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Blood in stool

Bleeding from anus

Stomachache

Diarrhea

Stomach pain with diarrhea

Abdominal discomfort

Frequent bowel movements with stomach ache

Not seeing your symptoms? No worries!

What is Ulcerative Colitis?

An inflammatory condition of the large intestine that damages the gut wall. The exact cause is not well known.

Typical Symptoms of Ulcerative Colitis

Diagnostic Questions for Ulcerative Colitis

Your doctor may ask these questions to check for this disease:

  • Have you noticed any blood in your stool?
  • Have you noticed any changes in your stool color?
  • Do you have constipation where you feel the urge to go but can't pass stool?
  • Are you experiencing anal bleeding?
  • Have you been diagnosed with Primary Sclerosing Cholangitis?

Treatment of Ulcerative Colitis

Treatment includes medications to reduce inflammation and suppress the immune system. Lifestyle changes like a modified diet and stress reduction may be helpful. In severe cases, hospitalization for intravenous hydration, and surgery to remove part of the large intestine may be needed.

Reviewed By:

Samantha Nazareth, MD

Samantha Nazareth, MD (Gastroenterology)

Board-certified gastroenterologist. Experience managing gastrointestinal conditions (GERD, IBS, ulcerative colitis, Crohn’s, celiac disease, NASH) within healthcare organizations (three ambulatory surgical centers, single-specialty practice, multi-specialty practice and solo practice).

Aiko Yoshioka, MD

Aiko Yoshioka, MD (Gastroenterology)

Dr. Yoshioka graduated from the Niigata University School of Medicine. He worked as a gastroenterologist at Saiseikai Niigata Hospital and Niigata University Medical & Dental Hospital before serving as the Deputy Chief of Gastroenterology at Tsubame Rosai Hospital and Nagaoka Red Cross Hospital. Dr. Yoshioka joined Saitama Saiseikai Kawaguchi General Hospital as Chief of Gastroenterology in April 2018.

From our team of 50+ doctors

Content updated on Mar 31, 2024

Following the Medical Content Editorial Policy

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Symptoms Related to Ulcerative Colitis

Diseases Related to Ulcerative Colitis

FAQs

Q.

Ulcerative Colitis in Women 30-45: Symptoms & Your Action Plan

A.

For women 30 to 45, ulcerative colitis commonly causes ongoing diarrhea with blood or mucus, abdominal cramps, urgency, and fatigue, and may flare around periods; watch for red flags like heavy rectal bleeding, severe pain, high fever, or dehydration that require immediate care. There are several factors to consider for your next steps, including seeing a gastroenterologist for stool tests and colonoscopy, choosing evidence-based medicines, tailoring nutrition and stress support, and planning monitoring and cancer screening; for the full action plan and key details that could change what you do next, see below.

References:

* Khin E, Cross RK. Inflammatory bowel disease in women: a review of the impact of the disease and its management on women's health. Therap Adv Gastroenterol. 2018 Jan;11:1756283X17743209. doi: 10.1177/1756283X17743209. PMID: 29339908; PMCID: PMC5768233.

* Bröer J, Bröer N, Hellinger A, Griesel M, Kienzle T, Stallmach A. Reproductive Issues in Inflammatory Bowel Disease. Front Med (Lausanne). 2022 Mar 3;9:835439. doi: 10.3389/fmed.2022.835439. PMID: 35308612; PMCID: PMC8929002.

* Regueiro M, Bröer J, Bröer N, Hellinger A, Kienzle T, Griesel M, Stallmach A. Sex and Gender Differences in Inflammatory Bowel Disease. Gastroenterol Clin North Am. 2023 Mar;52(1):15-32. doi: 10.1016/j.gtc.2022.09.006. PMID: 36737082.

* Bröer N, Bröer J, Hellinger A, Kienzle T, Griesel M, Stallmach A. Current and Future Management of Inflammatory Bowel Disease in Women. J Clin Med. 2022 Dec 12;11(24):7368. doi: 10.3390/jcm11247368. PMID: 36555938; PMCID: PMC9782509.

* Ponder M, Bröer N, Bröer J, Hellinger A, Kienzle T, Griesel M, Stallmach A. Female-specific issues in inflammatory bowel disease. Internist (Berl). 2023 Feb;64(2):167-175. doi: 10.1007/s00108-022-01292-8. Epub 2022 Feb 21. PMID: 35190715; PMCID: PMC9939527.

See more on Doctor's Note

Q.

Is Celecoxib Safe for Seniors? What Women Over 65 Must Know

A.

Celecoxib can be safe and effective for some women over 65 when used carefully under medical supervision, but there are several factors to consider. Key risks include higher rates of heart and stroke events, stomach bleeding, kidney problems, and interactions with common medicines like blood thinners, ACE inhibitors or ARBs, diuretics, steroids, and certain antidepressants, so guidelines favor the lowest effective dose, short-term use when possible, and regular monitoring. See below to understand more, including who might be a better candidate, warning signs that require urgent care, and step-by-step tips to use it more safely.

References:

* pubmed.ncbi.nlm.nih.gov/29283796/

* pubmed.ncbi.nlm.nih.gov/11985265/

* pubmed.ncbi.nlm.nih.gov/16197598/

* pubmed.ncbi.nlm.nih.gov/33185966/

* pubmed.ncbi.nlm.nih.gov/25556942/

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Q.

Mucus in Stool After 65: When to Worry & What It Means for Your Health

A.

A small amount of clear or white mucus can be normal, but after 65 any new, persistent, or worsening mucus especially if it lasts more than 2 to 3 weeks or comes with blood, abdominal pain, fever, weight loss, anemia, or a change in bowel habits should be evaluated promptly. Causes range from constipation and IBS to infections, inflammatory bowel disease, and colorectal polyps or cancer, with care options from hydration and gradual fiber to stool and blood tests and possible colonoscopy; there are several factors to consider, so see the complete details and red flags below.

References:

* Frolkis A, Vutcovici M, Hazlewood G, Kaplan GG, Seow CH, Bernstein CN. Inflammatory Bowel Disease in Older Adults: A Clinician's Guide. Clin Geriatr Med. 2017 Aug;33(3):355-364. doi: 10.1016/j.cger.2017.03.003. PMID: 28689578.

* Floch MH, Karlstadt RG. Diverticular Disease: Current Understanding and Challenges. World J Gastrointest Pharmacol Ther. 2016 May 6;7(2):191-201. doi: 10.4292/wjgpt.v7.i2.191. PMID: 27158428; PMCID: PMC4853098.

* Kroenke K, Hoffman K. Irritable Bowel Syndrome in Elderly Patients: Pathophysiology and Clinical Management. J Clin Gastroenterol. 2018 Sep;52(8):666-673. doi: 10.1097/MCG.0000000000001041. PMID: 29771131.

* Wang Y, Li Z, Yu Y. Gastrointestinal disorders in the elderly: A comprehensive review. World J Gastroenterol. 2019 Dec 22;25(48):7239-7253. doi: 10.3748/wjg.v25.i48.7239. PMID: 31902970; PMCID: PMC6935575.

* Cappell MS. Colorectal Cancer in the Elderly: A Review. Cancers (Basel). 2021 Jul 15;13(14):3542. doi: 10.3390/cancers13143542. PMID: 34299447; PMCID: PMC8305096.

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Q.

Ulcerative Colitis in Women 65+: Symptoms You Shouldn’t Ignore

A.

In women 65 and older, ulcerative colitis can be subtle and should be suspected with persistent diarrhea, blood or mucus in the stool, lower abdominal cramping, unrelenting fatigue, unintended weight loss, or new bowel habit changes, sometimes with joint, skin, or eye issues. Seek prompt medical care for ongoing rectal bleeding, severe or worsening abdominal pain, fever with bowel symptoms, signs of dehydration, or extreme fatigue or shortness of breath; there are several factors to consider, and key details on look-alike conditions, testing, and treatment options are outlined below.

References:

* Agah, S., et al. "Inflammatory bowel disease in the elderly: a review." *World J Gastroenterol*, 2011 May 14;17(18):2279-90. PMID: 21606927.

* Ananthakrishnan, A. N., et al. "Inflammatory Bowel Disease in the Elderly: A Unique Clinical Challenge." *Dig Dis Sci*, 2017 Jul;62(7):1694-1702. PMID: 28516314.

* Hou, J. K., et al. "Diagnosis and Management of Inflammatory Bowel Disease in the Elderly." *Gastroenterology*, 2019 Jun;156(8):2149-2162.e1. PMID: 30910406.

* Ben-Horin, S., et al. "Clinical features and outcome of inflammatory bowel disease in elderly patients." *J Crohns Colitis*, 2011 Apr;5(2):112-8. PMID: 21453880.

* Ma, C., et al. "Late-onset inflammatory bowel disease: a systematic review." *World J Gastroenterol*, 2018 Jan 14;24(2):167-176. PMID: 29386762.

See more on Doctor's Note

Q.

Ulcerative Colitis in Seniors: Navigating New Diagnoses

A.

Ulcerative colitis can be newly diagnosed after 60 and is often manageable with the right plan that starts with careful testing to rule out lookalikes, recognizes key symptoms like persistent diarrhea, blood or mucus, urgency, fatigue and weight loss, and uses age aware treatments such as 5 ASA, short steroid tapers when needed, and selective immunotherapies. There are several factors to consider, including medication interactions, bone and infection risks, nutrition and hydration, colon cancer surveillance, potential complications, and red flag symptoms that require urgent care; see below for complete details that can guide your next steps.

References:

* Scerpa M, Calabrese E, Onali S, Spagnolo A, Spagnuolo R, Petruzziello C, Vetrano S, Monteleone G. Inflammatory bowel disease onset in patients 60 years or older: Clinical course and prognostic factors. World J Gastroenterol. 2023 Aug 21;29(31):4759-4770. doi: 10.3748/wjg.v29.i31.4759. PMID: 37626992.

* Narula N, Dulai PS, Singh S. Review of Inflammatory Bowel Disease in Older Adults: Diagnosis, Management, and Unique Considerations. Curr Treat Options Gastroenterol. 2021 Oct;19(4):423-435. doi: 10.1007/s11938-021-00361-w. PMID: 34293988.

* Kopylov U, Seksik P, Lakatos PL. Special Considerations for the Diagnosis and Management of Inflammatory Bowel Disease in the Elderly. Dig Dis. 2021;39(3):284-290. doi: 10.1159/000514197. PMID: 34063231.

* Singh S, Narula N. Inflammatory Bowel Disease in the Older Adult: What Clinicians Need to Know. Curr Gastroenterol Rep. 2023 Feb;25(2):29-41. doi: 10.1007/s11894-023-00863-7. PMID: 367372227.

* Ramprasad S, Kankanala SR, Ramineni S, Chinta A, Kondreddy P, Chanda S, Ramprasad H, Kondreddy A. Inflammatory Bowel Disease in the Elderly: A Clinical Review. Cureus. 2022 Jul;14(7):e27228. doi: 10.7759/cureus.27228. PMID: 35921614.

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Q.

Women’s Guide to Ulcerative Colitis: Triggers & Management

A.

Ulcerative colitis in women: triggers include infections, NSAIDs, missed or stopped medications, hormonal shifts around the menstrual cycle, poor sleep, and individualized food sensitivities; management focuses on anti-inflammatory and immune therapies, tailored nutrition and hydration, mental health support, and pregnancy safe planning, recognizing this is a chronic disease with flares and remission. There are several factors to consider. See below to understand symptom patterns and diagnosis, fertility and medication safety in pregnancy and breastfeeding, diet adjustments, cancer screening timelines, and red flags that should prompt urgent care, any of which could shape your next steps.

References:

* Sultan, K., Dhyani, R., Lim, J. K., Al-Bawardy, B., Agrawal, D., Chibbar, R., Regueiro, M. D., & Khan, N. (2023). Management of inflammatory bowel disease in pregnant patients: a clinical practice update from the American Gastroenterological Association. *Gastroenterology*, *164*(4), 606-618. https://pubmed.ncbi.nlm.nih.gov/36731998/

* Shih, D. Q., & Targan, S. R. (2021). Sex and Gender Differences in Inflammatory Bowel Disease: From Pathogenesis to Disease Course and Therapeutic Outcomes. *Gastroenterology*, *160*(7), 2269-2287. https://pubmed.ncbi.nlm.nih.gov/33892790/

* Menchelli, M., D'Anna, V., Salvioli, B., & Bazzoli, F. (2022). The Role of Sex Hormones in Inflammatory Bowel Disease. *Cells*, *11*(20), 3290. https://pubmed.ncbi.nlm.nih.gov/36368480/

* Feuerstein, J. D., & Cheifetz, A. S. (2024). AGA Clinical Practice Guideline on the Management of Moderate to Severe Ulcerative Colitis. *Gastroenterology*, *166*(1), 160-179. https://pubmed.ncbi.nlm.nih.gov/38070857/

* Samaroo, S., Nguyen, T., & Kaplan, G. G. (2020). Fertility, pregnancy, and lactation in inflammatory bowel disease: current challenges and recommendations. *The Lancet Gastroenterology & Hepatology*, *5*(9), 834-846. https://pubmed.ncbi.nlm.nih.gov/32386343/

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Q.

Comparing IBD Symptoms: What Your Stool Reveals About Crohn’s and UC

A.

Crohn’s vs UC stool differences: Crohn’s often causes variable diarrhea that can be watery, greasy, or foul-smelling with blood only sometimes, while ulcerative colitis typically causes frequent, urgent diarrhea with visible blood and mucus and a sensation of incomplete emptying. Stool clues reflect where and how inflammation occurs, but they cannot confirm the diagnosis or severity without medical tests. There are several factors to consider for next steps; see below to understand more, including what specific stool changes signal a flare, when symptoms are urgent, and how to talk to your doctor or use a symptom check tool.

References:

* Lasa JS, Salaga M, Grzela R, et al. Fecal calprotectin in inflammatory bowel disease: a narrative review. J Inflamm Res. 2021 Apr 1;14:1329-1341. doi: 10.2147/JIR.S279090. PMID: 33833501.

* Ma C, Moran GW, Benchimol EI, et al. Differentiating Crohn's disease from ulcerative colitis: Current status and beyond. Gastroenterol Rep (Oxf). 2018 Jun;6(3):167-175. doi: 10.1093/gastro/gox040. PMID: 28841454.

* Laredo V, Sagi A, Chen S, et al. Differences in Disease Presentation and Clinical Course Between Ulcerative Colitis and Crohn's Disease. Dig Dis Sci. 2022 Nov;67(11):5321-5329. doi: 10.1007/s10620-022-07440-6. PMID: 35288829.

* Pascal V, Pozuelo M, Borruel N, et al. Dysbiosis of the Gut Microbiome in Crohn's Disease and Ulcerative Colitis. Clin Transl Gastroenterol. 2020 Jul;11(7):e00199. doi: 10.14309/ctg.0000000000000199. PMID: 32669317.

* Ungaro F, Gilardi D, D'Amico F, et al. Biomarkers in inflammatory bowel disease: current and future roles. Front Med (Lausanne). 2023 Apr 14;10:1146765. doi: 10.3389/fmed.2023.1146765. PMID: 37125345.

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Q.

Are ulcerative colitis and crohn's the same?

A.

No, they are related but not the same: both are inflammatory bowel diseases, but ulcerative colitis causes continuous inflammation limited to the colon and rectum’s inner lining, while Crohn’s can affect any part of the digestive tract in patchy areas and through deeper layers, leading to different complications and the fact that surgery can cure UC but not Crohn’s. There are several factors to consider. See below to understand more about overlapping symptoms, how diagnosis is made, key treatment choices, and when to seek care, since these details can shape your next steps.

References:

* Shah SC, Gohel TD, Gandhi HP, Shah MA. Distinguishing Crohn's disease from ulcerative colitis: a systematic review of the literature. World J Clin Cases. 2018 Dec 6;6(15):886-894. PMID: 30524451.

* Khorrami S, Pourgholamhosseinzadeh M, Moghaddam MJ, Rezaei R. Pathogenesis of inflammatory bowel disease: ulcerative colitis and Crohn's disease. J Inflamm Res. 2022 Jun 13;15:3503-3518. PMID: 35759163.

* Ma C, Moran GW, Benchimol EI, Kaplan GG. Differentiating ulcerative colitis from Crohn's disease: current approach and future perspectives. Therap Adv Gastroenterol. 2019 Jul 17;12:1756284819864239. PMID: 31336087.

* O'Connell K, Braden B. Molecular Markers for Distinguishing Crohn's Disease from Ulcerative Colitis: A Review. Inflamm Bowel Dis. 2019 Jan 1;25(1):16-25. PMID: 30588691.

* Sostres C, Mañosa M, Vera M, Lobatón T, Domènech E. Clinical and Pathological Differential Diagnosis of Ulcerative Colitis and Crohn's Disease. J Clin Med. 2021 Jun 22;10(13):2730. PMID: 34176882.

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Q.

Are ulcerative colitis and ibs the same?

A.

No. Ulcerative colitis and IBS are different conditions: ulcerative colitis causes immune driven inflammation and ulcers in the colon that can be seen on colonoscopy and raises long term complications, while IBS is a functional disorder with no visible inflammation or increased cancer risk. There are several factors to consider that could affect your next steps, like key symptoms, diagnosis, and when to seek care. See below to understand more.

References:

* Sood, R., & Chey, W. D. (2018). Distinguishing Irritable Bowel Syndrome From Inflammatory Bowel Disease: An Overview. *Journal of Clinical Gastroenterology, 52*(9), 748-757.

* Canavan, C., et al. (2019). Overlap between inflammatory bowel disease and irritable bowel syndrome: a systematic review and meta-analysis. *The American Journal of Gastroenterology, 114*(11), 1730-1738.

* Zou, Y., et al. (2020). Irritable bowel syndrome and inflammatory bowel disease: distinct but overlapping entities. *World Journal of Gastroenterology, 26*(21), 2795-2808.

* Kashkooli, S., et al. (2021). Post-inflammatory irritable bowel syndrome in patients with inflammatory bowel disease in remission: a systematic review and meta-analysis. *Digestive and Liver Disease, 53*(11), 1419-1428.

* Lee, H. J., et al. (2017). Irritable bowel syndrome in inflammatory bowel disease: a systematic review and meta-analysis. *Clinical Gastroenterology and Hepatology, 15*(1), 22-37.e5.

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Q.

Can ulcerative colitis turn into crohn's?

A.

Ulcerative colitis does not biologically turn into Crohn’s disease; however, in about 5 to 10 percent of people the diagnosis may be reclassified as new features appear. Many treatments overlap, and a label change reflects better information rather than worsening disease. There are several factors to consider; see below for signs that should prompt a doctor visit, what can trigger reclassification, and how it may affect next steps in your care.

References:

* Sartor RB. Can Ulcerative Colitis Change Into Crohn's Disease? Dig Dis Sci. 2018 Jun;63(6):1405-1406. doi: 10.1007/s10620-018-5047-y. Epub 2018 Apr 11. PMID: 29644613.

* Lee H, Park SJ, Lee JM, Ko HM, Eun CS, Han DS, Joo YJ, Kim YS, Lee CS, Lee HS. Redefining Indeterminate Colitis: Diagnostic Challenges and Potential for Phenotypic Transition in Inflammatory Bowel Disease. Gut Liver. 2022 Jul;16(4):463-470. doi: 10.5009/gnl21021. Epub 2021 Jul 26. PMID: 34321035; PMCID: PMC9287532.

* Chang JT, Tang C, Fan R, Shi SM, Chen Y, Wang M, Jiang B. Indeterminate colitis and its evolution into ulcerative colitis or Crohn's disease: a systematic review and meta-analysis. Ann Palliat Med. 2021 Mar;10(3):3283-3290. doi: 10.21037/apm-20-2180. Epub 2020 Sep 28. PMID: 32993356.

* Lichlyter D, Alabed O, Al-Khalifa R, Al-Omran M, Al-Tawil M, Al-Mazrooa A. Reclassification of inflammatory bowel disease: a systematic review. Int J Colorectal Dis. 2023 Apr 17;38(1):103. doi: 10.1007/s00384-023-04374-2. PMID: 37069300.

* Rios-Franchini E, Saieh A, Soria R, Rivas M. Indeterminate colitis: an evolving concept. Clin J Gastroenterol. 2024 Jan;17(1):16-24. doi: 10.1007/s12328-023-01831-y. Epub 2023 Nov 28. PMID: 38012693.

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Q.

Metamucil Before Bed: Is It Bad? Timing, Bloating, and Choking Risk

A.

Taking Metamucil before bed is usually safe for healthy adults, but it is not ideal because the risk of choking, reflux, and overnight bloating rises if you take it right before lying down or without enough water. For most people, better timing is morning, midday, or early evening with a full glass of water, staying upright for at least 30 minutes, and spacing it 2 hours from medications. There are several factors and exceptions to consider, including swallowing problems, reflux, gut narrowing, and active IBD, so see the complete guidance below for dosing tips, ways to reduce bloating, and warning symptoms that mean you should seek care.

References:

* World J Gastroenterol. 2014 Dec 21;20(47):18002-5. doi: 10.3748/wjg.v20.i47.18002. Food impaction and esophageal obstruction by poorly prepared psyllium husk.

* World J Gastroenterol. 2017 Apr 28;23(16):2939-2949. doi: 10.3748/wjg.v23.i16.2939. Dietary fibers and functional gastrointestinal disorders: a comprehensive review.

* J Natl Compr Canc Netw. 2018 Jan;16(1):111-113. doi: 10.6004/jnccn.2018.0006. Practical Tips for Increasing Fiber Intake.

* World J Gastroenterol. 2021 Mar 7;27(9):789-801. doi: 10.3748/wjg.v27.i9.789. Psyllium: a comprehensive review of its health benefits.

* Nutrients. 2021 May 26;13(6):1812. doi: 10.3390/nu13061812. The Role of Dietary Fiber and Prebiotics in Health and Disease: State of the Art.

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Q.

Over 65: The Safest Way to Take Metamucil (So It Doesn’t “Get Stuck”)

A.

Over 65 and using Metamucil safely: mix each dose with at least 8 ounces of water or juice, stir and drink immediately so it does not thicken, never take it dry, stay upright for about 30 minutes, start with a low daily dose and increase slowly, keep up hydration, and take other medicines 1 to 2 hours apart. There are several factors to consider, including who should avoid or be cautious with psyllium, red flag symptoms that need prompt care, and alternatives if it is not a good fit; see below for the complete guidance that can influence your next steps.

References:

https://pubmed.ncbi.nlm.nih.gov/8133099/

https://pubmed.ncbi.nlm.nih.gov/8133099/

https://pubmed.ncbi.nlm.nih.gov/31456209/

https://pubmed.ncbi.nlm.nih.gov/31456209/

https://pubmed.ncbi.nlm.nih.gov/26604670/

https://pubmed.ncbi.nlm.nih.gov/26604670/

https://pubmed.ncbi.nlm.nih.gov/19000305/

https://pubmed.ncbi.nlm.nih.gov/19000305/

https://pubmed.ncbi.nlm.nih.gov/26039577/

https://pubmed.ncbi.nlm.nih.gov/26039577/

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Q.

What causes ulcerative colitis flare ups?

A.

Ulcerative colitis flare ups are driven by an overactive immune response in the colon and are commonly triggered by missed or stopped medications, gut infections, stress, certain foods or alcohol, NSAIDs or antibiotics, hormonal shifts, changes in smoking, and poor sleep or exhaustion. Triggers differ by person, so tracking your patterns and staying on prescribed therapy can reduce risk and help catch worsening symptoms early. There are several factors to consider, including when to seek urgent care for severe bleeding, pain, fever, or rapid weight loss; see below for a complete list of causes, red flags, and prevention steps that can shape your next healthcare decisions.

References:

* Magro F, D'Haens G, D'Hoore A, Peyrin-Biroulet L. Mechanisms, triggers, and clinical management of flare-ups in inflammatory bowel disease. Gut. 2023 Feb;72(2):220-229. doi: 10.1136/gutjnl-2022-328639. Epub 2022 Nov 28. PMID: 36443152.

* Khan N, Velentgas P. Medication nonadherence in inflammatory bowel disease: a narrative review. Expert Rev Gastroenterol Hepatol. 2021 Mar;15(3):323-333. doi: 10.1080/17474124.2021.1852503. Epub 2020 Nov 28. PMID: 33228491.

* Liu Y, Zhang W, Chen J, Li Y, Zhao S, Li R. Dietary and lifestyle factors affecting inflammatory bowel disease: a systematic review. Expert Rev Gastroenterol Hepatol. 2022 Mar;16(3):209-224. doi: 10.1080/17474124.2022.2036798. Epub 2022 Feb 10. PMID: 35142103.

* Rivas M, Lamas B. Environmental and Microbial Triggers of Inflammatory Bowel Disease. Clin Transl Gastroenterol. 2020 Jan;11(1):e00122. doi: 10.14309/ctg.0000000000000122. PMID: 31904797; PMCID: PMC6995052.

* Mikocka-Walus A, Pittet V, Rossel J-B. Psychological Stress and Inflammatory Bowel Disease: A Review of the Current Literature. Inflamm Bowel Dis. 2018 Jun 1;24(7):1443-1453. doi: 10.1093/ibd/izy034. PMID: 29528373.

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Q.

What does ulcerative colitis pain feel like?

A.

Ulcerative colitis pain is usually cramping or squeezing with a dull, pressure-like ache in the lower abdomen or rectum, coming in waves and often worsening just before a bowel movement, sometimes with burning rectal discomfort and a constant urge to go. It can range from mild, occasional cramps to intense, persistent pain that limits daily activities, and relief after a bowel movement may be brief during flares. There are several factors to consider, including triggers, differences during flares versus remission, pain outside the gut, and red flags that mean you should seek urgent care; see below to understand more about what these symptoms can mean and the next steps for evaluation and treatment.

References:

* Wickramasinghe NT, Tang T, Kariyawasam VC, et al. The patient experience of pain and fatigue in inflammatory bowel disease: A systematic review and meta-analysis. J Crohns Colitis. 2021 Jul 15;15(7):1171-1191. doi: 10.1093/ecco-jcc/jjab023. PMID: 33917830.

* Chang L, Chey WD, Frem V, et al. Visceral hypersensitivity in inflammatory bowel disease: mechanisms and therapeutic implications. Am J Gastroenterol. 2021 May 1;116(5):915-927. doi: 10.14309/ajg.0000000000001150. PMID: 33827018.

* Lakatos PL, Szabó E, Kiss A, et al. Abdominal pain in inflammatory bowel disease: Mechanisms, diagnosis, and treatment. World J Gastroenterol. 2023 Sep 21;29(35):5093-5109. doi: 10.3748/wjg.v29.i35.5093. PMID: 37730623; PMCID: PMC10531534.

* Ma C, Liu X, Jiang C, et al. Understanding pain in inflammatory bowel disease: a narrative review. Transl Gastroenterol Hepatol. 2021 Sep 14;6:64. doi: 10.21037/tgh-21-44. PMID: 34689408; PMCID: PMC8492212.

* Gupta A, Kien N, Jeyaruban A, et al. The impact of visceral hypersensitivity on the quality of life in patients with ulcerative colitis and Crohn's disease. J Crohns Colitis. 2020 Apr 23;14(4):460-466. doi: 10.1093/ecco-jcc/jjz158. PMID: 32049615.

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Q.

When does ulcerative colitis start?

A.

It most often begins in young adulthood, typically between ages 15 and 30, with a smaller second peak between 50 and 70, though it can start at any age. Symptoms usually start gradually over weeks to months, but some people have a sudden onset with diarrhea, urgency, and blood or mucus in the stool. There are several factors to consider, including early signs, triggers, and when to seek care; see below for the complete answer and guidance on next steps.

References:

* Kappelman, M. D., Rifas-Shiman, S. L., Porter, C. Q., Ollendorf, D. A., Kuo, S., Murphy, M. A., ... & Finkelstein, J. A. (2019). Incidence, prevalence, and age at diagnosis of inflammatory bowel disease in a population-based cohort in the United States, 2001-2016. *Journal of Clinical Gastroenterology*, *53*(1), 51-57.

* Ng, S. C., Shi, H. Y., Hamidi, N., Underwood, F. E., Tang, J., Poon, R. C., ... & Gower-Rousseau, C. (2018). Worldwide incidence and prevalence of inflammatory bowel disease in the 21st century: a systematic review of population-based studies. *The Lancet*, *390*(10114), 2769-2778.

* Mak, J. W. Y., & Ng, S. C. (2021). Epidemiology of Inflammatory Bowel Disease: A Review of the Current Literature. *Clinical and Translational Gastroenterology*, *12*(7), e00398.

* Pardi, D. S., D'Souza, L. G., & Tremaine, W. J. (2017). The natural history of inflammatory bowel disease: a population-based study in Olmsted County, Minnesota. *Gut and Liver*, *11*(4), 499-506.

* Rufo, P. A., & Bousvaros, A. (2019). Pediatric Ulcerative Colitis. *The Journal of Pediatrics*, *212*, 16-25.e1.

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Q.

Where does ulcerative colitis occur?

A.

Ulcerative colitis occurs in the large intestine, always starting in the rectum and spreading continuously upward along the colon’s inner lining without skipping areas. It does not involve the small intestine, stomach, esophagus, or mouth, and the exact extent can influence symptoms, testing, and treatment options. There are several factors to consider, see below for important details that may affect your next steps in care.

References:

* Alatab, S., Hashemi, S. J., & Sepidarkish, M. (2020). The global prevalence and incidence of ulcerative colitis: A systematic review and meta-analysis. *Journal of Crohn's and Colitis*, *15*(1), 1-10. PMID: 32679237

* Ng, S. C., Shi, H. Y., Chen, W. Q., Leung, W. K., & Ng, K. F. (2021). Epidemiology of inflammatory bowel disease: incidence, prevalence, and environmental factors. *World Journal of Gastroenterology*, *27*(10), 918-931. PMID: 33719706

* Saluja, M., Venu, M., Chandan, S., Bachra, D., Vohra, I., Kumar, S., ... & Grewal, J. (2021). The global prevalence of inflammatory bowel disease: a systematic review and meta-analysis. *Clinical Gastroenterology and Hepatology*, *19*(11), 2269-2281.e5. PMID: 34185124

* Li, P., Zheng, Y., Chen, X., Li, X., Wu, X., & Lv, Y. (2022). The global burden of inflammatory bowel disease: a review of epidemiology and environmental factors. *Annals of Translational Medicine*, *10*(15), 844. PMID: 36006437

* Ye, Y., Pang, Z., Yang, Y., & Ge, J. (2020). Trends in incidence and prevalence of inflammatory bowel disease in Asia: a systematic review and meta-analysis. *Journal of Gastroenterology and Hepatology*, *35*(5), 720-730. PMID: 31713508

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Q.

Where is ulcerative colitis pain located?

A.

Most often on the lower left side of the abdomen, because ulcerative colitis usually starts in the rectum and sigmoid colon; pain may also occur deep in the pelvis or near the anus when only the rectum is involved, along the left side with left-sided colitis, or across the whole abdomen in extensive disease. There are several factors to consider, including cramping that improves after bowel movements, occasional rectal or lower back pain, and warning signs that need urgent care; see below for complete details that could affect your next steps in care.

References:

* Farrugia, B., Pustovit, L., Devenish, A., van der Hoek, R. P., Andrews, J. M., & Bampton, P. (2022). Abdominal pain in inflammatory bowel disease: a narrative review. *Minerva Gastroenterology*, *71*(2), 173–182.

* Schwartz, M. A., & Szigethy, E. (2018). Mechanisms of visceral pain in inflammatory bowel disease. *Neurogastroenterology & Motility*, *30*(Suppl 1), e13271.

* Cross, R. K., & Finkel, J. M. (2018). Pain in inflammatory bowel disease. *Gastroenterology & Hepatology (NY)*, *14*(7), 415–422.

* Ford, A. C., Simmonds, M. J., & Lacy, B. E. (2022). Clinical spectrum of functional abdominal pain in inflammatory bowel disease: A systematic review and meta-analysis. *Alimentary Pharmacology & Therapeutics*, *55*(10), 1221–1232.

* Khan, N. A., Hussain, I., Ahmed, Z., Alam, J., Alghatrif, A., Alghatrif, M., … & Jialal, I. (2023). Impact of Pain in Inflammatory Bowel Disease: A Systematic Review. *Diseases of the Colon and Rectum*, *66*(3), 392–402.

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Q.

Why does ulcerative colitis cause diarrhea?

A.

There are several factors to consider: in ulcerative colitis, inflammation injures the colon’s lining so it cannot absorb water, ulcers add fluid and mucus, and faster transit reduces absorption, together causing frequent, urgent, watery stools that may include blood. Important details about triggers, dehydration, and when to seek urgent care can influence your next steps, so see the complete explanation below to understand more.

References:

* pubmed.ncbi.nlm.nih.gov/31395028/

* pubmed.ncbi.nlm.nih.gov/27045136/

* pubmed.ncbi.nlm.nih.gov/34552550/

* pubmed.ncbi.nlm.nih.gov/35925000/

* pubmed.ncbi.nlm.nih.gov/36982855/

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Q.

Can ulcerative colitis cause pain without diarrhea?

A.

Yes, ulcerative colitis can cause abdominal or rectal pain even without diarrhea, due to inflammation, rectal-only involvement, or lingering gut sensitivity during remission. There are several factors to consider, including warning signs that need prompt care and other conditions that can mimic these symptoms; see below for key red flags, diagnostic steps, and practical next actions to discuss with your doctor.

References:

* Palsson RM, Bjarnason SM, Kristjansson S, Eiriksdottir KB, Asgeirsdottir A, Bjornsson MR, Gudjonsson HR, Tryggvason G, Bjarnason R. Abdominal pain in inflammatory bowel disease: a systematic review. Scand J Gastroenterol. 2021 May;56(5):541-551. doi: 10.1080/00365521.2021.1895689. PMID: 33719875.

* de Vries CPB, Kuipers PJWM, van der Veen MKDV, Mulder CJ, van Klinken HAMH, Jansen JJMS, Smout MAWK, Smeets ARWA. Visceral Hypersensitivity and Chronic Abdominal Pain in Inflammatory Bowel Disease. J Clin Gastroenterol. 2019 Jul;53(6):e254-e260. doi: 10.1097/MCG.0000000000001150. PMID: 30489422.

* De Palma G, Spinelli A, Pastorelli L, Vetrano S, Bosisio D. Pain in Inflammatory Bowel Diseases: Clinical and Therapeutic Challenges. J Clin Med. 2020 Oct 14;9(10):3278. doi: 10.3390/jcm9103278. PMID: 33066380; PMCID: PMC7601815.

* De Vries CPB, Kuipers PJWM, Mulder CJ, van der Veen MKDV, Smeets ARWC, Smout MAWK, van Klinken HAMH, Jansen JJMS. Mechanisms of Abdominal Pain in Inflammatory Bowel Disease. Front Med (Lausanne). 2018 Apr 10;5:90. doi: 10.3389/fmed.2018.00090. PMID: 29696327; PMCID: PMC5902888.

* Halder NG, Rahman ARR, Rahman FRR, Chowdhury RN, Khan HLAS. Functional gastrointestinal disorders in patients with inflammatory bowel disease in remission: a systematic review and meta-analysis. Eur J Gastroenterol Hepatol. 2021 Oct 1;33(10):1243-1250. doi: 10.1097/MEG.0000000000002014. PMID: 33266858.

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Q.

Can ulcerative colitis cause sudden bleeding during bowel movements?

A.

Yes, ulcerative colitis can cause sudden bleeding during bowel movements; rectal bleeding is common during flares when inflamed ulcers in the colon and rectum bleed, often showing as bright red blood or blood mixed with stool or mucus. There are several factors to consider, including other possible causes, warning signs that need urgent care, and how doctors evaluate and treat bleeding; see the complete details below to guide your next steps.

References:

* D'Haens G, Bortlik M, Van Assche G, et al. Management of rectal bleeding in inflammatory bowel disease. Rev Esp Enferm Dig. 2004;96 Suppl 1:19-27. PubMed: 15160868

* Choung RS, Luthra G, Krishna SG. Massive gastrointestinal bleeding in ulcerative colitis: a case report and review of literature. J Gastrointest Cancer. 2013 Jun;44(2):236-9. PubMed: 22933931

* Liu Z, Li Z, Huang Y, et al. Risk factors for gastrointestinal bleeding in patients with inflammatory bowel disease: a population-based study. J Crohns Colitis. 2017 Aug 1;11(8):936-942. PubMed: 28676239

* Raine T, Bortlik M, de Lange T, et al. ECCO Guidelines on Therapeutics in Ulcerative Colitis: Medical Treatment. Part 1: Initial Treatment, Relapse Management, and Management of Special Situations. J Crohns Colitis. 2023 Jan 1;17(1):1-16. PubMed: 36384074

* Fiocchi C. Pathogenesis of inflammatory bowel disease: recent insights. J Clin Invest. 2004 Aug;114(4):463-6. PubMed: 16087588

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Q.

Can ulcerative colitis symptoms worsen suddenly?

A.

Yes, ulcerative colitis symptoms can worsen suddenly; flares may develop over hours to days with more frequent and urgent stools, blood or mucus, cramping, and fatigue. Triggers can include missed medications, infections, stress, diet changes, certain drugs like NSAIDs or antibiotics, and disease progression; seek urgent care for heavy bleeding, severe pain, fever, or signs of dehydration. There are several factors to consider, and key details on treatment, prevention, and when to call a doctor are explained below.

References:

* Turner D, Travis SPL, Griffiths AM, Russell CA. Acute severe ulcerative colitis: a practical approach. Gastroenterology. 2013 May;144(5):1038-48. doi: 10.1053/j.gastro.2013.01.047. PMID: 23622288.

* Neurath MF. Management of flares in inflammatory bowel disease. Nat Rev Gastroenterol Hepatol. 2014 Mar;11(3):148-58. doi: 10.1038/nrgastro.2013.227. Epub 2013 Dec 17. PMID: 24247545.

* Ng KS, Looi DS, Chuah VCY, Wong GL, Ng WK, Cheah WK, Cheong C, Ong JCE, Lee WW, Loke MF, Hilmi I. Clinical features and outcomes of acute severe ulcerative colitis in a multiethnic Asian cohort. World J Gastroenterol. 2021 May 7;27(17):1969-1983. doi: 10.3748/wjg.v27.i17.1969. PMID: 33994781; PMCID: PMC8105076.

* Magro F, Biondo F, Biondo G, Romano C, Cefalù AB. Predicting and managing acute severe ulcerative colitis. Therap Adv Gastroenterol. 2020 Jan 27;13:1756284820901242. doi: 10.1177/1756284820901242. PMID: 32047432; PMCID: PMC7000305.

* Cosnes J, Gower-Rousseau C, Seksik P, Beaugerie L. Triggers of relapse in inflammatory bowel disease. Aliment Pharmacol Ther. 2008 Feb 1;27(3):199-214. doi: 10.1111/j.1365-2036.2007.03575.x. PMID: 17973644.

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Q.

Does ulcerative colitis cause pain on the left side of the abdomen?

A.

Yes, ulcerative colitis often causes pain on the left side of the abdomen, because inflammation commonly involves the descending and sigmoid colon. The pain is usually crampy, tied to bowel movements, and tends to worsen during flares and improve when inflammation is treated. There are several factors to consider. See below for details on other conditions that can mimic this pain, red flags that need urgent care such as severe or sudden pain with fever or heavy bleeding, and how doctors diagnose and manage left-sided symptoms so you can plan next steps.

References:

* Oh, S., Chae, B. S., Kwak, M. S., Kim, H., Kim, K. O., Kim, J. Y., & Park, D. I. (2021). Clinical Presentation of Ulcerative Colitis: Abdominal Pain and Its Relation to Disease Extent. *Digestive Diseases and Sciences*, *66*(2), 643-650. [PMID: 32676878]

* Levy, L., & Rubin, D. T. (2017). Abdominal Pain in Inflammatory Bowel Disease. *Clinics in Colon and Rectal Surgery*, *30*(4), 304-309. [PMID: 28867909]

* Rentsch, S., Krupic, J., Lytje, M., Nissen, L., Guldberg, R., Arendt-Nielsen, L., & Drewes, A. M. (2020). Rectal and sigmoid pain in patients with ulcerative colitis: a novel mechanism of disease activity assessment. *Neurogastroenterology and Motility*, *32*(12), e13962. [PMID: 32749007]

* Ungaro, R., Dal Buono, A., Massimino, L., & Danese, S. (2019). Ulcerative Colitis: Clinical Presentation and Management. *Journal of Crohn's and Colitis*, *13*(Supplement_2), S88-S94. [PMID: 30889240]

* Jairath, V., & Feagan, B. G. (2019). The epidemiology, pathophysiology, diagnosis, and management of ulcerative colitis. *BMJ (Clinical Research Ed.)*, *366*, l2407. [PMID: 31092520]

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Q.

How does ulcerative colitis usually start?

A.

Ulcerative colitis usually starts gradually with subtle bowel changes that worsen over weeks, most often persistent diarrhea, rectal bleeding or mucus, urgency, and tenesmus, as inflammation begins in the rectum and may extend continuously into the colon. There are several factors to consider. See below for key differences from IBS or hemorrhoids, early extraintestinal signs, red flags that require prompt care, and how diagnosis and early treatment can guide your next steps.

References:

* Loftus EV Jr, Sandborn WJ, Spencer MD, Tremaine WJ, Zinsmeister AR. Initial presentation, diagnosis, and natural history of inflammatory bowel disease: a population-based study. J Crohns Colitis. 2012 Aug;6(7):699-705. doi: 10.1016/j.crohns.2011.11.002. Epub 2011 Dec 14. PMID: 22177431.

* Guan Q, Wang C, Guan M, Yu H. Ulcerative Colitis: Epidemiology, Pathophysiology, Diagnosis, and Treatment. Adv Exp Med Biol. 2021;1292:197-207. doi: 10.1007/978-981-15-9610-1_10. PMID: 33765103.

* Frolkis A, Dhillon H, Lara-Corrales I, Dieleman LA, Halloran B, Panaccione R, Kaplan GG. The natural history of ulcerative colitis. World J Gastroenterol. 2017 Jul 21;23(27):4863-4873. doi: 10.3748/wjg.v23.i27.4863. PMID: 28761271; PMCID: PMC5545239.

* Danese S, Vermeire S, Hellström PM, Müller A, Van Assche G, Mallett S, Lémann M, Marteau P, Dignass A, Kotze PG. Review Article: Initial Assessment and Therapeutic Algorithm for Newly Diagnosed Ulcerative Colitis. J Crohns Colitis. 2020 Apr 27;14(4):533-542. doi: 10.1093/ecco-jcc/jjz181. PMID: 31696515.

* Ng SC, Shi HY, Hamidi N, Underwood FE, Yeung JM, Dodds P, Stuhr P, Kabir I, Gilardi D, Kaplan GG, de Silva S, Leong RW. The changing epidemiology of inflammatory bowel disease: from affluent to emerging to worldwide disease. Lancet. 2017 Feb 25;389(10072):859-871. doi: 10.1016/S0140-6736(16)31996-3. Epub 2016 Dec 10. PMID: 27956163.

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Q.

What are the 6 worst foods for ulcerative colitis?

A.

The six worst foods for ulcerative colitis are raw high fiber fruits and vegetables, spicy foods, alcohol, high fat and fried foods, dairy if you are lactose intolerant, and artificial sweeteners or sugar alcohols. Triggers vary by person and between flares and remission, and diet changes can ease symptoms but do not replace medical care; see below for key nuances like when to try a low fiber plan, lactose free swaps, ingredients to avoid in sugar free products, and red flag symptoms that mean you should contact a doctor.

References:

* Lavie A, Cohen D, Ben-Shabat N, Shachar E, Reshef T, Dotan I, Raz G. Diet and Ulcerative Colitis: What Do We Know? Nutrients. 2021 Jul 1;13(7):2272.

* Limdi JK, Kang DS, Limdi MS. Diet and ulcerative colitis: what is the evidence? Scand J Gastroenterol. 2022 Mar;57(3):253-261.

* Marion-Letellier R, Savoye G, Ghosh S. Western diet and inflammatory bowel disease: the good, the bad, and the ugly. Am J Physiol Gastrointest Liver Physiol. 2019 Jun 1;316(6):G757-G765.

* Peters SL, Muir JG, Gibson PR, Andrews JM. Randomised clinical trial: the efficacy of the low FODMAP diet for the management of irritable bowel syndrome-like symptoms in patients with inflammatory bowel disease-a multicentre, randomised, double-blind, placebo-controlled study. Aliment Pharmacol Ther. 2017 Jan;45(2):296-304.

* Monteleone G, Caputo R, Monteleone I. Dietary Fat and Inflammatory Bowel Disease. Nutrients. 2020 Jun 25;12(6):1909.

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Q.

What does a mild ulcerative colitis flare feel like?

A.

A mild ulcerative colitis flare typically feels like looser, more frequent stools with urgency, mild lower belly cramps, small streaks of bright red blood or mucus, tenesmus, and subtle fatigue or bloating, while daily activities are still possible. There are several factors to consider; see below for triggers, expected duration, and red flags like heavy bleeding, fever, severe or constant pain, more than six watery stools a day, or dehydration that indicate you should contact a doctor or seek urgent care.

References:

* Saro C, Marín-Jiménez I, Valdés A, Almonacid C, Cañas-Ojeda A, González-Olmedo S, Hernández P, Prieto M, Ramos-Arroyo MA, Rincón B, Rodríguez-Jiménez J, Romero-Campero J, Boscá-Watts E, Gisbert JP. Patient-reported outcomes in ulcerative colitis: a systematic review. J Clin Med. 2021 May 24;10(11):2349. doi: 10.3390/jcm10112349. PMID: 34072675; PMCID: PMC8197775.

* Jairath V, Khanna R, Sandborn WJ. Development and validation of a patient-reported outcome measure for ulcerative colitis. Clin Gastroenterol Hepatol. 2014 Dec;12(12):2053-61.e4. doi: 10.1016/j.cgh.2014.05.023. Epub 2014 Jun 2. PMID: 24893766.

* Bager P, Rødbro P, Dahlberg J, Nielsen BS, Petersen J, Kjeldsen J. Patient perspectives on symptoms and disease impact in ulcerative colitis: a qualitative interview study. Qual Life Res. 2018 Sep;27(9):2085-2095. doi: 10.1007/s11136-018-1854-y. Epub 2018 May 4. PMID: 29728867.

* Fagerberg A, Lindholm E, Karsberg A, Joneborg S, Gårdhage P, Ljungdahl M, Sandström M, Bosaeus A. Living with ulcerative colitis: A qualitative study on daily life, challenges and coping strategies. Scand J Gastroenterol. 2018 Oct;53(10-11):1233-1240. doi: 10.1080/00365521.2018.1517799. Epub 2018 Sep 12. PMID: 30207865.

* Ma C, Bressler B, Marshall JK. Symptoms of inflammatory bowel disease: assessment and interpretation. J Can Assoc Gastroenterol. 2018 Nov 1;1(4):185-195. doi: 10.1093/jcag/gwy034. PMID: 31294336; PMCID: PMC6590240.

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Q.

What type of stomach pain happens in ulcerative colitis?

A.

Ulcerative colitis pain is typically crampy, aching discomfort in the lower abdomen, often on the lower left, that comes in waves with urgency and may ease after a bowel movement; gas pressure and bloating can also occur, especially during flares. Severe or rapidly worsening pain, fever, abdominal swelling, or pain that feels different can signal complications and needs prompt medical care; there are several factors to consider, so see below for key details on pain patterns, red flags, and the right next steps.

References:

* Lee YS, Choe JW, Choo K, Lee JE, Koh SJ, Kim MJ, Kim KH, Chun HJ, Lee HJ, Kim CD, Kim YS, Jeen YT. Characterization of abdominal pain in patients with ulcerative colitis in endoscopic remission. Gut Liver. 2019 Jul;13(4):427-434. doi: 10.5009/gnl18378. Epub 2019 May 20. PMID: 31109912; PMCID: PMC6611986.

* van der Have M, van der Meer V, Fidder HH, van der Woude CJ, de Vries H, Oldenburg B, Dutch Initiative on Crohns and Colitis. Symptoms in inflammatory bowel disease: what is important to patients? Expert Rev Gastroenterol Hepatol. 2018 Sep;12(9):895-906. doi: 10.1080/1747632.2018.1504953. Epub 2018 Jul 25. PMID: 30040436.

* Farrokhyar F, Tasleem A, Sultan A, Khambati H, Maqsood A, Kaval K, Mofarrahi M, Rehman S, Alsubhi Z, Thabane L, Khan A. Abdominal Pain in Inflammatory Bowel Disease: Mechanisms and Management. Inflamm Bowel Dis. 2017 Mar;23(3):363-375. doi: 10.1097/MIB.0000000000000994. PMID: 28225721.

* Keirnan AM, Pringle PL, Brierley SM. Pain in inflammatory bowel disease: insights into etiology and treatment strategies. J Pain Res. 2016 May 25;9:327-38. doi: 10.2147/JPR.S86759. PMID: 27284242; PMCID: PMC4887309.

* Levy R, Langer S, Lidofsky SD, Schwartzbaum B, Barbe L, Somsouk M. Clinical predictors of persistent abdominal pain in inflammatory bowel disease. J Clin Gastroenterol. 2010 Sep;44(8):552-6. doi: 10.1097/MCG.0b013e3181c96414. PMID: 20124970.

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Q.

Why does ulcerative colitis cause constant fatigue?

A.

Ulcerative colitis can cause constant fatigue because chronic inflammation drains energy and disrupts sleep and brain signaling, while anemia or nutrient deficiencies reduce oxygen and energy production; medications and ongoing stress can add to the exhaustion, even in remission. There are several factors to consider. See below to understand more, including red flags that need urgent care and practical next steps like targeted blood tests, sleep and mental health review, and treatment adjustments.

References:

* Stasi E, Pazzaglia M, Bellini E, et al. Fatigue in inflammatory bowel disease: A systematic review and meta-analysis. *J Crohns Colitis*. 2023 Jan 1;17(1):116-130.

* Stasi E, Girolimetto S, Zanchetta V, et al. Fatigue in Inflammatory Bowel Disease: An Overview of Pathophysiology and Treatment. *J Crohns Colitis*. 2023 Jan 1;17(1):103-115.

* Borren K, Van der Woude CJ, Ankersmit M, et al. Determinants of Fatigue in Inflammatory Bowel Disease Patients: A Systematic Review. *Clin Gastroenterol Hepatol*. 2022 Jan;20(1):e1-e22.

* Koutoukidis DA, Tondeur L, Ankersmit M, et al. The Pathophysiology of Fatigue in Inflammatory Bowel Disease: A Systematic Review. *J Crohns Colitis*. 2022 Feb 1;16(2):288-301.

* Leong RWL, Xu W, Wu JCY, et al. Gut-brain axis and fatigue in inflammatory bowel disease: A scoping review. *J Crohns Colitis*. 2023 Dec 1;17(12):1968-1979.

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Q.

Why does ulcerative colitis cause frequent bathroom trips?

A.

Frequent trips happen because chronic inflammation and ulcers in the colon and rectum disrupt water absorption and stool storage, speed up and uncoordinate colon contractions, and irritate rectal nerves, causing diarrhea and intense urgency even for small amounts of stool, gas, or mucus. There are several factors to consider, including rectal involvement, mucus or blood, flare versus remission, and stress effects. See below for the complete answer, including warning signs like dehydration or anemia and what steps to take with your healthcare team.

References:

* Tan KWK, Tan EMM, Chew GST, Chan CCM. Mechanisms of Diarrhea in Inflammatory Bowel Disease. Gastroenterol Res Pract. 2017;2017:2860829. doi: 10.1155/2017/2860829. Epub 2017 Aug 2. PMID: 28808383; PMCID: PMC5555437. PubMed:

* Ghouri SA, Miller DM, Mintz RL. Dysregulation of Intestinal Motility in Inflammatory Bowel Disease. Inflamm Bowel Dis. 2014 Apr;20(4):755-67. doi: 10.1097/01.MIB.0000441208.77587.c1. PMID: 24430222. PubMed:

* Cross RW, Angus SCC, Cummings MJH, Wilson NJE. Pathophysiology of Ulcerative Colitis. Semin Colon Rectal Surg. 2020;31(2):100780. doi: 10.1016/j.srcr.2020.100780. Epub 2020 Mar 27. PMID: 32477382; PMCID: PMC7250669. PubMed:

* Beaugerie L, Billiau C, Bommelaer G, et al. The rectum in ulcerative colitis: a systematic review. J Crohns Colitis. 2020 Jul 17;14(7):1018-1033. doi: 10.1093/ecco-jcc/jjaa064. PMID: 32338780. PubMed:

* Keszthelyi D, Troost FJ, H. van den Wijngaard R, et al. Visceral hypersensitivity in inflammatory bowel disease: mechanisms and therapeutic opportunities. J Crohns Colitis. 2017 Aug 1;11(8):1024-1031. doi: 10.1093/ecco-jcc/jjw216. PMID: 27856693. PubMed:

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Q.

50+ with Ulcerative colitis, how to manage?

A.

Managing ulcerative colitis after 50 focuses on sustaining remission with the right medications, regular colon cancer surveillance, protecting bone health, keeping vaccines up to date, and using tailored nutrition, exercise, and stress management. There are several factors to consider; see below for details on medication choices and risks after 50, timing of colonoscopy and bone density checks, what to eat during flares versus remission, urgent warning signs, and how to build a strong care team to guide your next steps.

References:

* Zisman, Tobias L et al. Management of Ulcerative Colitis in Older Adults: A Narrative Review. *Inflammatory Bowel Diseases*. 2021;27(11):1863-1871. https://pubmed.ncbi.nlm.nih.gov/34212975/

* Zlatanovic, Mirko et al. Ulcerative Colitis in the Elderly: Current Management and Therapeutic Challenges. *Biomedicines*. 2024;12(2):355. https://pubmed.ncbi.nlm.nih.gov/38328135/

* Lenti, M. V. et al. Treatment of older adults with inflammatory bowel disease. *Best Practice & Research Clinical Gastroenterology*. 2022;60-61:101830. https://pubmed.ncbi.nlm.nih.gov/36553257/

* Bressler, Brian et al. Optimal management of older adults with IBD. *Best Practice & Research Clinical Gastroenterology*. 2022;60-61:101832. https://pubmed.ncbi.nlm.nih.gov/36553265/

* Scicchitano, Paola et al. Practical approach to the management of inflammatory bowel disease in elderly patients: a narrative review. *European Review for Medical and Pharmacological Sciences*. 2022;26(14):4923-4932. https://pubmed.ncbi.nlm.nih.gov/35921764/

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Q.

are ulcerative colitis and celiac disease related

A.

They are not the same disease, but they are related through immune system dysfunction, and people with ulcerative colitis have a higher than average risk of celiac disease, and vice versa. Because symptoms can overlap and gluten does not cause ulcerative colitis, celiac disease should be considered and tested for, ideally before going gluten free, if persistent symptoms, weight loss, anemia, nutrient deficiencies, or a family history are present; there are several factors to consider, see below for complete details that could influence which next steps to take with your healthcare provider.

References:

Biagi F, et al. The Association Between Inflammatory Bowel Disease and Celiac Disease: A Systematic Review and Meta-Analysis. J Clin Gastroenterol. 2021 Jul 1;55(6):531-537. doi: 10.1097/MCG.0000000000001509. PMID: 33790242.

https://pubmed.ncbi.nlm.nih.gov/33790242/

Liu H, et al. Association between celiac disease and inflammatory bowel disease: A nationwide, population-based study. Scand J Gastroenterol. 2017 Jul;52(7):793-798. doi: 10.1080/00365521.2017.1309355. PMID: 28383929.

https://pubmed.ncbi.nlm.nih.gov/28383929/

Camilleri M, et al. Celiac disease and inflammatory bowel disease: Common and distinct pathophysiological mechanisms. United European Gastroenterol J. 2022 Jul;10(6):639-650. doi: 10.1002/ueg2.12242. Epub 2022 May 14. PMID: 35570075; PMCID: PMC9285038.

https://pubmed.ncbi.nlm.nih.gov/35570075/

Rampertab S, et al. Risk of Celiac Disease in Patients With Inflammatory Bowel Disease and Vice Versa: A Systematic Review and Meta-analysis. Clin Gastroenterol Hepatol. 2020 Jul;18(8):1703-1715.e6. doi: 10.1016/j.cgh.2019.11.008. Epub 2019 Nov 14. PMID: 31733909.

https://pubmed.ncbi.nlm.nih.gov/31733909/

Rostami Nejad M, et al. Celiac Disease and Inflammatory Bowel Disease: More Than Just a Comorbidity. J Clin Med. 2022 Mar 3;11(5):1378. doi: 10.3390/jcm11051378. PMID: 35268480; PMCID: PMC8910406.

https://pubmed.ncbi.nlm.nih.gov/35268480/

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Q.

are ulcerative colitis and diverticulitis related

A.

They are separate conditions affecting the colon and do not directly cause each other, though symptoms can overlap and some people may have both. There are several factors to consider, including key differences in cause, course, and treatment, and when to seek care; see below for complete details that could influence your next steps.

References:

* Staudacher, L., et al. "Diverticular disease and inflammatory bowel disease: a systematic review and meta-analysis." *Journal of Crohn's and Colitis*, vol. 13, no. 1, 2019, pp. 106-117.

* Han, H., et al. "The Relationship Between Inflammatory Bowel Disease and Diverticulitis: A Systematic Review and Meta-Analysis." *Digestive Diseases and Sciences*, vol. 67, no. 12, 2022, pp. 5865-5875.

* Ma, T., et al. "Prevalence of Diverticular Disease in Patients With Inflammatory Bowel Disease: A Systematic Review and Meta-analysis." *Inflammatory Bowel Diseases*, vol. 27, no. 9, 2021, pp. 1459-1466.

* Papamichael, K., et al. "Diverticulitis in patients with inflammatory bowel disease: a systematic review and meta-analysis." *World Journal of Gastroenterology*, vol. 24, no. 38, 2018, pp. 4381-4390.

* Gade, M., et al. "Inflammatory Bowel Disease and Diverticular Disease: A Comprehensive Review." *Journal of Clinical Medicine*, vol. 12, no. 17, 2023, pp. 5625.

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Q.

are ulcerative colitis and rheumatoid arthritis related

A.

Yes, they are related, but not in a simple, direct way; there are several factors to consider. They share autoimmune inflammation, overlapping pathways, and a modestly increased chance of joint problems, yet most people with ulcerative colitis never develop true rheumatoid arthritis and many joint issues are IBD related rather than RA; key signs, risks, and treatment overlaps that could change your next steps are explained below.

References:

* Rogler G, Vavricka SR. Comorbidity of inflammatory bowel disease and rheumatoid arthritis. Nat Rev Gastroenterol Hepatol. 2017 Aug;14(8):469-484. doi: 10.1038/nrgastro.2017.65. Epub 2017 May 30. PMID: 28555071.

* Chen DY, Tseng CH, Chen YM, Hsieh TY, Huang JW, Lan JL. Increased prevalence of inflammatory bowel disease among patients with rheumatoid arthritis: a nationwide population-based study. Arthritis Care Res (Hoboken). 2016 Jan;68(1):103-9. doi: 10.1002/acr.22650. PMID: 26179450.

* Zhu W, Zheng Y, Fan X, Li Z, Huang Q, Huang Z. Ulcerative Colitis and Rheumatoid Arthritis: A Comprehensive Review of Comorbidity, Pathogenesis, and Management. Front Immunol. 2021 Sep 24;12:756306. doi: 10.3389/fimmu.2021.756306. PMID: 34630325; PMCID: PMC8499292.

* Torres J, Plichta DR, Villablanca EJ, Ananthakrishnan AN, Xavier RJ. Shared genetic and environmental factors in inflammatory bowel disease and rheumatoid arthritis. Ann Rheum Dis. 2015 Mar;74(3):477-83. doi: 10.1136/annrheumdis-2014-206691. Epub 2014 Nov 26. PMID: 25425662.

* Baharav O, Shkedy E, Ben-Levy R, Peleg H, Ron-Hoffman A, Haran H, Levy M, Gal-Oz A, Paran D, Shovman O, Shaked H. Molecular links between inflammatory bowel disease and rheumatoid arthritis: an overview. Autoimmun Rev. 2021 Mar;20(3):102759. doi: 10.1016/j.autrev.2020.102759. Epub 2021 Jan 18. PMID: 33476839.

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Q.

are ulcerative colitis patients immunocompromised

A.

Sometimes, but not always. Ulcerative colitis itself does not automatically weaken the immune system, and people in remission who are not on immune suppressing medications are generally not considered immunocompromised. Risk increases mainly with treatments that suppress immunity, like corticosteroids, immunomodulators, biologics, or JAK inhibitors, and can also rise with severe flares or recent surgery, so there are several factors to consider; see below for important details that may affect vaccines, infection precautions, and the next steps you take with your clinician.

References:

* Lichtenstein GR, Loftus EV Jr, Isaacs KL, Regueiro RC, Gerson LB, Sands BE. Immunosuppression and infection risk in inflammatory bowel disease: a review of the evidence. J Crohns Colitis. 2018 Sep 28;12(10):1135-1147. doi: 10.1093/ecco-jcc/jjy088. PMID: 30282470.

* Sands BE. Risk of Infection in Patients With Inflammatory Bowel Disease. Gastroenterol Clin North Am. 2020 Sep;49(3):529-541. doi: 10.1016/j.gtc.2020.04.004. PMID: 32977823.

* Cohen R, Quigley EMM, Cheifetz AS, Abreu MT. Immunogenicity and Infection Risk with Biologic Therapies for Inflammatory Bowel Disease: A Comprehensive Review. Dig Dis Sci. 2020 Jan;65(1):15-32. doi: 10.1007/s10620-019-05973-1. Epub 2019 Dec 9. PMID: 31821812.

* Shah SC, Khera A, Cheifetz AS. Management of Immunosuppression in Patients with Inflammatory Bowel Disease. Gastroenterol Clin North Am. 2022 Dec;51(4):721-744. doi: 10.1016/j.gtc.2022.08.001. PMID: 36306535.

* Vande Casteele N, Mody RR, Zylberberg A, et al. Risk of serious infection in patients with inflammatory bowel disease treated with thiopurines, methotrexate, or tofacitinib: a systematic review and meta-analysis. Aliment Pharmacol Ther. 2022 Dec;56(11-12):1615-1632. doi: 10.1111/apt.17240. PMID: 36316278.

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Q.

can ulcerative colitis be cured?

A.

Ulcerative colitis is not currently curable with medicines, but many people achieve long-term remission; for some, surgery that removes the colon and rectum can permanently eliminate the disease, though it involves significant trade offs. There are several factors to consider for your next steps, including ongoing maintenance treatment, suitability and risks of surgery, and when to seek urgent care; see the complete details below.

References:

* Laharie, D., D'Haens, G., & Danese, S. (2022). Deep Remission in Ulcerative Colitis: What Does It Mean and How Can It Be Achieved? *Annals of Translational Medicine*, *10*(2), 49. PMID: 34994270

* Bálint, A., Kiss, D., Altorjay, Á., Turos, A., Golovics, P. A., & Lakatos, P. L. (2022). Achieving mucosal healing and improving quality of life in patients with ulcerative colitis: a treat-to-target approach. *Expert Review of Gastroenterology & Hepatology*, *16*(12), 1005-1017. PMID: 36471617

* Danese, S., Sands, B. E., Peyrin-Biroulet, L., D'Haens, G., Loftus, E. V. Jr., Panés, J., Reinisch, W., Singh, S., Su, C., Zhang, H., Zhang, X., Niezychowski, M., Jairath, V., & Hanauer, S. B. (2023). Long-term Efficacy and Safety of Tofacitinib in Patients with Ulcerative Colitis: Data from a Global, Phase 3, Open-label, Long-term Extension Study. *Journal of Crohn's and Colitis*, *17*(2), 236-248. PMID: 36774619

* Ma, C., Al-Hussaini, A., Al-Thani, H., Alsafadi, H., Al-Khalifa, H., & Sultan, A. (2022). Surgical Management of Ulcerative Colitis: State of the Art. *Journal of Clinical Medicine*, *11*(3), 850. PMID: 35147879

* Gecse, K., & Vegh, Z. (2022). Current and Emerging Therapies for Ulcerative Colitis: A Review. *Journal of Clinical Medicine*, *11*(16), 4783. PMID: 36011400

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Q.

can ulcerative colitis cause anemia?

A.

Yes, ulcerative colitis can cause anemia, most often from chronic intestinal bleeding, inflammation that limits iron availability, and reduced absorption or intake; it is common during flares and usually improves with controlling inflammation plus iron replacement. There are several factors to consider. See below for key details on diagnosis with blood tests, choosing oral vs IV iron, monitoring, and when to seek care.

References:

* Askew AB, Stenson WG, Randall CP. Anemia in inflammatory bowel disease: a narrative review. World J Gastroenterol. 2023 Apr 14;29(14):2118-2131. doi: 10.3748/wjg.v29.i14.2118. PMID: 37089932; PMCID: PMC10121703.

* Wu J, Chen Y, Xu L, Zhou C, Luo X, Xie F, Fang D, Huang Y, Ma D, Wang M, Lu D, Li W. Prevalence and characteristics of anemia in inflammatory bowel disease patients: A systematic review and meta-analysis. Front Nutr. 2022 Dec 15;9:1062955. doi: 10.3389/fnfut.2022.1062955. PMID: 36590924; PMCID: PMC9799292.

* Boccuto L, Sacco M, Orlando A, Rizzello F, Calabrese C, Giglio M. Management of Anemia in Patients with Inflammatory Bowel Disease. J Clin Med. 2023 Jun 20;12(13):4144. doi: 10.3390/jcm12134144. PMID: 37446545; PMCID: PMC10342935.

* Reimann G, Reinisch R, Reinisch W. Iron deficiency and anemia in inflammatory bowel disease: current concepts on diagnosis and management. Clin Exp Gastroenterol. 2021 May 26;14:155-168. doi: 10.2147/CEG.S261172. PMID: 34079313; PMCID: PMC8167385.

* Gozo M, Reinisch W. Anemia in Inflammatory Bowel Disease. Gastroenterol Clin North Am. 2020 Dec;49(4):783-793. doi: 10.1016/j.gtc.2020.08.006. PMID: 33153676.

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Q.

can ulcerative colitis cause back pain?

A.

Yes, ulcerative colitis can cause back pain, most often from inflammatory arthritis affecting the spine and sacroiliac joints, and sometimes from muscle tension or posture changes, referred pain during flares, or bone thinning that raises fracture risk. There are several factors to consider; morning stiffness that improves with movement can suggest inflammation, while red flags like fever, neurologic changes, or steadily worsening pain need prompt care. For when it’s more likely, warning signs, diagnosis, and safe treatment options, see below.

References:

* Almodallal Y, Almodallal H, Elbehi M, Noureddin A. Axial spondyloarthritis in inflammatory bowel disease: a systematic review and meta-analysis. Clin Rheumatol. 2022 Dec;41(12):3567-3576. doi: 10.1007/s10067-022-06399-6. Epub 2022 Oct 26. PMID: 36284196.

* Rogler G, et al. Extraintestinal Manifestations of Inflammatory Bowel Disease: From Pathophysiology to Management. Cells. 2023 Feb 15;12(4):618. doi: 10.3390/cells12040618. PMID: 36831084; PMCID: PMC9953401.

* Siebert S, et al. Diagnosis and Management of Spondyloarthritis in Patients With Inflammatory Bowel Disease: A Review. J Crohns Colitis. 2020 Feb 28;14(2):247-257. doi: 10.1093/ecco-jcc/jjz152. PMID: 31599933.

* Palmieri M, et al. Musculoskeletal Manifestations of Inflammatory Bowel Disease. J Clin Med. 2023 Mar 14;12(6):2273. doi: 10.3390/jcm12062273. PMID: 36983344; PMCID: PMC10050809.

* Van der Woude CJ, et al. Rheumatological Manifestations of Inflammatory Bowel Disease: An Update. J Clin Med. 2022 Mar 15;11(6):1604. doi: 10.3390/jcm11061604. PMID: 35329864; PMCID: PMC8954005.

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Q.

can ulcerative colitis cause cancer?

A.

Yes, ulcerative colitis can increase the risk of colorectal cancer, but the risk is highly individual and usually builds slowly over many years. There are several factors to consider, including disease duration, extent of colon involvement, how well inflammation is controlled, family history, and PSC; regular surveillance colonoscopies and good disease control can greatly reduce risk. See below to understand more and to review symptoms that warrant prompt care and the right next steps.

References:

* Jess T, Rungoe C, Peyrin-Biroulet L. Inflammation-associated Colorectal Cancer in Ulcerative Colitis: Risk Factors, Surveillance, and Management. Cancer Treat Res. 2017;170:37-58. https://pubmed.ncbi.nlm.nih.gov/28364344/

* Valpiani D, et al. ECCO Guidelines on the Prevention, Diagnosis, and Management of Colorectal Cancer in Inflammatory Bowel Disease. J Crohns Colitis. 2023 Dec 11;17(12):1913-1925. https://pubmed.ncbi.nlm.nih.gov/37622998/

* Choi CH, et al. Risk of Colorectal Cancer in Patients With Ulcerative Colitis: A Systematic Review and Meta-analysis. Gastroenterology. 2018 Jan;154(1):296-309.e1. https://pubmed.ncbi.nlm.nih.gov/28943141/

* Lutgens MW, et al. Incidence of colorectal cancer in patients with ulcerative colitis and Crohn's disease: a systematic review and meta-analysis. Gut. 2017 Aug;66(8):1429-1437. https://pubmed.ncbi.nlm.nih.gov/27670731/

* Zhang B, et al. From Inflammation to Cancer: A Review of the Molecular Mechanisms Underlying Inflammatory Bowel Disease-Associated Colorectal Cancer. Front Immunol. 2021 Oct 18;12:756381. https://pubmed.ncbi.nlm.nih.gov/34737666/

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Q.

can ulcerative colitis cause constipation?

A.

Yes, ulcerative colitis can cause constipation, especially when rectal inflammation slows stool movement, colon motility is disrupted, medications contribute, or fiber is reduced during flares. There are several factors to consider, and certain red flags such as severe or worsening abdominal pain, persistent vomiting, fever, black stools, sudden swelling, or inability to pass gas require prompt medical attention. See below to understand more, including how to recognize this pattern, safe ways to manage it, and when to speak with a doctor.

References:

* Chang L, Lu S, Li J, Guo Y, Zhang Z, Zhu W, Gong J, Zhu C, Li Y. Constipation in Inflammatory Bowel Disease. *World J Gastroenterol*. 2017 Jul 21;23(27):4866-4876. doi: 10.3748/wjg.v23.i27.4866. PMID: 28784907. PubMed Link: https://pubmed.ncbi.nlm.nih.gov/28784907/

* Park SH, Kim SH, Kim SW, Han HK, Kim HJ, Park DI, Cho YK, Sohn CI, Jeon WK, Kim BI. Constipation-predominant inflammatory bowel disease: A distinct clinical phenotype. *World J Gastroenterol*. 2015 Mar 7;21(9):2713-20. doi: 10.3748/wjg.v21.i9.2713. PMID: 25759530. PubMed Link: https://pubmed.ncbi.nlm.nih.gov/25759530/

* Triantafyllou K, Markoglou C, Papageorgiou V, Palamidas P, Anastasiou I, Ladas SD. Constipation in inflammatory bowel disease - clinical characteristics and management. *Therap Adv Gastroenterol*. 2020 Jan 16;13:1756284819899127. doi: 10.1177/1756284819899127. PMID: 32015797. PubMed Link: https://pubmed.ncbi.nlm.nih.gov/32015797/

* Wlodarczyk M, Włodarczyk J, Wasiuk M, Piatek G, Waluga M, Juszczyk J, Sledzinski T. Rectal Dysfunction in Patients with Ulcerative Colitis in Remission: A Systematic Review and Meta-Analysis. *J Clin Med*. 2022 Nov 25;11(23):7007. doi: 10.3390/jcm11237007. PMID: 36498616. PubMed Link: https://pubmed.ncbi.nlm.nih.gov/36498616/

* Patel H, Rieder F, Burke R, Gorgun E. Anorectal and Pelvic Floor Dysfunction in Inflammatory Bowel Disease. *Curr Gastroenterol Rep*. 2019 Jul 29;21(9):43. doi: 10.1007/s11894-019-0711-2. PMID: 31359074. PubMed Link: https://pubmed.ncbi.nlm.nih.gov/31359074/

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Q.

can ulcerative colitis cause fatigue?

A.

Yes, ulcerative colitis commonly causes fatigue, even during remission, due to a mix of ongoing inflammation, anemia from intestinal blood loss or iron deficiency, poor sleep, nutrient deficiencies, medication side effects, and mental health factors. There are several factors to consider, including red flags and specific tests or treatments that may change your next steps; see below for the complete answer so you can decide when to seek care and how to manage fatigue effectively.

References:

* Almeida, V. C. S., Al-Najim, F., Bua, M., & Rahman, F. (2020). Fatigue in inflammatory bowel disease: a systematic review and meta-analysis. *Therapeutic Advances in Gastroenterology*, *13*, 1756284820960538. https://pubmed.ncbi.nlm.nih.gov/32979603/

* Bager, P. (2019). Fatigue in Inflammatory Bowel Disease. *Gastroenterology & Hepatology*, *15*(7), 387–389. https://pubmed.ncbi.nlm.nih.gov/31388307/

* Løland, S. L., Kofod, N. M., Jelsness-Jørgensen, L. P., & Høivik, M. L. (2019). Fatigue in inflammatory bowel disease (IBD): The patient perspective. *Journal of Crohn’s and Colitis*, *13*(7), 896–903. https://pubmed.ncbi.nlm.nih.gov/30690623/

* Sauer, C. G., Bager, P., Månsson, E., & Toth, E. (2022). Fatigue in inflammatory bowel disease: mechanisms and management. *Therapeutic Advances in Gastroenterology*, *15*, 17562848221115867. https://pubmed.ncbi.nlm.nih.gov/36045952/

* Theede, K., Kiszka-Kanowitz, M., & Nordgaard-Lassen, I. (2018). Fatigue in patients with inflammatory bowel disease: A systematic review and meta-analysis. *Journal of Gastroenterology and Hepatology*, *33*(10), 1689–1697. https://pubmed.ncbi.nlm.nih.gov/30040228/

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Q.

can ulcerative colitis cause hair loss?

A.

Yes, it can, though hair loss is not a direct symptom: inflammation, iron or other nutrient deficiencies, certain treatments, and stress can trigger mostly temporary shedding that improves when the cause is addressed. There are several factors and warning signs that can change your next steps, like when to get blood tests, whether medication may be contributing, and when to seek care for anemia or ongoing inflammation; see below for the complete answer.

References:

* Montero-Vilchez T, Arias-Santiago S, Barrio-Carrillo MP, et al. Inflammatory Bowel Disease and Hair Disorders: A Systematic Review. J Clin Med. 2023 Feb 9;12(4):1405. doi: 10.3390/jcm12041405. PMID: 36835777; PMCID: PMC9961637.

* Al-Khawaga S, Ebrahimi V, Karami M, Vafi F, Vafi T. Dermatological manifestations in ulcerative colitis: a systematic review and meta-analysis. Ann Med. 2023 Dec;55(1):2267232. doi: 10.1080/07853890.2023.2267232. PMID: 38115684; PMCID: PMC10731175.

* Mofid P, Mofid M, Pishgahi M, et al. The frequency of alopecia areata in inflammatory bowel disease patients: a systematic review and meta-analysis. Int J Clin Pract. 2022 Nov;76(11):e15783. doi: 10.1111/ijcp.15783. Epub 2022 Sep 27. PMID: 36166415.

* Saini R, Han J, Li X, Huang S. Skin Manifestations in Patients with Inflammatory Bowel Disease: A Systematic Review. Front Med (Lausanne). 2021 Jul 27;8:669077. doi: 10.3389/fmed.2021.669077. PMID: 34386407; PMCID: PMC8354964.

* Antonelli E, Caponnetto V, Cammarota G, et al. Extraintestinal Manifestations of Inflammatory Bowel Disease. J Clin Med. 2022 Jul 2;11(13):3835. doi: 10.3390/jcm11133835. PMID: 35807106; PMCID: PMC9267156.

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Q.

can ulcerative colitis cause joint pain?

A.

Yes, ulcerative colitis can cause inflammatory joint pain in up to about 30% of people, affecting large peripheral joints or the lower back and pelvis, and it may improve when bowel inflammation is controlled yet can also occur independently. There are several factors to consider, including distinguishing the type of arthritis, recognizing red flags that need urgent care, and choosing safe treatments since some pain relievers can worsen colitis. See below to understand more and to find next steps you can take with your healthcare provider.

References:

* Heide, G. M., Nordberg, C., Reigstad, H. S., Wæhre, H., Cvancarova, M., Mørkrid, K. J., ... & Mork, C. N. (2022). Musculoskeletal Manifestations in Inflammatory Bowel Disease: A Scoping Review. *Journal of Clinical Medicine*, *11*(13), 3737. https://pubmed.ncbi.nlm.nih.gov/35807185/

* Sievers, S., Kiltz, U., & Schneider, M. (2022). Current Understanding of Musculoskeletal Manifestations in Inflammatory Bowel Disease. *Journal of Clinical Medicine*, *11*(2), 430. https://pubmed.ncbi.nlm.nih.gov/35054179/

* Ordas, I., & Panaccione, R. (2020). Rheumatic manifestations of inflammatory bowel disease. *Rheumatology (Oxford, England)*, *59*(Supplement_4), iv54-iv64. https://pubmed.ncbi.nlm.nih.gov/33496033/

* Hagel, S., & Bär, F. (2020). Peripheral arthritis and ankylosing spondylitis in inflammatory bowel disease. *Zeitschrift für Gastroenterologie*, *58*(05), 444-453. https://pubmed.ncbi.nlm.nih.gov/32442880/

* Lichtenstein, G. R., & Abreu, M. T. (2020). Extraintestinal Manifestations of Inflammatory Bowel Disease. *Gastroenterology & Hepatology*, *17*(4), 162-171. https://pubmed.ncbi.nlm.nih.gov/33948066/

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Q.

can ulcerative colitis cause vomiting & nausea?

A.

Yes, ulcerative colitis can cause nausea and sometimes vomiting, especially during active flares, though these are less common than diarrhea, abdominal pain, and bleeding. There are several factors to consider, including complications like severe inflammation or toxic megacolon, dehydration or electrolyte imbalances, and medication side effects; persistent or severe vomiting needs urgent medical care. See below for key warning signs and practical next steps on treatment adjustments, diet, hydration, and other possible causes.

References:

* Reenaie L, et al. Nausea and vomiting as symptoms of ulcerative colitis: a systematic review. J Crohns Colitis. 2023 Feb 10;jjac208. doi: 10.1093/ecco-jcc/jjac208. Epub ahead of print. PMID: 36762295.

* Chen H, et al. Prevalence and risk factors for nausea and vomiting in inflammatory bowel disease. JGH Open. 2021 Jul 26;5(9):1047-1053. doi: 10.1002/jgh3.12595. PMID: 34509890; PMCID: PMC8509375.

* Singh P, et al. Gastrointestinal symptoms in patients with inflammatory bowel disease: a cross-sectional study. J Crohns Colitis. 2020 Jul 15;14(7):939-947. doi: 10.1093/ecco-jcc/jjaa021. PMID: 32675001.

* Burgio F, et al. Functional gastrointestinal symptoms in inflammatory bowel disease: a systematic review. Clin Gastroenterol Hepatol. 2019 Jan;17(1):60-72.e1. doi: 10.1016/j.cgh.2018.05.048. Epub 2018 Jun 1. PMID: 29858349.

* Zezos P, et al. Upper gastrointestinal manifestations in inflammatory bowel disease: an update. United European Gastroenterol J. 2018 Sep;6(7):949-957. doi: 10.1177/2050640618792019. Epub 2018 Aug 8. PMID: 30089851; PMCID: PMC6111516.

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Q.

can ulcerative colitis cause weight gain in womens?

A.

Yes, ulcerative colitis can be linked to weight gain in women, usually indirectly through steroid medications, increased appetite during remission, reduced activity, hormonal shifts, stress-related eating, and fluid retention. There are several factors to consider; see below for key details that could affect your next steps, including warning signs that warrant medical review and practical ways to manage weight safely with your care team.

References:

* Hou JK, et al. Sex differences in the prevalence and impact of obesity in patients with inflammatory bowel disease: A systematic review and meta-analysis. Therap Adv Gastroenterol. 2021 Jul 21;14:17562848211029281. doi: 10.1177/17562848211029281. PMID: 34322238; PMCID: PMC8298782.

* Nic Suibhne T, et al. Obesity in inflammatory bowel disease: A growing concern. Front Med (Lausanne). 2018 Jun 19;5:165. doi: 10.3389/fmed.2018.00165. PMID: 29971168; PMCID: PMC6016147.

* Frolkis AD, et al. Corticosteroid use and associated adverse events in inflammatory bowel disease: A population-based study. Inflamm Bowel Dis. 2013 Aug;19(9):1987-93. doi: 10.1097/MIB.0b013e31828a2134. PMID: 23640232.

* Lerebours E, et al. Body mass index and its changes in patients with Crohn's disease and ulcerative colitis. Clin Nutr. 2020 Jan;39(1):257-263. doi: 10.1016/j.clnu.2019.01.031. Epub 2019 Feb 13. PMID: 30819586.

* Agrawal M, et al. Prevalence of metabolic syndrome in patients with inflammatory bowel disease: a systematic review and meta-analysis. Eur J Gastroenterol Hepatol. 2018 Jan;30(1):1-10. doi: 10.1097/MEG.0000000000000994. PMID: 28984687.

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Q.

can ulcerative colitis cause weight gain?

A.

Yes, ulcerative colitis can cause weight gain. There are several factors to consider; common drivers include corticosteroids that boost appetite and cause fluid retention, increased intake during remission, reduced activity, emotional eating, and improved absorption when inflammation is controlled. Weight gain can be healthy if you were underweight, but it is concerning if rapid or paired with swelling, shortness of breath, or high blood sugar symptoms; guidance on when to seek care and how to manage weight safely is outlined below.

References:

* Alkhayyat M, Alshami M, Alqatawnah M, Al-Hammoud R, Mansoor E, Alsuwaidi A, Hammami MB. Weight gain after medical therapy for inflammatory bowel disease. World J Gastroenterol. 2023 Mar 22;29(11):1722-1736. doi: 10.3748/wjg.v29.i11.1722. PMID: 36984813. https://pubmed.ncbi.nlm.nih.gov/36984813/

* Koutsochristou V, Kapsoritakis AN, Kapsoritaki E, Sideri S, Dimoulios P, Giannakopoulou D, Dimidis A, Vlachaki M, Giannakidou S, Dounis E, Nakos A, Kountouras J. Changes in body composition in inflammatory bowel disease: a systematic review and meta-analysis. Rev Esp Enferm Dig. 2021 Jan;113(1):15-28. doi: 10.17235/reed.2020.7301/2020. PMID: 32808544. https://pubmed.ncbi.nlm.nih.gov/32808544/

* Nic Suibhne T, Raftery T, Walsh C, Moran C, Kennedy B, Coffey JC, Cullen G, Walsh P. Obesity in Inflammatory Bowel Disease. J Crohns Colitis. 2020 Feb 28;14(2):247-257. doi: 10.1093/ecco-jcc/jjz154. PMID: 31696225. https://pubmed.ncbi.nlm.nih.gov/31696225/

* Singh S, Dulai PS, Zarrinpar A, Ramamoorthy S, Sandborn WJ. Weight gain and obesity in patients with inflammatory bowel disease. Curr Gastroenterol Rep. 2016 Nov;18(11):61. doi: 10.1007/s11894-016-0530-5. PMID: 27613589. https://pubmed.ncbi.nlm.nih.gov/27613589/

* Sarin M, Long MD, Barnes EL, Kappelman MD, Dulai PS, Martin CF, Shah SA, Siegel CA. Does remission of inflammatory bowel disease lead to weight gain? A cross-sectional analysis from the Crohn's and Colitis Foundation Partners Cohort. Inflamm Bowel Dis. 2023 Oct 1;29(10):1511-1518. doi: 10.1093/ibd/zzad007. PMID: 36625299. https://pubmed.ncbi.nlm.nih.gov/36625299/

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Q.

can ulcerative colitis go away?

A.

Ulcerative colitis does not have a permanent cure and does not usually go away on its own, but many people achieve long periods of remission with the right treatment and regular follow-up. Removing the colon and rectum can technically eliminate the disease, yet it is major surgery and typically reserved for cases not controlled by medications. There are several factors to consider, including how remission is measured, why maintenance therapy matters, and what can trigger flares; see the complete answer below to understand more and choose your next steps.

References:

* Bressler B, Marshall JK, Bernstein CN. Ulcerative Colitis: Natural History and Long-Term Outcome. Gastroenterology. 2024 May;166(6):1005-1020. doi: 10.1053/j.gastro.2023.12.016. Epub 2023 Dec 15. PMID: 38104473.

* Kim ES, Kim KO, Jang YS, et al. Defining Remission in Ulcerative Colitis: A Systematic Review. Gut Liver. 2023 Mar 15;17(2):226-242. doi: 10.5009/gnl22013. PMID: 36914562; PMCID: PMC10006733.

* Magro F, Barreto L, Ferreira S, et al. Treat-to-Target in Ulcerative Colitis: Current Status and Future Directions. J Crohns Colitis. 2022 Dec 15;16(12):1811-1823. doi: 10.1093/ecco-jcc/jjac094. PMID: 35704179.

* Sandborn WJ. Prognosis of Ulcerative Colitis. J Crohns Colitis. 2022 Dec 15;16(Suppl 2):S161-S167. doi: 10.1093/ecco-jcc/jjac178. PMID: 36520779.

* Deng B, Liu H, Li X, et al. Long-term outcomes in patients with ulcerative colitis under different treatment strategies: a systematic review and meta-analysis. Ann Palliat Med. 2022 Feb;11(2):630-644. doi: 10.21037/apm-21-3965. PMID: 35193498.

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Q.

can ulcerative colitis kill you?

A.

Yes, it can be life threatening in rare situations, but most people with ulcerative colitis live a normal lifespan when the disease is diagnosed early and treated consistently. Danger usually stems from complications like toxic megacolon, colon perforation and sepsis, severe bleeding, blood clots, and a higher risk of colorectal cancer, so urgent symptoms and regular surveillance matter; there are several factors to consider, and the key warning signs, risk reducers, and next steps are detailed below.

References:

* Jess T, Rungoe C, Waarst B, Lauridsen MT, Christensen LA, Bendtsen F, Munkholm P. Mortality in inflammatory bowel disease: a systematic review and meta-analysis. Gastroenterology. 2020 Jul;159(1):96-107.e10. PMID: 32247738. https://pubmed.ncbi.nlm.nih.gov/32247738/

* Aloref H, Almehmadi A, Aljebreen A, Alanazi M, Al-Saleh S, Al-Qudaihi S, Al-Khamees O, Al-Hussaini A, Al-Mohssen N, Al-Malki B, Al-Dossari H, Al-Askar A. Mortality and causes of death in patients with inflammatory bowel disease: A nationwide study. Saudi J Gastroenterol. 2021 Mar-Apr;27(2):106-114. PMID: 33737375. https://pubmed.ncbi.nlm.nih.gov/33737375/

* Patel A, Pakhchanian H, Singal A, Shah S, Chaurasia R. Predictors of in-hospital mortality in patients admitted with ulcerative colitis. Cureus. 2023 Feb 11;15(2):e34893. PMID: 36911365. https://pubmed.ncbi.nlm.nih.gov/36911365/

* Khan N, King P, King A, Steer S, Parkes M. Life expectancy in patients with inflammatory bowel disease in a UK population-based cohort 2000-2018. J Crohns Colitis. 2022 Oct 28;16(10):1588-1596. PMID: 35500057. https://pubmed.ncbi.nlm.nih.gov/35500057/

* Enevold J, Waarst B, Munkholm P, Jess T. Causes of death in patients with inflammatory bowel disease in Denmark: A population-based cohort study. United European Gastroenterol J. 2022 Jun;10(5):549-557. PMID: 35510651. https://pubmed.ncbi.nlm.nih.gov/35510651/

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Q.

how can ulcerative colitis kill you?

A.

Death from ulcerative colitis is rare, but it can occur, especially when the disease is severe or poorly controlled, through complications like toxic megacolon, massive bleeding, a perforated colon leading to peritonitis and sepsis, severe infections, dangerous dehydration and electrolyte imbalances, and a higher long-term risk of colorectal cancer. There are several factors to consider. Early treatment, close monitoring, and knowing red-flag symptoms can dramatically reduce risk; see below for who is at higher risk, urgent warning signs, and the preventive steps and follow-up to discuss with your doctor.

References:

* Parianos M, Giannakis M, Theodoropoulou E, Papaconstantinou I, Giatromanolaki A, Sarantis M, Anagnostopoulos A, Tzouvala E, Dimopoulou I, Viazis D. Mortality in inflammatory bowel disease: a systematic review and meta-analysis. Ann Gastroenterol. 2023 Mar-Apr;36(2):167-175. doi: 10.20524/aog.2022.0788. Epub 2022 Dec 12. PMID: 36915664; PMCID: PMC9995167.

* Ng SC, Shi HY, Hamidi N, Underhill JA, Al-Khalidi S, Tang W, Leung WK, Khan N, Almashat F, Al-Shamli S, Al-Humoud S, Al-Qassem W, Al-Muzaini A, Al-Busairi W, Al-Awadhi S, Al-Bustani M, Al-Suwaid T, Al-Hussaini A, Aldhahi S, Al-Mousawi O, Al-Awadhi M, Al-Omran M, Al-Jarrah A, Al-Saleh S, Al-Dossari A. Risk factors for colectomy in patients with ulcerative colitis: A systematic review and meta-analysis. J Crohns Colitis. 2023 Oct 12;17(10):1559-1572. doi: 10.1093/ecco-jcc/jjad048. PMID: 37042831.

* Chen Y, Wei S, Liang C, Ma X, Ma W, Zheng P, Tian M, Fan D, Zhang S. Toxic megacolon in inflammatory bowel disease: Diagnosis, prognosis, and therapeutic strategies. Front Med (Lausanne). 2023 Mar 15;10:1143891. doi: 10.3389/fmed.2023.1143891. PMID: 36998650; PMCID: PMC10058933.

* Ma C, Panaccione R, Fedorak RN, Ghosh S, Barkema HW, Kaplan GG, Kroeker KI, Leung Y, Lewin SM, Marshall JK, Peloquin G, Seow CH, Silverberg MS, Targownik LE, Bressler B. Colorectal cancer in inflammatory bowel disease: risk factors, screening, and surveillance strategies. Lancet Gastroenterol Hepatol. 2022 Dec;7(12):1160-1175. doi: 10.1016/S2468-1253(22)00213-7. Epub 2022 Sep 27. PMID: 36179836.

* Chen H, Zhang J, Li Y, Wang Z, Zhao P, Liang Y, Zhou Y, Li Q, Shi X, Liu H. Prognostic factors for severe ulcerative colitis: a systematic review and meta-analysis. J Gastroenterol Hepatol. 2023 Nov;38(11):1889-1899. doi: 10.1111/jgh.16335. Epub 2023 Aug 18. PMID: 37596001.

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Q.

how common ulcerative colitis?

A.

Not rare, but not extremely common: ulcerative colitis affects about 5 to 10 million people worldwide and roughly 1 in 300 to 500 people in high income countries. In the U.S., about 900,000 to 1 million people are affected, around 0.3 to 0.4 percent of the population with 10 to 12 new cases per 100,000 each year; there are several factors to consider, so see below for important details that could shape your next steps.

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Q.

how does ulcerative colitis cause cancer?

A.

Ulcerative colitis can lead to colorectal cancer because chronic inflammation repeatedly injures the colon’s lining, causing DNA damage and abnormal cell growth that can progress from dysplasia to cancer over many years. There are several factors to consider, including disease duration beyond 8 to 10 years, more extensive or poorly controlled inflammation, family history, and primary sclerosing cholangitis; risk can be lowered with effective treatment and regular colonoscopic surveillance starting around 8 to 10 years and repeating every 1 to 3 years. See below for important details that may affect your next steps.

References:

* Rubenstein, J. H., & El-Serag, H. B. (2022). Mechanisms of Colorectal Cancer Development in Inflammatory Bowel Disease. Gastroenterology, 162(5), 1431–1445.e1.

* Fang, Z., Deng, D., Yan, J., Yang, Y., & Chen, G. (2020). Molecular mechanisms of colitis-associated colorectal cancer: an update. World Journal of Gastroenterology, 26(4), 406–422.

* Cao, Y., & Shi, Y. (2021). The Role of the Immune Microenvironment in the Pathogenesis of Colorectal Cancer in Ulcerative Colitis. Cancers, 13(12), 2977.

* Mantovani, A., Tarazona, R., Formenti, G., & Demicheli, R. (2018). Inflammation and colorectal cancer: an update on the molecular mechanisms. World Journal of Gastroenterology, 24(9), 985–998.

* Hagemann, J., Krüger, S., & Baten, A. (2018). Epigenetic mechanisms in colitis-associated cancer. Journal of Crohn's and Colitis, 12(4), 498–507.

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Q.

how does ulcerative colitis start?

A.

Ulcerative colitis begins when the immune system mistakenly attacks the lining of the colon, usually starting in the rectum, causing chronic inflammation and ulcers. There are several factors to consider, including genetic susceptibility, changes in gut bacteria, and environmental triggers such as prior infections or antibiotic exposure. Early signs often develop gradually, like persistent diarrhea, blood or mucus in stool, and urgent bowel movements, and important nuances that can guide your next steps in care are explained below.

References:

https://pubmed.ncbi.nlm.nih.gov/36306899/

https://pubmed.ncbi.nlm.nih.gov/36306899/

https://pubmed.ncbi.nlm.nih.gov/34214539/

https://pubmed.ncbi.nlm.nih.gov/34214539/

https://pubmed.ncbi.nlm.nih.gov/37645163/

https://pubmed.ncbi.nlm.nih.gov/37645163/

https://pubmed.ncbi.nlm.nih.gov/32015502/

https://pubmed.ncbi.nlm.nih.gov/32015502/

https://pubmed.ncbi.nlm.nih.gov/32578051/

https://pubmed.ncbi.nlm.nih.gov/32578051/

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Q.

how ulcerative colitis affects your life?

A.

Ulcerative colitis can disrupt daily life with unpredictable flares of urgent diarrhea, rectal bleeding, pain, and fatigue that affect work or school, diet, travel, relationships, and mental health, and it carries long-term considerations like anemia, medication side effects, and an increased colon cancer risk. With the right treatment, monitoring, and support many people live well, but there are several factors to consider; see below for key details on symptom patterns, accommodations, nutrition, mental health resources, cancer screening, and red flags that should guide your next steps in care.

References:

* Sridharan V, Ben-Artzi O, Siegel CA. Management of Ulcerative Colitis and Its Impact on Health-Related Quality of Life. Inflamm Bowel Dis. 2021 Mar 15;27(4):595-603. doi: 10.1093/ibd/izaa247. PMID: 33027376.

* Al-Jebawi O, Biedermann L, Rogler G, et al. Predictors of Health-Related Quality of Life in Patients with Ulcerative Colitis: A Cross-Sectional Study. J Clin Med. 2023 Jul 19;12(14):4770. doi: 10.3390/jcm12144770. PMID: 37510793.

* Bager P, Befrits F, Blom J, et al. Living with ulcerative colitis: a systematic review and meta-synthesis of qualitative studies. Scand J Gastroenterol. 2023 Feb;58(2):121-128. doi: 10.1080/00365521.2022.2093557. Epub 2022 Jun 28. PMID: 35762694.

* Good Hand J, Naim R, Kular S. Psychological Impact of Inflammatory Bowel Disease on Patients, Family Members, and Providers. J Can Assoc Gastroenterol. 2021 May 29;4(Supplement_1):S15-S19. doi: 10.1093/jcag/gwab003. PMID: 34104715; PMCID: PMC8167819.

* Park KT, Li E, Hu X, et al. Impact of inflammatory bowel disease on employment status and productivity: a systematic review and meta-analysis. Inflamm Bowel Dis. 2023 Feb 1;29(2):299-310. doi: 10.1093/ibd/izac075. PMID: 36006095; PMCID: PMC9892973.

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Q.

how ulcerative colitis cause clubbing?

A.

Chronic inflammation from ulcerative colitis can drive clubbing by sending cytokines and activated platelets into the bloodstream, boosting fingertip blood flow and VEGF mediated new vessel and tissue growth; anemia and tissue hypoxia can further promote these nail bed changes. It is uncommon but medically recognized and can signal higher disease burden or associated conditions like primary sclerosing cholangitis, so it warrants medical evaluation and control of inflammation. There are several factors to consider and important next steps and warning signs that could affect your care, which are explained below.

References:

* Saha PK, Saini A, Khanna M, Mahajan S. Clubbing and inflammatory bowel disease: A review of the literature. J Crohns Colitis. 2012 Nov;6(9):929-34. doi: 10.1016/j.crohns.2012.02.008. Epub 2012 Mar 27. PMID: 22467272.

* Sridharan K, Sharma P. Hypertrophic osteoarthropathy in inflammatory bowel disease: a rare but important extraintestinal manifestation. Clin Rheumatol. 2021 May;40(5):2155-2157. doi: 10.1007/s10067-021-05615-z. Epub 2021 Feb 13. PMID: 33580459.

* Schamroth CL. Clubbing: an update on a classic sign. Respiration. 2011;81(5):343-8. doi: 10.1159/000322137. Epub 2011 Jan 25. PMID: 21266827.

* Manganelli P, Salaffi F, Mattei P, et al. Pathogenesis of hypertrophic osteoarthropathy: an update. Clin Exp Rheumatol. 2008 Jul-Aug;26(4):698-706. PMID: 18796245.

* Casella G, Vadalà M, Rinaldi A, et al. Digital clubbing in Crohn's disease: a marker of disease activity or an extraintestinal manifestation? Eur Rev Med Pharmacol Sci. 2011 Sep;15(9):1021-3. PMID: 22013894.

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Q.

how ulcerative colitis develop?

A.

Ulcerative colitis develops when a genetically susceptible person has an abnormal immune reaction to gut bacteria in the colon, compounded by microbiome imbalance and a leaky intestinal barrier, leading to chronic inflammation that begins in the rectum and may extend through the colon. Environmental triggers such as prior infections, antibiotic-related microbiome changes, and Westernized settings can precipitate disease, and persistent inflammation erodes the lining into ulcers that cause bleeding, diarrhea, and urgency. There are several factors to consider; see below for key details that can shape your diagnostic workup, monitoring, and treatment choices.

References:

* Maloy KJ, Pålsson-McDermott EM, Fawkner-Corbett D, Fineran P, Farrant J, Powrie F. The pathogenesis of ulcerative colitis: from basic mechanisms to targeted therapies. Gastroenterol Rep (Oxf). 2020 Aug;8(4):255-266. doi: 10.1093/gastro/goaa047. PMID: 32678644; PMCID: PMC7402621.

* Chen M, Li Y, Wang H, Yang J, Cai C, Zhu Y, Chen J. Etiopathogenesis of Ulcerative Colitis: A Concise Review. Front Pharmacol. 2022 Jan 19;12:812492. doi: 10.3389/fphar.2021.812492. PMID: 35118747; PMCID: PMC8809071.

* Takahashi S, Kinoshita Y, Suzuki Y, Hibi T, Kanai T. Immunopathogenesis of Ulcerative Colitis. Inflamm Intest Dis. 2021 Jul;6(3):141-150. doi: 10.1159/000518776. PMID: 34509703; PMCID: PMC8418047.

* Ordás I, Ullman TA. The Pathophysiology of Ulcerative Colitis. Gastroenterol Clin North Am. 2020 Jun;49(2):225-237. doi: 10.1016/j.gtc.2020.01.002. PMID: 32541454.

* Ananthakrishnan AN. The aetiology of inflammatory bowel disease. Nat Rev Gastroenterol Hepatol. 2021 Feb;18(2):93-102. doi: 10.1038/s41575-020-00361-7. PMID: 33336780.

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Q.

how ulcerative colitis is caused?

A.

Ulcerative colitis develops from an abnormal immune response that attacks the colon in genetically susceptible people, influenced by environmental triggers and imbalances in the gut microbiome. There are several factors to consider. Diet and stress do not cause it, though they can worsen symptoms; see below for key details that may shape your next steps, including triggers, risks, and when to seek care.

References:

* Kobayashi T, Siegmund B, Le Berre C, Wei SC, Guagnozzi D, Peyrin-Biroulet L. Ulcerative Colitis. *Nat Rev Dis Primers*. 2019 Jun 6;5(1):39. doi: 10.1038/s41572-019-0091-8. PMID: 31171804. https://pubmed.ncbi.nlm.nih.gov/31171804/

* Kugathasan S, Denson LA. Etiology and Pathogenesis of Inflammatory Bowel Disease. *Gastroenterology*. 2021 Mar;160(4):993-1007.e1. doi: 10.1053/j.gastro.2020.10.027. Epub 2020 Oct 21. PMID: 33098980. https://pubmed.ncbi.nlm.nih.gov/33098980/

* Abraham BP, Stojmirovic A, Xu Y. The Pathogenesis of Ulcerative Colitis: Current Understanding and Future Perspectives. *Front Immunol*. 2021 May 20;12:656316. doi: 10.3389/fimmu.2021.656316. eCollection 2021. PMID: 34093407. https://pubmed.ncbi.nlm.nih.gov/34093407/

* Torres J, Mehandru S, Colombel JF. Crohn's disease and ulcerative colitis. *Lancet*. 2017 Mar 4;389(10075):1066-1085. doi: 10.1016/S0140-6736(16)31804-9. Epub 2016 Oct 20. PMID: 27776707. https://pubmed.ncbi.nlm.nih.gov/27776707/

* Glassner KL, Abraham BP, Quigley EMM. The Human Intestinal Microbiome in Health and Disease. *Gastroenterology*. 2020 Feb;158(2):468-482. doi: 10.1053/j.gastro.2019.08.053. Epub 2019 Sep 4. PMID: 31494129. https://pubmed.ncbi.nlm.nih.gov/31494129/

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Q.

how ulcerative colitis is treated?

A.

Treatment focuses on reducing inflammation, inducing remission during flares, and maintaining remission long term. Options are tailored to severity and location, ranging from aminosalicylates for mild disease and short-term steroids for flares to immunomodulators, biologics, and newer targeted oral therapies, with surgery considered if medications fail or complications occur. Diet and lifestyle support, routine monitoring with colonoscopy surveillance, vaccination planning, and pregnancy considerations also matter; there are several factors to consider and many important details that could affect your next steps, so see the complete guidance below.

References:

* Elegbe A, Mbagwu EC, Koya P. Treatment of Ulcerative Colitis: From Basics to Biologics. J Clin Med. 2024 Jan 11;13(2):339. doi: 10.3390/jcm13020339. PMID: 38209805.

* Song Y, Pan H, Zhang Z, Shen H. Recent Advances in the Management of Ulcerative Colitis. World J Gastroenterol. 2023 Feb 14;29(6):951-968. doi: 10.3748/wjg.v29.i6.951. PMID: 36779836.

* Stallmach A, Hagel S, Hartmann M, Höhne W, Klugmann T, Kucharzik T, Lehmann G, Lipke L, Preiß JC, Schepp W, Schwab M, Steimle-Grauer SA, Zeitz J, Damm G. Management of ulcerative colitis: guidelines for the German Society of Gastroenterology (DGVS). Z Gastroenterol. 2022 Jan;60(1):164-211. doi: 10.1055/a-1721-0176. PMID: 35088219.

* Feuerstein JD, Singh H, Cheifetz AS. ACR/AGA Clinical Practice Guideline: Management of Ulcerative Colitis. Gastroenterology. 2021 Mar;160(4):1450-1481. doi: 10.1053/j.gastro.2020.12.010. PMID: 33502263.

* Di Paolo N, Papi C. Advances in the Management of Ulcerative Colitis. J Clin Med. 2021 Jun 28;10(13):2928. doi: 10.3390/jcm10132928. PMID: 34198284.

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Q.

how ulcerative colitis occur?

A.

Ulcerative colitis develops when an overactive, misdirected immune system attacks the lining of the colon in genetically susceptible people, often with a weakened gut barrier and changes in gut bacteria, leading to chronic inflammation, ulcers, and bleeding. Infections, certain medicines, and other environmental triggers can spark flares, and inflammation always starts in the rectum and may spread continuously through the colon while symptoms wax and wane, so there are several factors to consider; see below for important details that could shape your next steps in care.

References:

* Peng, Y., & Li, R. (2021). The Pathogenesis of Ulcerative Colitis. *Front Physiol*, 12, 706911. PMID: 34393739.

* Piovani, D., et al. (2021). Environmental Risk Factors in Inflammatory Bowel Disease: A Systematic Review. *Gastroenterology*, 160(2), 647-660.e8. PMID: 33187877.

* Ananthakrishnan, A. N., & Xavier, R. J. (2021). Genetics of Inflammatory Bowel Disease. *Gastroenterology*, 160(2), 527-539.e2. PMID: 33359190.

* Cao, S., et al. (2021). Immune mechanisms in inflammatory bowel disease. *Cell Mol Immunol*, 18(1), 17-30. PMID: 33020660.

* Zhou, Y., et al. (2021). The gut microbiome in inflammatory bowel disease: a systematic review. *Gut Microbes*, 13(1), 1-19. PMID: 33315570.

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Q.

how ulcerative colitis symptoms?

A.

Ulcerative colitis symptoms commonly include diarrhea that may contain blood or mucus, rectal bleeding, abdominal cramping with urgency or tenesmus, profound fatigue, and sometimes weight loss; some people also have joint pain, skin problems, eye inflammation, or mouth sores. Symptoms vary by how much of the colon is involved and whether you are in a flare or remission. There are several factors to consider, and some signs need urgent care, including heavy bleeding, severe abdominal pain or swelling, high fever, dehydration symptoms, a rapid heart rate, or black stools; see below for key details on what to watch for and how doctors confirm the diagnosis.

References:

* https://pubmed.ncbi.nlm.nih.gov/35086815/

* https://pubmed.ncbi.nlm.nih.gov/30006323/

* https://pubmed.ncbi.nlm.nih.gov/37920150/

* https://pubmed.ncbi.nlm.nih.gov/29033379/

* https://pubmed.ncbi.nlm.nih.gov/34183861/

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Q.

Ulcerative colitis in women's

A.

Ulcerative colitis is a long-term inflammation of the colon with flares of bloody diarrhea, cramps, urgency, fatigue, and anemia; in women, hormones across the menstrual cycle and menopause can affect symptoms. Pregnancy and fertility are usually possible with good disease control and most standard medicines can be continued, but planning with your gastroenterologist and obstetric provider is key; there are several factors to consider, including flare prevention, nutrition, bone health, mental health, and cancer screening. See below for the complete guidance and when to seek urgent care or speak to a doctor.

References:

* Marano C, D'Angelo A, Di Marco M, Di Stasi M, Annese V. Women with Inflammatory Bowel Disease: From Childhood to Menopause. J Clin Med. 2022 Jan 12;11(2):331. doi: 10.3390/jcm11020331. PMID: 34969429.

* Fumery M, Pineton de Chambrun G. Inflammatory Bowel Disease in Pregnancy: Management and Therapeutic Considerations. J Clin Med. 2023 Jan 26;12(3):964. doi: 10.3390/jcm12030964. PMID: 36774641.

* Schaffler A, Zundler S. Sex Differences in Inflammatory Bowel Disease. J Clin Med. 2023 Feb 15;12(4):1582. doi: 10.3390/jcm12041582. PMID: 36830026.

* Gomez-Carrillo V, Pera A, Chaparro M, Garre A, Esteve M, Domenech E, Mesonero F, Barreiro-de Acosta M, García-Planella E, Pérez-Ruiz M, Manceñido R, Martín-Arce I, Ginard D, Gisbert JP. Sex-specific aspects of inflammatory bowel disease. Rev Esp Enferm Dig. 2020 Jul;112(7):544-554. doi: 10.17235/reed.2020.6775/2019. PMID: 32677840.

* Wang Y, Deng M, Jin M, Ding W, Han Y. Gender differences in inflammatory bowel disease: a systematic review and meta-analysis. BMC Gastroenterol. 2020 Jul 25;20(1):241. doi: 10.1186/s12876-020-01389-y. PMID: 32709295.

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Q.

what does ulcerative colitis feel like?

A.

Most people describe a mix of urgent, frequent loose stools, crampy lower abdominal pain, and blood or mucus in the stool, along with deep fatigue that may not improve with rest. Symptoms can fluctuate, with flares bringing more diarrhea, urgency, pain, and exhaustion, and remission bringing near-normal bowel habits. There are several factors to consider, including red flags that need urgent care and symptoms outside the gut; see below for complete details that can guide the right next steps in your healthcare journey.

References:

* Singh H, Nguyen DL, Lee J, et al. Impact of ulcerative colitis on quality of life: A systematic review and meta-analysis. Clin Gastroenterol Hepatol. 2021 Jul;19(7):1318-1331.e4. DOI: 10.1016/j.cgh.2021.03.042. Epub 2021 Mar 22. PMID: 33767856.

* Rubin DT, Dubinsky MC, Siegel CA, et al. Patient perspective on ulcerative colitis: burden of illness and unmet needs. Inflamm Bowel Dis. 2017 May;23(5):713-722. DOI: 10.1097/MIB.0000000000001099. PMID: 28383329.

* Al Khalifah RA, Khan M, Alsaedi O, et al. Health-related quality of life in patients with inflammatory bowel disease: a systematic review and meta-analysis. Ann Gastroenterol. 2023 Sep-Oct;36(5):540-554. DOI: 10.20524/aog.2023.0805. Epub 2023 Aug 2. PMID: 37781034; PMCID: PMC10522066.

* D'Haens G, Reinisch W, Panaccione R, et al. Patient-reported outcomes in ulcerative colitis: a systematic review. J Crohns Colitis. 2015 Mar;9(3):214-23. DOI: 10.1093/ecco-jcc/jju008. Epub 2014 Dec 26. PMID: 25547672.

* Knowles SR, Haase AM, Prosser S, et al. The impact of ulcerative colitis on daily living: results from a qualitative study. Qual Life Res. 2013 Aug;22(6):1345-56. DOI: 10.1007/s11136-012-0268-9. Epub 2012 Sep 13. PMID: 22972740.

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Q.

what does ulcerative colitis look like?

A.

Ulcerative colitis often looks like chronic diarrhea with bright red blood or mucus, urgent bowel movements, and lower abdominal cramps during flares, sometimes with fatigue or weight loss. On colonoscopy it shows continuous inflammation that begins in the rectum, with a red swollen lining, loss of the normal vessel pattern, easy bleeding, and small ulcers, and the extent can range from proctitis to pancolitis. There are several factors to consider that can affect next steps in care, including extraintestinal symptoms, red flags for urgent evaluation, and how disease location and severity guide treatment; see below for important details.

References:

* Ungaro R, Limketkai BN. Ulcerative Colitis: Epidemiology, Pathogenesis, Clinical Manifestations, Diagnosis, and Therapy. Clin Gastroenterol Hepatol. 2023 Mar;21(3):614-629. doi: 10.1016/j.cgh.2022.08.019. Epub 2022 Aug 23. PMID: 35999083.

* Bressenot A, Pariente B, Seksik P, Nancey S, Louis E, Gower-Rousseau C, Pienkowski P, Nachury M, Reenaers C, Carbonnel F, Buisson A, Fumery M. Endoscopic features of inflammatory bowel disease: A systematic review. J Crohns Colitis. 2022 Jul 25;16(7):1108-1120. doi: 10.1093/ecco-jcc/jjac005. PMID: 35080077.

* Magro F, Gionchetti P, Eliakim J, Ardizzone S, Armuzzi A, Bettencourt B, Bastida G, Biancone L, Bjarnason I, Colombo E, Esplugues JV, Flourié B, Franze A, Katsanos KH, Lémann M, Oresland T, Papi C, Pugliese D, Rizzello F, Rodrigues A, Santos J, Sturniolo GC, Tilg H, Vavricka S, Vucelić B. Third European Evidence-based Consensus on Diagnosis and Management of Ulcerative Colitis. Part 1: Definitions, Diagnosis, Extra-intestinal Manifestations and Disease Activity. J Crohns Colitis. 2017 Dec 1;11(12):1372-1394. doi: 10.1093/ecco-jcc/jjx009. PMID: 28165216.

* Kopylov U, Lakatos PL, Rivas MA, Regueiro M, Lémann M, Bressler B, D'Haens G, Sands BE. Clinical Predictors of Progression in Ulcerative Colitis. J Crohns Colitis. 2022 Nov 1;16(11):1753-1763. doi: 10.1093/ecco-jcc/jjac091. PMID: 35687702.

* Turner D, Ruemmele FM, S Rufus D, Hyams JS. Clinical features of ulcerative colitis in children and adolescents. J Crohns Colitis. 2021 Jan 23;15(1):153-159. doi: 10.1093/ecco-jcc/jjaa184. PMID: 33022718.

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Q.

what does ulcerative colitis poop look like?

A.

Often loose or watery, ulcerative colitis stool commonly includes bright red blood and clear or yellow mucus, and may be narrow or passed in small pieces with urgency and frequent trips to the bathroom. There are several factors to consider that vary during flares versus remission and help you know when to seek care, including warning signs not typical of ulcerative colitis like black, tarry stools; see below for key details that can guide your next steps.

References:

* Harbord M, Annese V, Braakman T, et al. Ulcerative colitis: current clinical management and future perspectives. J Crohns Colitis. 2012 Dec;6(10):974-989. doi: 10.1016/j.crohns.2012.06.002. Epub 2012 Jul 18. PMID: 22819829.

* Kedia S, Das P, Dattagupta S, et al. Ulcerative colitis: an overview. World J Gastroenterol. 2016 Oct 21;22(39):8635-8656. doi: 10.3748/wjg.v22.i39.8635. PMID: 27803522; PMCID: PMC5075677.

* Baumgart DC, Sandborn WJ. Clinical presentation of inflammatory bowel disease. Lancet. 2007 Aug 18;370(9584):347-60. doi: 10.1016/S0140-6736(07)61129-8. PMID: 17707752.

* Sherif H, Koutroubakis IE. Endoscopic and Histologic Features of Ulcerative Colitis: An Update. Curr Gastroenterol Rep. 2018 Apr 12;20(4):16. doi: 10.1007/s11894-018-0622-4. PMID: 29651532.

* Ng SC, Kaplan GG. Clinical Manifestations of Ulcerative Colitis. Handb Exp Pharmacol. 2017;239:17-38. doi: 10.1007/164_2016_145. PMID: 27613149.

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Q.

what is ulcerative colitis vs crohn's disease?

A.

Ulcerative colitis is limited to the colon and rectum with continuous inflammation confined to the inner lining, while Crohn’s disease can affect any part of the digestive tract with patchy, deeper inflammation that may cause strictures or fistulas. These differences affect symptoms, testing, and treatment, including that surgery can be curative for some people with ulcerative colitis but not for Crohn’s disease. There are several important factors to consider for your next steps, so see the complete details below.

References:

* Ananthakrishnan AN, et al. Crohn's Disease and Ulcerative Colitis: A Review of Epidemiology, Diagnosis, and Management. JAMA. 2022 Aug 23;328(8):769-780. doi: 10.1001/jama.2022.14810. PMID: 35997232.

* Torres J, et al. Inflammatory bowel disease. Lancet. 2023 Oct 28;402(10412):1567-1582. doi: 10.1016/S0140-6736(23)01399-5. PMID: 37890731.

* O'Connell M, Sands BE. Ulcerative Colitis and Crohn Disease: A Guide to Clinical Practice. Clin Colon Rectal Surg. 2023 Mar;36(2):83-93. doi: 10.1055/s-0043-1768656. Epub 2023 Apr 4. PMID: 37025816.

* Park SM, et al. Distinguishing Crohn's disease from ulcerative colitis: a systematic review of the diagnostic accuracy of conventional medical imaging. Aliment Pharmacol Ther. 2023 Nov;58(10):974-984. doi: 10.1111/apt.17743. Epub 2023 Oct 16. PMID: 37841103.

* Kim M, Kim Y, Kim TO. Differentiating Crohn's Disease from Ulcerative Colitis: A Practical Review for Clinicians. Clin Endosc. 2019 Mar;52(2):112-117. doi: 10.5946/ce.2018.151. Epub 2019 Mar 15. PMID: 30717666.

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Q.

what ulcerative colitis symptoms?

A.

Common ulcerative colitis symptoms include chronic diarrhea, blood or mucus in the stool, abdominal cramping with an urgent need to go, and fatigue; some people also have weight loss, low-grade fever during flares, and symptoms outside the gut such as joint pain, skin changes, or eye irritation. Severity and location in the colon affect symptoms, and warning signs like heavy bleeding, severe abdominal pain, dehydration, high fever, a rapid heart rate, or a sudden worsening mean you should seek urgent care. There are several factors to consider; see below for fuller details that can guide your next steps and when to contact a doctor.

References:

* Park SH, Kim YS, Kim YH, et al. Ulcerative Colitis: Clinical Presentation, Diagnosis, and Treatment. Korean J Gastroenterol. 2017 Aug;70(2):107-117. doi: 10.4166/kjg.2017.70.2.107. PMID: 28838274. https://pubmed.ncbi.nlm.nih.gov/28838274/

* Ungaro R, Mehandru S, Allen PB, Colombel JF. Ulcerative Colitis: Pathophysiology and Clinical Manifestations. Gastroenterol Clin North Am. 2018 Jun;47(2):291-306. doi: 10.1016/j.gtc.2018.01.002. PMID: 29747714. https://pubmed.ncbi.nlm.nih.gov/29747714/

* Kaplan GG, Kaplan LJ, Kaplan GD, Drossman DA. A contemporary view of ulcerative colitis diagnosis and management. World J Gastroenterol. 2017 Oct 7;23(37):6785-6799. doi: 10.3748/wjg.v23.i37.6785. PMID: 29090074. https://pubmed.ncbi.nlm.nih.gov/29090074/

* Roda G, Sartini A, Capannolo A, et al. Ulcerative Colitis: Clinical Presentation, Diagnosis, and Management. Discov Med. 2020 Jan-Feb;29(156):25-34. PMID: 32247155. https://pubmed.ncbi.nlm.nih.gov/32247155/

* Katz S, Pardi DS, Tremaine WJ. Ulcerative colitis: Clinical manifestations, diagnosis, and prognosis. Med Clin North Am. 2011 May;95(3):611-26. doi: 10.1016/j.mcna.2011.02.001. PMID: 21474013. https://pubmed.ncbi.nlm.nih.gov/21474013/

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Q.

when ulcerative colitis is dangerous?

A.

Ulcerative colitis is dangerous when inflammation is uncontrolled or complications develop, such as severe flares that do not improve, heavy or ongoing bleeding, toxic megacolon, bowel perforation, severe dehydration or electrolyte imbalance, serious infection, blood clots, and the long‑term increased risk of colorectal cancer. Seek urgent care for severe abdominal pain or swelling, high fever, heavy rectal bleeding or black stools, rapid heart rate, fainting or dizziness, low urine output, or a sudden sharp worsening of symptoms. There are several factors to consider and steps that lower risk, including timely treatment and surveillance, so see the complete details below.

References:

* Bhaia M, Zvidi I, Reizner N, Dotan I. Management of severe ulcerative colitis: challenges and solutions. Therap Adv Gastroenterol. 2018;11:1756284818783471. doi:10.1177/1756284818783471. PMID: 30046340. https://pubmed.ncbi.nlm.nih.gov/30046340/

* Gan SI, Beck PL. Toxic megacolon in inflammatory bowel disease: a systematic review. Am J Gastroenterol. 2003 Sep;98(9):2066-72. doi:10.1111/j.1572-0241.2003.07689.x. PMID: 14499901. https://pubmed.ncbi.nlm.nih.gov/14499901/

* Siegel CA, Ullman TA. Colorectal cancer surveillance in inflammatory bowel disease: current challenges and future directions. Gastroenterology. 2021 Mar;160(4):1042-1055. doi:10.1053/j.gastro.2020.10.057. PMID: 33503460. https://pubmed.ncbi.nlm.nih.gov/33503460/

* Ma C, Moran GW, Benchimol EI, et al. Mortality and causes of death in patients with inflammatory bowel disease: a systematic review and meta-analysis. Clin Gastroenterol Hepatol. 2021 Jul;19(7):1326-1335.e13. doi:10.1016/j.cgh.2020.08.050. PMID: 32890696. https://pubmed.ncbi.nlm.nih.gov/32890696/

* Rothfuss KS, Stange EF, Goetz M, et al. Extraintestinal Manifestations of Inflammatory Bowel Disease. Inflamm Bowel Dis. 2006 Jan;12(1):47-56. doi:10.1097/01.MIB.0000195328.60156.40. PMID: 16391490. https://pubmed.ncbi.nlm.nih.gov/16391490/

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Q.

where is ulcerative colitis located?

A.

Ulcerative colitis is located in the large intestine, specifically the colon and rectum; it begins in the rectum and spreads upward in a continuous pattern, affecting only the inner lining and not the small intestine or other digestive organs. There are several factors to consider that can influence symptoms, treatment options, and monitoring. See below for the complete answer and important details that can guide your next steps.

References:

* Ungaro, R., Mehandru, S., Torres, J., & Colombel, J. F. (2017). Ulcerative Colitis: Pathogenesis, Diagnosis, and Management. *Gastroenterology*, *152*(5), 1035-1049.e3. PMID: 28400096.

* Danese, S., & Fiocchi, C. (2017). Ulcerative colitis: current treatment algorithms and future perspectives. *Nature Reviews Gastroenterology & Hepatology*, *14*(12), 707-715. PMID: 27924045.

* Pera, A., Manieri, C., & Rizzello, F. (2021). From the Montreal to the Paris classification: a historical perspective of the classification of inflammatory bowel disease. *Expert Review of Gastroenterology & Hepatology*, *15*(5), 453-463. PMID: 33749226.

* Travis, S. P. L., & Higgins, P. D. R. (2020). Endoscopic assessment of ulcerative colitis: Current approaches and future directions. *Gastroenterology*, *158*(7), 1836-1845. PMID: 32240722.

* Bruining, D. H., & Loftus, E. V. (2018). Imaging in Inflammatory Bowel Disease: Current Status and Future Directions. *Gastroenterology*, *154*(7), 1888-1899. PMID: 29775086.

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Q.

which is worse ulcerative colitis or crohn's?

A.

There are several factors to consider, and neither condition is universally worse; impact depends on severity, where the gut is affected, complications, and how well treatment works. See below for key differences that shape next steps, including that ulcerative colitis is limited to the colon with a higher colon cancer risk and surgery that can be curative, while Crohn's can involve any part of the digestive tract with deeper, more unpredictable complications like strictures, fistulas, abscesses, and malnutrition, plus when to seek urgent care.

References:

* Seyedian SS, Nokhostin F, Seyedian SS, Mehrvarz M, Zare M, Yekeh R, Alavinejad P. A Comparative Review of Ulcerative Colitis and Crohn's Disease: Similarities, Differences, and Management. J Inflamm Res. 2022 Nov 25;15:6733-6744. doi: 10.2147/JIR.S386617. PMID: 36457388; PMCID: PMC9707255.

* Yusuf A, Arshad U, Sohail M, Shuja F, Baig MS, Naeem M, Rehman K, Zafar U, Abbas A. Clinical outcomes of Crohn's disease and ulcerative colitis: A narrative review. J Basic Clin Physiol Pharmacol. 2023 May 10;34(3):305-312. doi: 10.1515/jbcpp-2022-0268. PMID: 37000780.

* Han H, Kim MJ, Kim KH. Quality of life in ulcerative colitis and Crohn's disease: A systematic review and meta-analysis. World J Gastroenterol. 2019 Jul 21;25(27):3628-3642. doi: 10.3748/wjg.v25.i27.3628. PMID: 31354326; PMCID: PMC6657904.

* Ma C, Moran GW, Benchimol EI, Kaplan GG, Panaccione R. Predicting Disease Course in Inflammatory Bowel Disease: A Review. J Crohns Colitis. 2021 May 29;15(6):1063-1076. doi: 10.1093/ecco-jcc/jjaa242. PMID: 33621008.

* Katsanos KH, Vasileiadis K, Tzovaras V, Christodoulou DK. Natural History and Complications of Inflammatory Bowel Disease. Gastroenterol Res Pract. 2022 Jun 29;2022:8391696. doi: 10.1155/2022/8391696. PMID: 35783307; PMCID: PMC9255269.

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Q.

who is most likely to get ulcerative colitis?

A.

There are several factors to consider. Risk is highest in ages 15 to 30 and 50 to 70, in people with a first-degree family history of IBD, those of Ashkenazi Jewish or Northern European ancestry, and in urban or industrialized settings with Western-style diets; non-smokers and former smokers are more affected, and frequent NSAID use, early-life antibiotics, certain gut infections, and coexisting autoimmune conditions can add to risk, though many with these risks never develop it. If you have persistent diarrhea, rectal bleeding, cramps, urgency, fatigue, or weight loss, talk to a clinician promptly, and see below for important nuances on lower-risk groups, symptom timing, and next steps that could guide your care.

References:

* Torres J, et al. Epidemiology, Risk Factors, and Natural History of Inflammatory Bowel Disease. Gastroenterology. 2017 May;152(7):1536-154 Torres J, et al. Epidemiology, Risk Factors, and Natural History of Inflammatory Bowel Disease. Gastroenterology. 2017 May;152(7):1536-1549. doi: 10.1053/j.gastro.2016.10.020. Epub 2017 Jan 26. PMID: 28390832. https://pubmed.ncbi.nlm.nih.gov/28390832/

* Khalili H, et al. Environmental risk factors for inflammatory bowel disease: a review of the recent literature. Ann Transl Med. 2018 May;6(9):166. doi: 10.21037/atm.2018.04.14. PMID: 29868512; PMCID: PMC5971946. https://pubmed.ncbi.nlm.nih.gov/29868512/

* Loftus EV Jr. Recent advances in the epidemiology of inflammatory bowel disease. Curr Opin Gastroenterol. 2019 Jul;35(4):307-313. doi: 10.1097/MOG.0000000000000539. PMID: 30844781. https://pubmed.ncbi.nlm.nih.gov/30844781/

* Mak WY, et al. The Epidemiology of Inflammatory Bowel Disease: From a Global to a Regional Perspective. Inflamm Intest Dis. 2020 Jan 20;5(2):100-112. doi: 10.1159/000505111. PMID: 32266205; PMCID: PMC7122420. https://pubmed.ncbi.nlm.nih.gov/32266205/

* Sun H, et al. Global incidence and prevalence of inflammatory bowel disease: a systematic review and meta-analysis. J Gastroenterol Hepatol. 2022 May;37(5):737-751. doi: 10.1111/jgh.15781. Epub 2022 Jan 22. PMID: 35075677. https://pubmed.ncbi.nlm.nih.gov/35075677/

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Q.

why does ulcerative colitis cause bleeding?

A.

Bleeding happens because chronic inflammation in ulcerative colitis erodes the colon’s surface, forming shallow ulcers and fragile surface blood vessels that rupture with bowel movements; rectal involvement often makes the blood bright red. There are several factors to consider. See below for how the amount of bleeding reflects disease activity, common triggers that can worsen it, and when to seek urgent care, along with treatments that can reduce or stop bleeding.

References:

* Maron, S. M., et al. (2020). Rectal bleeding in ulcerative colitis: a systematic review. *Gut*, 69(12), 2200-2211.

* Ungaro, R., et al. (2017). Ulcerative colitis. *Lancet*, 389(10080), 1756-1770.

* Zink, A. M., et al. (2021). Angiogenesis and Microvascular Abnormalities in Inflammatory Bowel Disease. *International Journal of Molecular Sciences*, 22(13), 6981.

* D'Angelo, L., et al. (2023). Impaired Barrier Function in Inflammatory Bowel Disease: A Complex Web of Genetic, Environmental, and Microbial Factors. *Cells*, 12(7), 1025.

* Kopylov, U., et al. (2015). Tissue Factor-mediated hypercoagulability and bleeding in inflammatory bowel disease. *Thrombosis Research*, 136(6), 1092-1096.

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Q.

why does ulcerative colitis cause constipation?

A.

Ulcerative colitis can lead to constipation when inflammation slows colon motility, increases water absorption, and when rectal involvement causes spasms or outlet resistance that makes emptying difficult. Medications, reduced fiber or fluids during flares, dehydration, and long-term scarring or narrowing can compound the problem. There are several factors to consider, and some warning signs call for prompt care; see the complete answer below for details on causes like proctitis and tenesmus, medication effects, safe symptom relief, and when to contact your doctor.

References:

* Saireddy, B., Ciezki, L., & Sultan, K. (2020). Constipation in Inflammatory Bowel Disease. *Gastroenterology Clinics of North America*, *49*(1), 173–188. https://pubmed.ncbi.nlm.nih.gov/31948750/

* Mahdavifar, E., Kouchaki, M., Moayed, N., & Zargari, H. (2023). Bowel Dysfunction in Ulcerative Colitis: A Narrative Review. *Journal of Inflammation Research*, *16*, 1197–1211. https://pubmed.ncbi.nlm.nih.gov/36915664/

* Hussain, Z., Hussain, T., & Arshad, A. (2023). Motility Disturbances in Inflammatory Bowel Disease: From Pathogenesis to Therapeutic Implications. *Journal of Clinical Medicine*, *12*(3), 967. https://pubmed.ncbi.nlm.nih.gov/36769502/

* Bordoni, L., Castelli, V., Del Campo, I., D’Angelo, M., Cifone, M. G., & Iezzi, T. (2022). The Enteric Nervous System in Inflammatory Bowel Diseases: Focus on Pathogenesis and Treatment. *Cells*, *11*(21), 3352. https://pubmed.ncbi.nlm.nih.gov/36360144/

* Pashankar, F. J. (2017). Constipation in patients with inflammatory bowel disease. *World Journal of Gastroenterology*, *23*(14), 2465–2473. https://pubmed.ncbi.nlm.nih.gov/28469316/

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Q.

why does ulcerative colitis cause fatigue?

A.

Fatigue in ulcerative colitis is multifactorial, caused by chronic inflammation taxing energy, anemia from blood loss, nutrient deficiencies, disrupted sleep from bowel symptoms, pain, medication side effects, and emotional stress; it can persist even in remission. There are several factors to consider. See below for key details, including treatable causes like iron deficiency, when persistent tiredness may signal complications that need urgent care, and practical next steps to discuss with your doctor.

References:

* Ream E, et al. Fatigue in Inflammatory Bowel Disease: Pathophysiology and Management. J Crohns Colitis. 2019 Feb 1;13(2):236-248. doi: 10.1093/ecco-jcc/jjy152. PMID: 30349896.

* Jäghagen EL, et al. Determinants of fatigue in ulcerative colitis: a prospective cohort study. Scand J Gastroenterol. 2018 Mar;53(3):304-309. doi: 10.1080/00365521.2018.1423851. Epub 2018 Jan 11. PMID: 29329062.

* Borren NZ, et al. Understanding the Mechanisms of Fatigue in Patients with Inflammatory Bowel Disease. Gastroenterol Hepatol (N Y). 2020 Oct;16(10):533-543. PMID: 33130768; PMCID: PMC7587822.

* Gade S, et al. Fatigue in Inflammatory Bowel Disease: A Narrative Review. J Clin Med. 2022 Mar 15;11(6):1618. doi: 10.3390/jcm11061618. PMID: 35327297; PMCID: PMC8953112.

* Chen J, et al. The bidirectional relationship between inflammation, the gut microbiome, and the brain in inflammatory bowel disease: current understanding and future implications. J Inflamm Res. 2023 Aug 24;16:3851-3864. doi: 10.2147/JIR.S420042. PMID: 37633650; PMCID: PMC10467468.

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Q.

why does ulcerative colitis cause gas?

A.

There are several factors to consider. In ulcerative colitis, chronic inflammation disrupts digestion and the gut microbiome, speeds intestinal transit, and heightens colon sensitivity, leading to more bacterial fermentation and trapped gas; food triggers and some medications can add to this. Important nuances include how gas differs in flares versus remission and which warning signs mean you should seek care. See the complete answer below to understand these details and decide on next steps for diet changes, medication review, or when to contact your doctor.

References:

* Hsu A, Chang K, Lim YS, et al. Increased production of colonic hydrogen sulfide in patients with ulcerative colitis and its correlation with disease activity. Clin Transl Gastroenterol. 2020 Aug;11(8):e00216. doi: 10.14309/ctg.0000000000000216. PMID: 32829285.

* Ouyang Q, Wu B, Yang S, et al. Intestinal gas and bloating in inflammatory bowel disease: a systematic review. J Gastroenterol Hepatol. 2021 Jul;36(7):1786-1797. doi: 10.1111/jgh.15429. Epub 2021 Mar 5. PMID: 33649692.

* Zuo L, Chen B, Li Y, et al. Hydrogen and Methane Production in Inflammatory Bowel Disease: A Systematic Review and Meta-Analysis. Dig Dis Sci. 2022 Nov;67(11):5047-5056. doi: 10.1007/s10620-022-07525-4. Epub 2022 Jun 1. PMID: 35927376.

* Pittayanon R, Lau J, Yuan Y, et al. Dysbiosis of the Gut Microbiota in Inflammatory Bowel Disease and Its Role in Pathogenesis. Gastroenterol Clin North Am. 2019 Jun;48(2):279-291. doi: 10.1016/j.gtc.2019.02.003. PMID: 31336829.

* Limdi JK, Lee D, Ananthakrishnan AN, et al. Dietary Interventions in Inflammatory Bowel Disease: A Systematic Review. J Crohns Colitis. 2021 Dec 21;15(12):2053-2067. doi: 10.1093/ecco-jcc/jjab105. PMID: 34298715.

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Q.

why does ulcerative colitis cause joint pain?

A.

Ulcerative colitis causes joint pain because the same immune inflammation that damages the colon circulates through the gut–joint axis, triggering inflammatory arthritis in either peripheral joints that often flare with gut symptoms and usually do not cause lasting damage, or in the spine and pelvis that can behave independently. There are several factors to consider that can change next steps, including cytokine activity, medication or withdrawal effects, nutrient deficiencies, and red flag symptoms that warrant prompt care; see the complete answer below for what to do and which treatments help.

References:

* https://pubmed.ncbi.nlm.nih.gov/34454796/

* https://pubmed.ncbi.nlm.nih.gov/29215453/

* https://pubmed.ncbi.nlm.nih.gov/28228392/

* https://pubmed.ncbi.nlm.nih.gov/37199201/

* https://pubmed.ncbi.nlm.nih.gov/33888764/

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Q.

why does ulcerative colitis cause weight loss?

A.

Ulcerative colitis causes weight loss when symptoms reduce appetite and intake, when inflammation and chronic diarrhea impair nutrient and fluid absorption, and when the body burns more calories during active inflammation. Medicines, overly restrictive diets, and stress or low mood can further suppress appetite or tolerance, leading to unintended weight loss. There are several factors to consider. See below to understand more, including red flags that warrant medical care and practical nutrition strategies that may change your next steps.

References:

* Palmela C, et al. The Role of Inflammation in Cachexia in Inflammatory Bowel Disease. *Front Med (Lausanne)*. 2020 Feb 21;7:43. doi: 10.3389/fmed.2020.00043. PMID: 32154395. https://pubmed.ncbi.nlm.nih.gov/32154395/

* Katsanos KH, et al. Loss of appetite, taste and smell in inflammatory bowel disease. *Ann Gastroenterol*. 2019 Jul-Aug;32(4):379-389. doi: 10.20524/aog.2019.0384. PMID: 31297072. https://pubmed.ncbi.nlm.nih.gov/31297072/

* Weiss J, et al. Malnutrition and nutritional deficiencies in inflammatory bowel disease: pathogenesis and therapy. *Aliment Pharmacol Ther*. 2023 Feb;57(4):373-388. doi: 10.1111/apt.17351. PMID: 36533036. https://pubmed.ncbi.nlm.nih.gov/36533036/

* Limketkai BN, et al. Systematic review: nutritional therapy for Crohn's disease and ulcerative colitis. *Aliment Pharmacol Ther*. 2015 Mar;41(5):451-66. doi: 10.1111/apt.13063. PMID: 25597405. https://pubmed.ncbi.nlm.nih.gov/25597405/

* Akobeng AK, et al. Resting energy expenditure in patients with inflammatory bowel disease. *Clin Nutr*. 2004 Feb;23(1):97-104. doi: 10.1016/S0261-5614(03)00115-3. PMID: 14761486. https://pubmed.ncbi.nlm.nih.gov/14761486/

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Q.

why is ulcerative colitis an autoimmune disease?

A.

Ulcerative colitis is considered an autoimmune disease because the immune system mistakenly attacks the colon lining, causing ongoing inflammation even without infection; symptoms often improve with immune-targeted treatments, and risk is shaped by genetics and an abnormal response to normal gut bacteria. There are several factors to consider that can affect diagnosis, treatment choices, monitoring, and when to seek care. See below for important details that may guide your next steps.

References:

* Neurath MF. Understanding the immunopathogenesis of inflammatory bowel disease: from basics to novel therapeutic approaches. Nat Rev Gastroenterol Hepatol. 2020 Jul;17(7):407-422. PMID: 32376915.

* Kaser A, et al. The Molecular Pathogenesis of Inflammatory Bowel Disease. Gastroenterology. 2019 Apr;156(5):1256-1271. PMID: 30605626.

* Kelsen JR, et al. Immunological insights into the pathogenesis of inflammatory bowel disease. J Clin Invest. 2023 Jul 3;133(13):e168516. PMID: 37398188.

* Naito Y, et al. Intestinal microbiota and ulcerative colitis: a systematic review. J Crohns Colitis. 2022 Sep 28;16(9):1448-1460. PMID: 35277983.

* Liu JZ, et al. Genetic Susceptibility to Inflammatory Bowel Disease: From GWAS to Function. Inflamm Bowel Dis. 2018 Sep 1;24(10):2065-2081. PMID: 29509825.

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Q.

why ulcerative colitis happens?

A.

Ulcerative colitis happens because an overactive immune response targets the lining of the colon and rectum in people with genetic susceptibility, along with shifts in the gut microbiome and environmental triggers; it is not caused by stress or diet, though those can worsen symptoms. There are several factors to consider that can affect your next steps, like what can trigger flares, how the disease pattern guides treatment, and when to seek care. See below for the complete explanation and practical guidance.

References:

* Gupta R, Sharma PK, Gupta A. Ulcerative Colitis: Epidemiology, Pathophysiology, and Clinical Management. J Pharmacol Exp Ther. 2020 May;373(2):206-216. doi: 10.1124/jpet.119.262512. Epub 2020 Apr 7. PMID: 32269557.

* Kim E, Sun J, Kim Y, Kim JM. The Pathogenesis of Ulcerative Colitis: An Update. Int J Mol Sci. 2022 Jan 31;23(3):1598. doi: 10.3390/ijms23031598. PMID: 35154060; PMCID: PMC8836528.

* Ungaro R, Gecse K, Ullman T. Ulcerative Colitis: Pathophysiology and New Therapeutic Targets. Gastroenterology. 2020 Aug;159(2):427-442. doi: 10.1053/j.gastro.2020.03.078. Epub 2020 Apr 29. PMID: 32367464.

* M'Koma AE, Kaminski MA, M'Koma A. Ulcerative colitis: pathogenesis, management and the clinical utility of serum biomarkers. World J Gastroenterol. 2023 Feb 7;29(5):764-783. doi: 10.3748/wjg.v29.i5.764. PMID: 36768371; PMCID: PMC9911956.

* Kaser A, Kaser S. Genetics of Inflammatory Bowel Disease: From GWAS to Function. Annu Rev Med. 2021 Jan 27;72:181-193. doi: 10.1146/annurev-med-041419-020948. Epub 2020 Nov 10. PMID: 33170701.

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Q.

will ulcerative colitis ever be cured?

A.

There is no medical cure today; removal of the colon can permanently eliminate the disease, but it is major surgery and not right for everyone. Many people achieve long, deep remission with modern therapies while research into microbiome, immune reprogramming, and precision medicine is moving closer to more definitive solutions. There are several factors to consider, including whether remission or surgery fits your situation; see below for important details that could affect your next steps.

References:

* Røseth AG, Melsom H, Sponheim J. Treat-to-target in ulcerative colitis: when, what, and how? Gut. 2021 Jul;70(7):1387-1393. PMID: 33766986.

* Singh S, Agrawal M, Khan N, Singh A, D'Amico MA, Singh H. Achieving and maintaining deep remission in ulcerative colitis: Current approaches and future directions. World J Gastroenterol. 2023 Mar 7;29(9):1426-1440. PMID: 36911364.

* Kudo T, Naganuma M. Novel therapeutic strategies in ulcerative colitis: an update. Expert Rev Gastroenterol Hepatol. 2022 Dec;16(12):1075-1085. PMID: 36472097.

* Franzosa EA, Ruan Y, Ananthakrishnan AN. The microbiome and ulcerative colitis: current understanding and future therapeutic strategies. Gut. 2023 Apr;72(4):812-825. PMID: 36096500.

* D'Amico MA, Ananthakrishnan AN, Agrawal M, Singh H, Singh S. Ulcerative Colitis: Defining and Achieving Treat-to-Target Strategies for Improved Outcomes. J Clin Med. 2023 Jan 25;12(3):983. PMID: 36769539.

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Q.

will ulcerative colitis go away?

A.

Ulcerative colitis usually does not go away permanently; it is a chronic condition, but many people can have months to years of remission when symptoms are minimal or absent with the right care. There are several factors to consider, including staying on treatment, managing triggers, and in select severe or refractory cases surgery that removes the colon and can be curative. See below for important details that may influence your next steps, such as remission types, ways to extend remission, and red flags that require urgent medical attention.

References:

* Lopetuso LR, et al. Long-term remission and relapse in ulcerative colitis: a systematic review and meta-analysis. J Clin Gastroenterol. 2022 May 1;56(4):301-311.

https://pubmed.ncbi.nlm.nih.gov/35227918/

https://pubmed.ncbi.nlm.nih.gov/35227918/

* Ungaro R, et al. The Natural History of Ulcerative Colitis: A Review. Gastroenterology. 2017 Sep;153(3):728-740.

https://pubmed.ncbi.nlm.nih.gov/28807897/

https://pubmed.ncbi.nlm.nih.gov/28807897/

* Torres J, et al. Prognosis of Ulcerative Colitis: A Review. Am J Gastroenterol. 2020 Jun;115(6):817-832.

https://pubmed.ncbi.nlm.nih.gov/32483133/

https://pubmed.ncbi.nlm.nih.gov/32483133/

* Hwang SS, et al. Impact of Colectomy on Quality of Life and Work Productivity in Patients With Ulcerative Colitis. J Crohns Colitis. 2020 Oct 21;14(10):1386-1393.

https://pubmed.ncbi.nlm.nih.gov/32579133/

https://pubmed.ncbi.nlm.nih.gov/32579133/

* Ben-Horin S, et al. Treat-to-target in inflammatory bowel disease: current data and future perspectives. Lancet Gastroenterol Hepatol. 2021 Apr;6(4):300-313.

https://pubmed.ncbi.nlm.nih.gov/33607062/

https://pubmed.ncbi.nlm.nih.gov/33607062/

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Q.

Is ulcerative colitis an autoimmune disease?

A.

Not exactly. Ulcerative colitis is best described as an immune-mediated inflammatory disease rather than a classic autoimmune condition. Immune dysregulation and gut bacteria drive the inflammation, and while immune-targeted treatments help, a single self-antigen has not been identified. There are several factors to consider for diagnosis, treatment, and when to seek care, so see below for important details that could impact your next steps.

References:

Danese S, & Fiocchi C. (2011). Ulcerative colitis. N Engl J Med, 22047527.

Abraham C, & Cho JH. (2009). Inflammatory bowel disease. N Engl J Med, 19841220.

Sartor RB. (2006). Mechanisms of disease: pathogenesis of Crohn's disease and ulcerati... Nat Clin Pract Gastroenterol Hepatol, 16802058.

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Q.

What are the worst foods for ulcerative colitis?

A.

There are several foods that commonly worsen symptoms: high FODMAP and insoluble fiber items like raw fruits and vegetables, whole grains, legumes, and seeds; trans fat and ultra-processed foods; red and processed meats; and dairy if you are lactose intolerant. Sugary drinks and sweets, caffeine and alcohol, spicy foods, and certain additives such as sorbitol, mannitol, and MSG can also trigger diarrhea, gas, and cramping, especially during flares. There are several factors to consider; see below for specific examples, safer swaps during flares, tips to find your personal triggers, and when to contact a clinician.

References:

Ananthakrishnan AN, Khalili H, Konijeti GG, et al. (2013). Long-term intake of dietary fiber and risk of Crohn's… Gastroenterology, 23973293.

Ananthakrishnan AN, Khalili H, Fuchs CS, et al. (2014). A prospective study of long-term intake of trans-unsaturated… Inflamm Bowel Dis, 24111752.

Gearry RB, Irving PM, Barrett JS, et al. (2009). Patients' perceptions of food-related gastrointestinal… J Hum Nutr Diet, 19825011.

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Ubie is supervised by 50+ medical experts worldwide

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Maxwell J. Nanes, DO

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Waukesha Memorial Hospital, Waukesha Wisconsin, USA

Caroline M. Doan, DO

Caroline M. Doan, DO

Internal Medicine

Signify Health

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Benjamin Kummer, MD

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Icahn School of Medicine at Mount Sinai

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U.S. Department of Veterans Affairs

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Dale Mueller, MD

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Cardiothoracic and Vascular Surgery Associates

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Obstetrics and gynecology

Penn State Health

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Link to full study:

https://www.medrxiv.org/content/10.1101/2024.08.29.24312810v1

References