Ulcerative colitis (UC) is a chronic disease that causes inflammation and
ulcers (open sores) in the innermost layers of the large intestine. UC is an
inflammatory bowel disease (IBD), the general name for diseases that cause
inflammation in the intestines. In UC, swelling typically occurs in the rectum
and lower colon, but the inflammation can spread throughout the entire colon.
The ulcers bleed and produce pus and mucus, and the inflammation causes the
colon to empty frequently, resulting in diarrhea.
UC is a rare, but serious disease that affects 50 out of every 100,000 people
in the United States. Although the condition most commonly affects those between
the ages of 15 and 35, children and older adults may also develop the disease.
UC occurs five times more frequently in those with a Jewish heritage than it
does in the general population. Although most people with UC can be successfully
treated without surgery, roughly 25% will need a colectomy (surgical removal of
Signs and Symptoms
The most common signs and symptoms of UC include abdominal pain and bloody
diarrhea. The symptoms can range from mild to severe and may come on either very
suddenly or more gradually.
Other common symptoms of UC include:
Frequent, even continuous diarrhea
Urgent desire to defecate
Abdominal cramps and pain
Loss of appetite
People with UC are at increased risk for malnutrition. UC can also cause a
host of other problems, including arthritis, eye infections, liver disease, skin
rashes, blood clots, or gallstones. Although it is not clear why such problems
occur outside the colon, some researchers speculate that they may be linked to a
faulty immune response.
There are many theories regarding the cause of UC, but none have been proven.
The most likely theory is that UC is caused by a variety of factors ranging from
genetics, faulty immune system reactions, stress, environmental influences, and
even diet. For example, some people are genetically at risk for UC (it runs in
their family), and an infection or other toxin may stimulate inflammation of the
large intestine. In some cases, stressful events or sensitivities to certain
foods may trigger symptoms of UC.
Family history of UC
Jewish heritage, especially Ashkenazi Jews
A diet high in sugar, cholesterol, and fat (particularly from meat and
A healthcare practitioner will perform a thorough physical exam as well as a
series of tests to diagnose UC. Blood tests may reveal a high white blood cell
count (a sign of inflammation somewhere in the body). Stool samples may indicate
whether there is bleeding or infection in the colon or rectum.
A procedure called colonoscopy—in which an endoscope
(a long, flexible, lighted tube connected to a computer and television monitor)
is inserted into the anus to enable investigation of the inside of the colon and
rectum—may be performed. A colonoscopy can reveal any
inflammation, bleeding, or ulcers on the colon wall. Tissue samples (biopsies)
may be taken from the colon wall for examination under a microscope in order to
make a definitive diagnosis of UC.
A daily dose of sulfasalazine, one of the most common
medications used to treat UC, is an
effective means of reducing the number of UC relapses.
Diet (especially a low-fat diet rich
in fruits, fluids, magnesium, and vitamin C), exercise, and
stress reduction techniques
(including hypnosis) may also help prevent recurrences.
herbs are used successfully to treat UC, but
whether or not they can prevent recurrences or stave off the disease in those
who are genetically at risk is unknown.
The primary goal in treating UC is to control inflammation and replenish lost
nutrients. The choice of treatment for UC depends on the severity of the
disease. For example, people with mild to moderate UC are usually treated with
medications that reduce swelling and
suppress the immune response. More severe cases of UC may require
surgery. In addition to medications, many
people with inflammatory bowel diseases such as UC commonly turn to
complementary and alternative remedies. Although these remedies still require
extensive research, preliminary studies indicate that
lifestyle changes, including stress
dietary adjustments (such as
including a rich variety of fruits and vegetables and maintaining low levels of
fat and sugar), specific
supplements (such as psyllium and
Salai guggal) and
mind/body techniques (such as
hypnosis) can help prevent and/or treat the disease.
At least one study has shown that IBD often begins within 1 year of a very
stressful life event, such as the death of a family member. In addition, people
with UC report that stress worsens their symptoms. Therefore, relaxation
techniques, such as yoga, tai chi, and meditation are worth considering,
particularly for people with chronic stress in their lives.
Exercise may also be very helpful for those with UC. Although exercise is
generally considered safe for people with UC, those with the condition must take
certain precautions when exercising and should talk to their healthcare
practitioners before starting an exercise program. It is especially important
for people with UC to drink one to two glasses of water before exercising and
one glass of water every twenty minutes while exercising to prevent dehydration.
Exercise should be avoided during symptom flare-ups or if the individual has a
The following medications can help reduce the symptoms of UC and decrease the
likelihood of recurrences:
Sulfasalazine—the most commonly used
medication for UC; taken orally; decreases inflammation, reduces frequency of
Mesalamine—decreases inflammation; taken
orally or as an enema
Corticosteroids—reduce inflammation by
decreasing the production of prostaglandins (fatty acids that produce pain and
inflammation); taken orally, given intravenously in severe cases, or may be
prescribed as an enema
Medications that suppress the immune system (such as azathioprine and
Medications used to treat diarrhea (such as diphenoxylate, loperamide, or
opiates) must be used only under medical supervision and with extreme caution.
These medications slow down the normal movements of the gastrointestinal tract
and, in severe cases of UC, may cause a complication known as toxic
Surgery and Other Procedures
Approximately 20% to 30% of people with UC must eventually have their colons
removed (colectomy) because of massive bleeding, severe illness, rupture of the
colon, or the risk of cancer. There are several different types of surgery
available for UC, and choosing the appropriate surgery depends on the severity
of the disease and the individual's needs, expectations, and lifestyle.
Many people with UC must have a proctocolectomy—a
procedure in which the colon, anus, and rectum are surgically removed. The
surgery cures UC, and removes any risk of colon or rectal cancer. When the
intestines are removed, however, the body needs a new way for waste to leave the
body so the surgeon creates a small opening (stoma) in the abdomen for stool to
pass through. A pouch is worn over the opening to collect waste, and the
individual empties the pouch as needed. Different types of procedures may be
performed depending on which parts of the intestines are
Ileostomy—colon and rectum are removed and
the surgeon attaches the bottom of the small intestine to the stoma; waste
travels through the small intestine and exits the body through the stoma
Colostomy—rectum is removed and the surgeon
attaches the colon to the stoma (a temporary colostomy may be performed when
part of the colon is removed and the rest needs to heal)
Ileorectal and ileoanal reservoir
surgery—diseased part of colon and/or rectum is removed
and the surgeon creates an internal pouch from the small intestine; waste is
stored in the pouch and passed through the anus in the usual manner; bowel
movements occur more frequently (on average, 5 to 7 times per day); risks
include leakage of stool at night and infection of the
Nutrition and Dietary Supplements
Preliminary evidence suggests that certain dietary patterns may be associated
with UC. For example, some studies indicate that low fruit and vegetable
consumption and high fat and sugar consumption may increase an individual's risk
for developing UC. Studies also suggest the following:
A bland, low-fiber diet is best during acute flare-ups.
Regular intakes of fruits and vegetables, and lowered fat and sugar
consumption when UC is not active may reduce the likelihood of
High intakes of fluids and foods rich in magnesium and vitamin C on a
regular basis may lower the risk of developing inflammatory bowel
Certain foods may aggravate symptoms of UC (including chocolate, dairy
products, fats, and artificial sweeteners) and should be avoided by people with
After surgery, people with UC should avoid foods high in organic acids
known as oxalates (for example, spinach, rhubarb, beets, coffee, tea, diet
sodas, and chocolate) because oxalates can increase the risk of kidney
People with significant malnourishment, severe symptoms, or those awaiting
surgery may require total parenteral nutrition (nutrition maintained entirely by
Vitamins and Minerals
Because many people with UC have vitamin and mineral deficiencies (due to
decreased nutritional intake and absorption by the colon and excessive
diarrhea), a multivitamin is recommended. Further research is needed to
determine whether specific vitamin or mineral supplements may help treat the
symptoms of UC.
Omega-3 Fatty Acids
At least one study has found that, compared to placebo, fish oil supplements
containing omega-3 fatty acids may reduce symptoms of UC and prevent recurrence
of the condition. The supplements are less effective than sulfasalazine,
however, at reducing inflammation in people with mild to moderate UC. Some
experts suggest that omega-3 fatty acids may prove particularly valuable when
used in combination with sulfasalazine or other medications.
Vitamin B9 (Folate)
People with UC often have low levels of folate in their blood cells and some
experts suggest that this may be due, at least in part, to sulfasalazine use.
Some researchers speculate that folate deficiencies contribute to the risk of
colon cancer in those with UC. Although preliminary studies suggest that folate
supplements may help reduce tumor growths in people with UC, further research is
needed to determine the precise role of folate supplementation in people with
inflammatory bowel diseases.
Preliminary evidence suggests that N-acetyl glucosamine supplements or enemas
may improve symptoms of UC in children with IBD who did not improve after using
other treatments, but further research is needed to determine whether the
substance is safe and effective for the treatment of UC.
Animal studies and preliminary human studies have found that probiotics, or
"good" bacteria such as lactobacillus, may improve symptoms of UC and
help prevent flare-ups. Further research is warranted.
There have been a few case reports in the medical literature about people
with mild forms of ulcerative colitis who have gotten better by taking
bromelain. Bromelain is an enzyme that comes from pineapples and has properties
that both reduce inflammation and help digestion. In theory, therefore, this
supplement may prove beneficial for people with ulcerative colitis. But, this
idea must be tested on large groups of people with this inflammatory bowel
condition before conclusions can be drawn.
Psyllium seeds (Plantaginis ovatae)
A study comparing the use of psyllium seeds to the prescription drug
mesalamine in people with UC reveal that the fiber-based supplement may be as
effective as the medication in decreasing recurrences of the disease. More
research is needed to confirm the conclusion of the authors of this study.
A professional herbalist may also recommend the following herbs to reduce
inflammation and diminish abdominal cramps associated with UC:
Marshmallow root (Althaea officinalis)
Siberian ginseng (Eleutherococcus senticosus)
Turmeric (Curcuma longa)
Ginger (Zingiber officinale)
Green tea (Camillia sinensis)
Bromelain (Ananas comosus)
Wild yam (Dioscorea villosa)
German chamomile flower (Matricaria recutita)
Studies have shown that hypnosis improves immune function, increases
relaxation, decreases stress, and ease feelings of anxiety. Many healthcare
practitioners and people with UC have reported that symptoms of the disease
improve with relaxation methods such as hypnosis, meditation, and
Salai guggal (Boswellia serrata)
Salai guggal is a traditional Ayurvedic therapy used to treat symptoms of
IBD. Findings from one small study suggest that this remedy may prove to be as
effective as sulfasalazine for the treatment of UC. Side effects of salai guggal
use include nausea, abdominal fullness, stomach pain, and anorexia.
Fifty percent of women in remission experience a recurrence of UC when they
become pregnant, usually during the first trimester or during the postpartum
period. For this reason, such women should continue maintenance therapy under
the guidance of their healthcare practitioner. Corticosteroids or sulfasalazine
are considered safe during this time because these drugs do not harm the fetus.
Pregnant women with UC do not have increased risk for stillbirths or premature
Pregnant women should avoid high doses of vitamins. An obstetrician can
provide instructions regarding appropriate multivitamin use during pregnancy.
Warnings and Precautions
People with UC should avoid herbs that loosen the bowels. These include:
Buckthorn bark (Rhamnus frangula)
Cascara sagrada bark (Rhamnus purshiana)
Senna leaf and senna pod (Senna alexandrina)
The following foods should also be avoided by people with UC because they
worsen symptoms of the disease:
Milk (and milk products)
Following surgery, people with UC should avoid the following foods as they
may increase the risk for kidney stones:
Prognosis and Complications
If left untreated, people with UC can develop a wide range of chronic,
sometimes dangerous complications. Fortunately, however, most of these
complications can be treated successfully. They include:
Hemorrhage (abnormal bleeding)
Perforation of the colon
Narrowing of the colon, which may cause obstruction
Abscesses (pus-filled pockets of infection) in the colon
Toxic megacolon (grossly swollen colon that may rupture)
Nutritional problems (including weight loss and reduced muscle
Joint pain and arthritis (such as ankylosing spondylitis)
Skin rashes, including erythema nodosum
Eye infections/inflammation including uveitis
Depression and anxiety
Although there is no complete cure for UC other than surgical removal of the
colon, many people with the disease lead active lives by controlling their
symptoms with medication. In fact, drug treatment is effective for about 70% to
80% of all people with the condition. About 45% of all people with UC are free
of symptoms at any given time, but most suffer at least one relapse in any
10-year period. Although extensive research is still needed in the area of
complementary and alternative medicine for UC, preliminary studies indicate that
lifestyle changes, including stress reduction, dietary adjustments, and
mind/body techniques can work well with conventional therapies to help prevent
and/or treat the disease.
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Review Date: June 2001
Reviewed By: Participants in the review process include: Robert A. Anderson, MD,
President, American Board of Holistic Medicine, East Wenatchee, WA; Ruth DeBusk,
RD, PhD, Editor, Nutrition in Complementary Care, Tallahassee, FL; Jacqueline A.
Hart, MD, Department of Internal Medicine, Newton-Wellesley Hospital, Harvard
University and Senior Medical Editor Integrative Medicine, Boston, MA; Jane
Hart, MD, Clinical Instructor, Case Western Reserve University School of
Medicine and Director for Preventive Medicine Consultations and Medical Director
for the Institute for Total Health at the Cleveland YMCA, Cleveland, OH; R. Lynn
Shumake, PD, Director, Alternative Medicine Apothecary, Blue Mountain Apothecary
& Healing Arts, University of Maryland Medical Center, Glenwood,
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