that usually occur in the beginning are:

  • Diarrhea (often with blood, mucus, or pus)
  • Loose and urgent bowel movements
  • Rectal pain
  • Rectal bleeding
  • Inability to poop despite having the constant urge to use the restroom
  • Abdominal cramping
  • Tiredness
  • Nausea
  • Fever
  • Weight Loss
  • Anemia

How Is UC Diagnosed?

Your doctor may conduct:

  • Blood tests: Signs of infections and anemia (low levels of iron in the blood) can indicate if you have bleeding in the colon or rectum.
  • Stool samples: Signs of infection, parasite, and inflammation can appear in your stool. A stool sample can help your doctor eliminate the possibility of symptoms arrising due to parasites, viruses, or bacteria.
  • Imaging tests: Imagining tests such as an MRI scan or a CT scan allows your doctor to get a better look at your colon and rectum.
  • Endoscopic tests: An endoscope is a thin, flexible tool with a tiny camera at the end. Specialized doctors will slide the endoscope through the anus to get a better look at your rectum and/or colon.

Does Ulcerative Colitis Go Away?

UC is a lifelong chronic condition that currently has no cure. The inflammation can calm down (with the help of treatments) and allow you to get back to living your daily life. One may even go through periods of remission where symptoms go away for months/years- but eventually, the symptoms return.

What Are My Options for UC Treatments?

Even though there is no cure for UC, individuals do have the hope of working with their doctor to develop a combination of treatment options that can help control symptoms of the disease. These treatments include:

  • Medications: Certain medications can help suppress inflammation in the colon- which allows tissues to heal. Other medications can help manage symptoms (such as diarrhea, abdominal pain, etc.). Meanwhile, others can also help decrease the frequency and/or severity of a flare-up.
  • Combination Therapy: Your doctor may suggest adding another therapy that will help increase the effectiveness of your current medication therapy.
  • Diet and Nutrition: While foods do not directly cause UC, they can trigger flare-ups. We suggest meeting with your doctor to discuss a nutrition plan that helps reduce your symptoms/flares and ensures that you are getting enough nutrients.
  • Surgery: Getting surgery is not an easy decision. One may consider surgery if their medical therapy is unsuccessful (which means that symptoms are progressively getting worse) or specific complications have arisen. Surgery for UC may involve the removal of the colon and rectum (also known as proctocolectomy).

Is UC an Autoimmune Disease?

Generally, your immune system is supposed to protect you from threats such as infections and illnesses. However, autoimmune diseases lead to your immune system mistakingly attacking the healthy cells/tissue of your body. In the case of UC, it is an autoimmune disease that leads to overactivity of the immune systems- which results in the body attacking and damaging the healthy tissues of the gut. This defense response results in inflammation in the large intestine (as well as other symptoms).

What Is Crohn’s Disease?

Meanwhile, Crohn’s disease is an inflammatory bowel disease that affects any part of the GI tract from the mouth to the anus. However, Crohn’s usually occurs at the end of the small intestine and the beginning of the colon.

Is UC or Crohn’s More Common?

The number of cases for both diseases will vary between geographic locations. Some countries may have higher levels of Crohn’s disease. Meanwhile, other areas (such as Northern America) have higher levels of UC.

Is UC the Same as Crohn’s?

UC and Crohn’s are inflammatory bowel diseases that cause chronic inflammation in the digestive tract. While both conditions share similar symptoms, they do have their differences. UC occurs in the colon. Meanwhile, Crohn’s can occur anywhere between the mouth and anus. Also, with Crohn’s, you can have healthy areas in the intestine between inflammation areas. In UC, the colon is continuously inflamed. Generally, UC also affects the innermost lining of the large bowel (the colon and rectum). Crohn’s can occur in all layers of the bowel wall.

Crohn's Disease Illustration of Symptoms and Conditions

Is UC Worse than Crohn’s?

UC and Crohn’s are both long-term, inflammatory diseases that affect the digestive tract. One cannot definitively say which condition is worse. The level of the severity of disease depends between each individual and each individual’s experience will vary. Both diseases lead to changes in people’s lives.

Can You Have UC and Crohn’s at the Same Time?

So far, there is limited research on whether individuals can have both UC and Crohn’s at the same time. Generally, you are diagnosed with one or the other. However, it is possible to experience symptoms of both diseases. It is known as indeterminate colitis, and it only affects about 10% of people.

What Triggers an Ulcerative Colitis Flare Up?

There are many reasons and triggers that can lead to a UC flare-up. The exact causes of flare-ups are still unknown. Cintributing factors will vary between each individual. Some possible factors that may lead to a flare-up may include:

  • Missing, skipping, or taking the wrong dose of medication:Not taking your medications as prescribed can worsen symptoms. However, if you are taking your medication and are still experiencing flares- we highly encourage you to talk with your doctor.
  • Eating foods that irritate your GI tract:No diet is known to cure or cause flare-ups. However, there are specific foods you can avoid if it triggers a flare. These food items/categories will vary from person to person. We encourage you to use a diary (such as the food diary available in our FEBO app) to help you keep track of this information. Using a diary can also help you remember any observations you may want to discuss with your doctor. They will know of you need to make any possible changes in your diet.
  • Stress:Stress does not directly cause UC, but it can lead to a worsening of symptoms. Stress generally triggers a fight-or-flight response in your body. As a result, it can increases your heart rate, release cortisol (a stress hormone), and produce adrenaline. All of this can stimulate your immune system and lead to a worsening of symptoms.
  • Smoking: Studies show that it is possible for cigarettes to raise your risk of developing UC. They can also trigger a flare-up.
  • Antibiotics: Antibiotics often can change the bacteria in your intestine. This change can cause or lead to a worsening of diarrhea or inflammation. Consider talking with your doctor if you notice that antibiotics tend to trigger a UC flare-up.
  • NSAIDs:Specific medications (such as aspirin, naproxen, and ibuprofen) can worsen any symptoms and/or lead to inflammation.

What Does Ulcerative Colitis Pain Feel Like?

Levels of pain will vary from individual to individual (depending on the intensity of your condition). However, stomach pain and cramps are common symptoms that many people experience with UC. Some people describe that their cramps feel like pressure within the abdomen. Others say it feels like a punch to the gut- or a bruising and swollen sensation. Generally, most describe it as a stabbing, burning, or aching sensation.

What Foods Trigger UC?

As mentioned briefly above, trigger foods will vary from individual to individual. We encourage you to keep a food diary (like the food diary available in our FEBO app) to track what foods trigger any flares. Discussing possible diet changes with your doctor will also help you develop a plan that ensures you are getting the proper nutrients you need throughout the day. Some potential trigger foods may include:

  • Insoluble foods that are hard to digest: fruits with skin and seeds, raw and stringy veggies (such as onions, celery, broccoli, cabbage, and Brussel sprouts) , whole nuts, wild rice, and whole grains
  • Lactose: diary products such as milk, soft cheeses, and cream cheese
  • Non-absorbable sugars: sorbitol, mannitol, and sugar-free items (such as gum, candy, ice cream), and certain types of fruits and juices (such as pear, peach, and prune)
  • Sugary foods: pastries, candy, juices
  • Foods high in fat or unhealthy fats: butter, coconut, magazine, cream, and fast-foods
  • Alcohol and caffeinated drinks: beer, wine, liquor, soda, and coffee
  • Spicy foods

What to Eat during an Ulcerative Colitis Flare Up?

Generally, experts recommend you eat more easily digestible foods when experiencing a UC flare. For example, you could eat:

  • Apple sauce
  • Low fiber fruits (bananas, cantaloupe, honeydew melon, and cooked fruits)
  • Cooked, seedless, and non-cruciferous vegetables (asparagus tips, cucumbers, potatoes, and squash)
  • Probiotics (such as yogurt)
  • Lean protein (fish, lean cuts of pork, white meat poultry, soy, eggs, and firm tofu)
  • Refined grains (sourdough, potato or gluten-free bread, white pasta, white rice, and oatmeal)
  • Water or drinks that help replace lost carbohydrates and electrolytes
  • Fruit juice with no pulp (avoid prune juice)

However, it is best to work with a registered dietician to help form a better plan on what foods you should avoid or limit. They will also help you find out what foods best suit your stomach when expecting a flare.

What Is the Life Expectancy of Someone with Ulcerative Colitis?

Given the advancements in medicine and technologies, people with UC can expect to have the same life expectancy as someone without UC. Seeking medical attention to receive treatment is crucial to prevent any complications (some of which may be life-threatening).

What Is the Main Cause of Ulcerative Colitis?

It is still unknown what directly causes UC. However, many studies show that these factors (or a combination of them) may lead to the development of UC:

  • Genetics and Heredity: Genes tend to play a significant role in the development of UC. It does not mean that someone with a family history will definitively develop UC (or that someone with no family history will never get it). However, many studies have found a correlation between UC and family history. Certain ethnic groups seem to have a higher chance of developing UC.
  • Environmental Factors:While no fully understood, studies show that where and how you live plays a role in your chances of developing UC. Environmental factors such as air pollution, medication, exposure to bacteria, and certain diets may be linked to UC.
  • Immune System Response:Swelling and inflammation of the body tissue in the infected area results because our immune system fights infections by releasing white blood cells to destroy the cause of infection. It is theorized that people with IBD (such as ulcerative colitis) have an immune system that mistakes “friendly bacteria” in the colon as a harmful infection. Thus, this leads to the colon and rectum becoming inflamed. Other researchers think that a viral/bacterial infection triggers the immune system, but it does not turn off once the infection has passed. Thus, inflammation still persists even after the infection has cleared up. Others believe that UC results from a malfunction of the immune system. Or that there is an imbalance between the good and bad bacteria in the bowel system.

Ulcerative Colitis Types Illustration Comparison Medical

What Organs Does Ulcerative Colitis Affect?

UC generally affects the lining of the large intestine (colon) and rectum. Of course other parts of your body may be affected as a result of UC symptoms, inflammation, or the medications you take.

Can Ulcerative Colitis Cause Back Pain?

Many studies have found a link between UC and back/joint pain. Some types of arthritis (such as ankylosing spondylitis, which involves inflammation of the spine) and back pain that are linked/related to UC. Lower back pain may result from the fact that the nerves of the back and abdominal area run through the lower part of the spine.

Can Ulcerative Colitis Cause Cancer?

Unfortunately, people with UC have a higher risk of developing colorectal cancer. Therefore, one needs to be more aware about screenings for colorectal cancer. Continuous inflammation (as a result of UC) can lead to a continuous turnover of cells in the intestinal lining- which increases the chance of irregularities forming within cells and leading to cancer. While many people with UC do not develop colon cancer- it is critical for one to seek medical treatment to find a treatment that best suits them. Especially when treatment of colorectal cancer is more successful if caught early enough.

Can Ulcerative Colitis Cause Constipation?

Inflammation in the rectum does increase your chance of experiencing constipation. Constipation usually occurs in a type of UC known as proctitis. In proctitis, your pelvic floor does not relax- which can interfere/make it difficult to pass stools. People who also have distal ulcerative colitis (which affects the left side of the colon) may also experience constipation on the right side of the colon-also known as proximal constipation.

What Else Triggers Ulcerative Colitis?

Genetics do play a significant role in the development of UC. However, some people with UC don’t have a family history. Other possible triggers may include:

  • diets high in fat, sugar, and meat (but low in omega-3 fatty acids and vegetables)
  • Vitamin D deficiency
  • Use of NSAIDs
  • Infections with bacteria and viruses (such as E. coli, Salmonella, and measles)
  • Antibiotic exposure in childhood
  • Lack of exposure to bacteria and other germs in childhood- does not allow the immune system to develop normally

How Long Does an Ulcerative Colitis Flare Last?

The answer to this question will vary for each individual. Some flare-ups can last for a few days or a few weeks- others last for much longer. Some people may even enter into a period of remission (where they don’t experience any symptoms) that can last for months or even years. The duration of flare-ups will vary on many factors and the level of severity of the disease.

Is Ulcerative Colitis a Disability?

UC can result in some individuals experiencing severe symptoms that can negatively impact their quality of life and ability to do certain things. Some people with severe complications of UC may be eligible to qualify for disability benefits. Besides obtaining a diagnosis from your doctor, you will also have to show more evidence of having certain complications resulting from UC. We encourage you to talk with your doctor and do more research to find out if you qualify for disability benefits.

Is Ulcerative Colitis Genetic?

Yes, genetics play a significant role in the development of UC within specific individuals. Certain studies have found correlations between twins, ethnicity, and families. People with a family history of UC tend to have a higher risk of developing UC within their life. This occurrence suggests a genetic inheritance component in the development of the disease. Researchers and studies have also found many genetic variations and changes that have been linked to the disease.

When Does Ulcerative Colitis Require Hospitalization?

Some people may experience acute UC, which means that individuals may experience severe symptoms that require them to go to the hospital. You may want to seek hospital treatment if you:

  • Have more than six bowel movements within a day for multiple days in the row
  • Have blood in your stool for many days
  • Have a high body temperature and heart rate
  • Have severe abdominal pain

Other complications that may arise (in serious situations) include:

  • Perforated colon- Uncontrolled inflammation damages/weaken the lining of the colon. This damage leads to a hole developing in the wall of the colon, which allows bacteria to spill into your stomach. This spill may lead to dangerous/life-threatening infections such as sepsis.
  • Fulminant colitis- Fulminant colitis is a severe form of UC that often requires hospitalization. Uncontrolled inflammation often causes the colon to swell and expand. If left untreated, this type of colitis can become life-threatening.
  • Toxic megacolon- Untreated fulminant colitis can progress to toxic megacolon. If left untreated, the colon can rapture and lead to life-threatening complications. If steroids and IV fluids do not work to calm the swelling, surgery may be required to prevent the colon from rupturing.
  • Severe Dehydration- Persistent dehydration may lead to severe dehydration. With UC, your body can lose a lot of fluid with constant bowel movements. Some may be able to treat dehydration by drinking more water. Severe dehydration requires hospitalization to receive IV fluids.
  • Rectal bleeding- Heavy rectal bleeding may require you to seek medical attention since there is little you can do at home.

Can You Be an Organ Donor with Ulcerative Colitis?

UC does not immediately exclude you from being an organ donor. However, if your UC affects your organs besides your intestines- you will probably not be able to donate.

Sources: www.crohnscolitisfoundation.org, www.mayoclinic.org, my.clevelandclinic.org,

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