Are you unintentionally losing weight? Experiencing unexplained, frequent bouts of diarrhea? Constantly feeling like you're bogged down with the flu (think, fatigue, nausea, and joint pain), only to be dismissed by the doctor because you’re “perfectly fine, no sign of bacterial or viral infection”? If yes, then, at this point, it’s only natural to suspect that you, like approximately a million people in the United States, may have ulcerative colitis (1).

This article covers the ins and outs of ulcerative colitis—from what it is to its symptoms to management methods—so you’re one step closer to figuring out what’s wrong with you (and how you could potentially get better).

What is ulcerative colitis? 

Ulcerative colitis (UC for short) is one of the two main forms of inflammatory bowel disease (IBD) (2, 3, 4). The other is Crohn’s disease (note: UC is three times more common than Crohn’s disease). Many experts consider UC an autoimmune disease—where the immune system mistakenly attacks healthy tissue. In the case of UC, specifically, the immune system ruthlessly attacks the colon's lining or mucosa, creating open, bleeding, pus-filled ulcers (5). Large armies of white blood cells then rush to the open wounds, triggering widespread inflammation. 

UC often starts in the rectum (the final portion of your large intestine that connects to your anus) but can spread through the whole colon. There are four different types of UC (6):

• Ulcerative proctitis: The “mildest” type of UC. Inflammation is limited to the rectum.

• Proctosigmoiditis: Inflammation extends beyond the rectum, involving the sigmoid colon (i.e., the lower end of the colon).

• Left side ulcerative colitis: Here, inflammation involves the rectum, sigmoid colon, and descending colon (which is, yep, you guessed it: the left part of your colon).

• Pancolitis: Inflammation affects the entire colon.  

What causes ulcerative colitis? 

While scientists still aren’t sure what causes UC, they believe the following factors play a contributing role:

Abnormal immune response 

Research suggests that UC could be triggered by an interaction between a virus or bacterial infection in the colon and the body’s (abnormal) immune response (7, 8, 9, 10). A normal immune response would cause temporary inflammation to fend off an illness or infection. The inflammation would then subside. In individuals with UC, however, the inflammation persists long after the immune system should have finished its job. As a result, the body continues sending white blood cells into the intestinal lining, promoting chronic inflammation and creating ulcers. 

Genetics 

Having a close family member with a form of IBD increases your risk of developing UC. Research indicates that up to 20% of UC patients have a first-degree relative—i.e., parents, siblings, and children—who also have the condition (11). 

Microbiome

A growing body of evidence shows that individuals with UC have a markedly reduced richness, uniformity, and biological diversity of the intestinal microbiome (i.e., “gut bacteria”) compared to healthy controls (12). It's also becoming increasingly clear that those with UC have a lower percentage of potentially protective bacteria species—"good" gut bacteria—than healthy individuals (13, 14). 

Environmental factors

There are two major environmental factors researchers believe may play a role in promoting the development of UC. The first is industrialization. Individuals in more developed countries (where UC is more common) are typically exposed to fewer microbes due to living in extremely clean homes; this may lead to alterations in gut bacteria, increasing the risk of UC in some people (15, 16, 17, 18). 

The second is the consumption of a "Western-style diet", which is high in processed carbohydrates and animal proteins or fats while being lower in dietary fiber, fresh fruits, and vegetables (19). Scientists theorize that this diet “style” may contribute to the development of UC by affecting helpful gut bacteria. 

Symptoms of ulcerative colitis

Here are some of the most common symptoms of UC (20):

• Bloody stools: Remember those ulcers (also known as open sores) we discussed earlier? That's where the blood in your stools or diarrhea comes from. 

• Abdominal pain and cramping: Surprisingly, those pesky ulcers aren’t responsible for the pain. Instead, according to a 2013 study, it comes down to a combination of abdominal cramping and bowel distension (i.e., stretching) due to inflammation (21). 

• The constant urge to have a bowel movement: This could be a constant, phantom urge (i.e., you don't have anything to poop out) or a real urgent need to run to the bathroom. It's frustrating either way. 

• Fatigue: Research shows that fatigue affects up to 80% of individuals with active inflammatory bowel disease (22). 

• (Unintended) weight loss and malnutrition: If you're plagued with abdominal cramps, bowel movement urges, and rectal pain, it's only understandable if you struggle to see the appeal of food. Chronic under-eating could then lead to weight loss and malnutrition.  

• Nausea: With all that inflammation in the GI tract, nausea can sometimes be an issue. This side effect is more commonly seen in more severe types of UC where inflammation affects larger portions of the colon.

• Joint pain: Not all UC symptoms are related to the digestive system. Sometimes, people can experience extraintestinal complications (i.e., symptoms outside the bowels). The most common one? Arthritis. According to research, it occurs in up to 30% of individuals with IBD (23). 

• Eye issues: When UC affects the eyes, it can cause eye pain and blurry vision, which could, scarily enough, lead to permanent vision loss if not treated right away (24). You may also notice inflammation and redness in the whites of your eyes.

Diagnosis

Regardless of whether you’re experiencing a handful of, or all the UC symptoms listed above, it’s always a good idea to visit your doctor for an official diagnosis (this way, you won’t have to play the guessing game—“Do I or do I not have UC?”—late into the night). Tests to diagnose UC include blood and stool tests, CT scans, endoscopy, biopsy, and colonoscopy (25). 

Ulcerative colitis treatment

Medications used to treat ulcerative colitis include (26, 27, 28):

• Anti-inflammatory medication: These drugs suppress inflammation. Examples include 5-aminosalicylates (5-ASA drugs), such as mesalamine, sulfasalazine, balsalazide, olsalazine, and corticosteroids. 

• Immunomodulators: These medications modify the activity of your immune system, in turn lowering inflammation levels in the colon. Examples include methotrexate and thiopurine drugs. However, it’s worth noting that current guidelines don’t recommend these as standalone treatments. 

• Biologics: Refers to medications developed from blood, proteins, viruses, or living organisms. Like anti-inflammatory medications and immunomodulators, biologics improve UC symptoms by essentially blocking inflammation.    

For those with severe UC (e.g., experience substantial blood loss, colon perforation, and debilitating symptoms), medications may not be enough—and that’s where surgery comes into play. The most common UC surgery is a proctocolectomy, which removes the colon and rectum.

Diet and lifestyle changes

Whether you’re looking to limit your use of UC medications (in hopes of side-stepping side effects like increased risk of cardiovascular events) or reduce flare-up frequency, incorporating the following diet and lifestyle changes may help: 

Prioritize anti-inflammatory foods

Who said you could only depend on medications to keep your inflammation levels low? The foods you eat could help, too. Ditch the "Western-style diet" and take inspiration from a Mediterranean-style diet instead. Focus on whole grains, beans, nuts, and seeds, lots of fruits and vegetables, and some amounts of low-fat dairy and lean protein sources (29, 30). Many of these foods are rich in antioxidants. You may also wish to add antioxidant supplements, like Alpha-Lipoic Acid, Turmeric Curcumin, and Royal Jelly, into your inflammation-fighting toolbox (31, 32, 33, 34, 35, 36).   

Load up on fermented foods

As mentioned earlier, gut dysbiosis—an imbalance of gut microbiota—is common in individuals with UC. To nudge your gut microbiome into a healthier place, shoring up your body's levels of beneficial gut bacteria through probiotic-rich foods is an excellent place to start (37, 38). That’s where fermented foods like yogurt, tempeh, and miso come in. Not a big fan of how fermented foods taste? Probiotic supplements (e.g., Dr. Danielle’s Probiotics) could work just as well. It may also be worthwhile throwing Dr. Danielle’s Gut Assist into the mix to bolster your body’s ability to heal those ulcers.    

Find a stress reduction strategy that works for you

Research shows that stress can exacerbate UC symptoms (39, 40, 41). So, managing your stress levels could help you prevent UC flare-ups. Meditation, deep breathing, exercise, and aromatherapy are some of the most effective stress reduction techniques you could try (42). If you're looking for quicker relief—where you don't have to find a quiet space, sweat, or light candles—then Dr. Danielle’s Stress Lift will be right up your alley. Formulated with a hefty helping of ashwagandha, one of nature’s most potent stressbusters, it'll help you find your zen in no time (43).

You can get ulcerative colitis under control

A diagnosis of UC (if you’re indeed diagnosed with the condition) can be stressful and emotionally straining. But, as outlined in this article, many effective treatment and management options are available to you. While it may take some time for you and your doctor to figure out the best way to get your UC under control, find comfort in the fact that most UC patients achieve remission (44). It’s thus likely that you will eventually get to a point where you can do anything or go anywhere without worrying about the proximity of the nearest toilet, too.