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DEFINITION
- Ulcerative colitis is an inflammatory bowel disease that causes inflammation and ulcers
(sores) in your digestive tract. Ulcerative colitis affects the innermost lining of your large
intestine (colon) and rectum. Symptoms usually develop over time, rather than suddenly
(Mayo Clinic, 2021)
- Ulcerative colitis (UC) is one of the two major types of inflammatory bowel disease
(IBD), along with Crohn disease (CD). Unlike Crohn disease, which can affect any part of
the gastrointestinal tract, ulcerative colitis characteristically involves the large bowel
(see the image below). Ulcerative colitis is a lifelong illness that has a profound
emotional and social impact on the affected patients. (WebMD, 2016)
- Ulcerative colitis (UC) is a type of inflammatory bowel disease (IBD). IBD comprises a
group of diseases that affect the gastrointestinal (GI) tract. It occurs when the lining of
your large intestine (also called the colon), rectum, or both become inflamed.This
inflammation produces tiny sores called ulcers on the lining of your colon. Inflammation
usually begins in the rectum and spreads upward. It can involve your entire colon.The
inflammation causes your bowel to move its contents rapidly and empty frequently. As
cells on the surface of the lining of your bowel die, ulcers form. The ulcers may cause
bleeding and discharge of mucus and pus. These ulcers produce pus and mucous, which
cause abdominal pain and the need to frequently empty the colon. (Higuera, 2021)
- UC is not contagious. Though some causes of colitis or inflammation in the colon can be
contagious. That includes inflammation caused by bacteria and viruses. However, UC is
not caused by anything that can be transmitted to another person.
- This condition is the result of the immune system’s overactive response

Ulcerative Colitis vs. Crohn’s Disease vs. Irritable Bowel (WebMD, 2016)

Other gut diseases can have some of the same symptoms.

 Ulcerative colitis affects only your large intestine and its lining.
 Crohn’s disease causes inflammation, but it affects other places in the digestive tract.
 Irritable bowel syndrome has some of the same symptoms as UC, but it doesn’t cause
inflammation or ulcers. Instead, it’s a problem with the muscles in the intestines.

Types
Doctors often classify ulcerative colitis according to its location. Types of ulcerative colitis
include:

 Ulcerative proctitis. Inflammation is confined to the area closest to the anus (rectum),

and rectal bleeding may be the only sign of the disease.
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 Proctosigmoiditis. Inflammation involves the rectum and sigmoid colon — the lower
end of the colon. Signs and symptoms include bloody diarrhea, abdominal cramps and
pain, and an inability to move the bowels in spite of the urge to do so (tenesmus).
 Left-sided colitis. Inflammation extends from the rectum up through the sigmoid and
descending colon. Signs and symptoms include bloody diarrhea, abdominal cramping and
pain on the left side, and urgency to defecate.
 Pancolitis. This type often affects the entire colon and causes bouts of bloody diarrhea
that may be severe, abdominal cramps and pain, fatigue, and significant weight loss.
Mayo Clinic (2021)
 Acute severe ulcerative colitis is rare. It affects your entire colon and causes severe pain,
heavy diarrhea, bleeding, and fever (WebMD, 2016)
 Fulminant colitis is a rare, potentially life threatening form of colitis that affects the
whole colon. Symptoms tend to include severe pain and diarrhea, which can lead to
dehydration and shock. Fulminant colitis can present a risk of colon rupture and toxic
megacolon, which causes the colon to become severely distended. (Medical News Today)

CAUSES

The exact cause of ulcerative colitis remains unknown. Previously, diet and stress were
suspected, but now doctors know that these factors may aggravate but don't cause ulcerative
colitis.
One possible cause is an immune system malfunction. When your immune system tries
to fight off an invading virus or bacterium, an abnormal immune response causes the immune
system to attack the cells in the digestive tract, too.
Heredity also seems to play a role in that ulcerative colitis is more common in people
who have family members with the disease. However, most people with ulcerative colitis don't
have this family history. (Mayo Clinic, 2021)

Ulcerative colitis happens when the immune system makes a mistake. Normally, it attacks invaders
in the body, like the common cold. But when you have UC, the immune system thinks food,
good gut bacteria, and the cells that line the colon are the intruders. White blood cells that usually
protect you attack the lining of the colon instead. They cause the inflammation and ulcers.
(WebMD, 2016)

Researchers think the cause of ulcerative colitis probably the result of an overactive immune
response. The immune system’s job is to protect the body from germs and other dangerous
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substances. But, sometimes the immune system mistakenly attacks the body, which causes
inflammation and tissue damage. (Cleveland Clinic)

Causes of ulcerative colitis flareups

When you’re in remission from ulcerative colitis, you’ll want to do everything you can to
prevent a flareup. Things that may cause a flareup include:

 Emotional stress: Get at least seven hours of sleep a night, exercise regularly and find
healthy ways to relieve stress, such as meditation.
 NSAID use: For pain relief or a fever, use acetaminophen (Tylenol®) instead of NSAIDs
like Motrin® and Advil®.
 Antibiotics: Let your healthcare provider know if antibiotics trigger your symptoms.

Some foods may make symptoms worse and should be avoided, especially during flareups.
Foods that trigger symptoms are different from person to person. To narrow down what foods
affect you, keep track of what you eat each day and how you feel afterward (a food journal).

Problem foods often include:

 Greasy foods.
 High sugar foods and drinks.
 Carbonated beverages.
 High-fiber foods.
 Alcohol.

In addition to the problem foods listed above, infants, children and teenagers can also
experience issues with:

 Salt.
 Dairy products.

Ulcerative colitis is the result of several factors that are not yet well understood. Abnormal
immune response, genetics, microbiome, and environmental factors all contribute to ulcerative
colitis.

Research suggests that ulcerative colitis could be triggered by an interaction between a virus or
bacterial infection in the colon and the body’s immune response.  

 Typically, the cells and proteins that make up your immune system protect you from
infection.
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 A normal immune response would cause temporary inflammation to combat an illness
or infection. The inflammation would then go away once you are healthy and free of the
illness.

 In ulcerative colitis patients, the inflammation persists long after the immune system
should have finished its job. The body continues to send white blood cells into the lining
of the intestines, where they produce chronic inflammation and ulcers. (Crohns & Colitis
Foundation)

RISK FACTORS

Ulcerative colitis affects about the same number of women and men. (Mayo Clinic, 2021)

- Age. Ulcerative colitis usually begins before the age of 30. But it can occur at any age,
and some people may not develop the disease until after age 60.
- Race or ethnicity. Although whites have the highest risk of the disease, it can occur in
any race. If you're of Ashkenazi Jewish descent, your risk is even higher.
- Family history. You're at higher risk if you have a close relative, such as a parent, sibling
or child, with the disease.

Researchers believe that UC may be the result of an overactive immune system. However, it’s
unclear why some immune systems respond by attacking the large intestines, and others don’t.
(Higuera, 2021)

Factors that may play a role in who develops UC include:

 Genes. You may inherit a gene from a parent that increases your chance of having UC.
 Other immune disorders. If you have one type of immune disorder, your chance of
developing a second is higher.
 Environmental factors. Bacteria, viruses, and antigens may trigger your immune system.
Environment
The following environmental factors might affect the onset of ulcerative colitis:
 diet
 air pollution
 cigarette smoke
Immune system
The body might respond to a viral or bacterial infection in a way that causes the inflammation
associated with ulcerative colitis.
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Once the infection resolves, the immune system continues to respond, which leads to ongoing
inflammation.
Another theory suggests that ulcerative colitis may be an autoimmune condition. A fault in the
immune system may cause it to fight nonexistent infections, leading to inflammation in the
colon.

INCIDENCE
According to NHS website (2021)
- The condition can develop at any age, but is most often diagnosed in people aged from
15 to 25 years old
- The risk of developing ulcerative colitis is between 1.6 percent and 30 percent if you
have a first-degree relative with the disease
- Ulcerative colitis can affect people of any racial or ethnic group . It's more common in
white people of European descent, especially those descended from Ashkenazi Jewish
communities, and black people
- The condition is rarer in people from Asian backgrounds, although the reasons for this
are unclear
- Both men and women seem to be equally affected by ulcerative colitis
- Individuals who eat a high-fat diet and use frequent nonsteroidal anti-inflammatory
drugs (NSAIDS) like ibuprofen (Advil® or Motrin®) is at risk
MANIFESTATIONS
The main symptom of ulcerative colitis is bloody diarrhea. There might be some pus in your stools,
too (WebMD, 2016)
According to NHS website (2021)
The severity of the symptoms varies, depending on how much of the rectum and colon is
inflamed and how severe the inflammation is
Symptoms of a flare-up
Some people may go for weeks or months with very mild symptoms, or none at all (remission),
followed by periods where the symptoms are particularly troublesome (flare-ups or relapses).
During a flare-up, some people with ulcerative colitis also experience symptoms elsewhere in
their body.
For example, some people develop:
- painful and swollen joints (arthritis)
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- mouth ulcers
- areas of painful, red and swollen skin
- irritated and red eyes
In severe cases, defined as having to empty your bowels 6 or more times a day, additional
symptoms may include:
- shortness of breath
- a fast or irregular heartbeat
- a high temperature (fever)
- blood in your stools becoming more obvious
In most people, no specific trigger for flare-ups is identified, although a gut infection can
occasionally be the cause.
Stress is also thought to be a potential factor.

Ulcerative colitis symptoms often get worse over time. In the beginning, you may notice:
(Cleveland Clinic)

 Diarrhea or urgent bowel movements.

 Abdominal (belly) cramping.
 Tiredness.
 Nausea.
 Weight loss.
 Anemia (reduced number of red blood cells).

Later you may also have:

 Blood, mucous, or pus in bowel movements.

 Severe cramping.
 Fever.
 Skin rashes.
 Mouth sores.
 Joint pain.
 Red, painful eyes.
 Liver disease.
 Loss of fluids and nutrients.

COMPLICATIONS
Complications of ulcerative colitis can include: (WebMD, 2016)

 Bleeding. This can lead to anemia.

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 Osteoporosis. The bones might become weak because of the diet or if you take a lot of
corticosteroids.
 Dehydration. You might need to get fluids through a vein (intravenous, or IV) if the large
intestine can’t absorb enough.
 Inflammation. This can affect the joints, skin, or eyes.
 Fulminant colitis. If the UC attack is severe, the colon might burst, or infection could spread
through the body. The intestines stop moving waste and the belly swells.
 Megacolon. Fulminant colitis can cause the large intestine to swell or burst. This is a
dangerous complication, and probably need surgery.
 Liver disease. The bile ducts or liver could become inflamed or could get scar tissue in the
liver.
 Colon cancer. Ulcerative colitis puts you at higher risk of getting colon cancer, especially if
the whole large intestine is affected or if you’ve had UC for a long time.

The possible complications of ulcerative colitis can range from a lack of nutrients to
potentially fatal bleeding from the rectum. Possible complications include: (Medical News
Today)
Colorectal cancer
Ulcerative colitis, especially if symptoms are severe or extensive, increases the risk of
developing colon cancer.
According to the NIDDK, colon cancer risk is highest when ulcerative colitis affects the entire
colon for longer than 8 years.
Toxic megacolon
This complication occurs in a few cases of severe ulcerative colitis.
In toxic megacolon, gas becomes trapped, causing the colon to swell. When this occurs,
there is a risk of colon rupture, septicemia, and shock.

UC increases your risk of developing colon cancer. The longer you have the disease, the higher
your risk of this cancer. Because of this increased risk, the doctor will perform a colonoscopy.
Repeat screenings every 1 to 3 years are recommended thereafter, according to the American
Cancer Society. Regular screenings help lower your risk of colon cancer. Follow-up screenings
can detect precancerous cells early. (Higuera, 2021)

Other complications of UC include:

 thickening of the intestinal wall
 intestinal bleeding
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 sepsis, or blood infection
 severe dehydration
 toxic megacolon, or a rapidly swelling colon
 rupture of your colon
 inflammation of your skin, joints, and eyes
 ankylosing spondylitis, which involves inflammation of joints between your spinal bones
 kidney stones
 liver disease, which is rare

PROGNOSIS

For most people, ulcerative colitis is a chronic, or long-term, condition. You’ll have flares and
periods with no symptoms at all (the doctor will call this remission). A small number of people have
one attack and are never troubled again.
A few people, about 10% of those with UC, have their first attack and quickly get worse, with
serious complications. In many people, the disease spreads to the large intestine over time. This can
turn into colon cancer, but about half the people who get it survive if doctors catch the disease
early enough and remove their colon. (WebMD, 2016)

Ulcerative colitis is a lifelong condition that can have mild to severe symptoms. For most
people, the symptoms come and go. Some people have just one episode and recover. A few
others develop a nonstop form that rapidly advances. In up to 30% of people, the disease
spreads from the rectum to the colon. When both the rectum and colon are affected, ulcerative
symptoms can be worse and happen more often. You may be able to manage the disease with
medications. But surgery to remove your colon and rectum is the only “cure.” About 30% of
people with ulcerative colitis need surgery. (Cleveland Clinic)

The outlook for ulcerative colitis varies widely. While it is a lifelong condition, the overall
mortality rate for people with ulcerative colitis is the same as for people without it, according
to experts. However, some ulcerative colitis complications, such as toxic megacolon, can be life
threatening. In addition, at least 5%Trusted Source of people with ulcerative colitis develop
colon cancer, and this risk increases over time. Ulcerative colitis involves remissions and flares,
periods when symptoms improve and worsen. Some people may experience remission all year
and experience few or no symptoms, while others may experience at least one flare at some
time during the year. (Medical News Today)

DIAGNOSTIC PROCEDURES
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 Blood tests can show if you have anemia or inflammation.
 Stool samples can help your doctor rule out an infection or parasite in your colon. They can
also show if there’s blood in your stool that you can’t see.
 Flexible sigmoidoscopy lets your doctor look at the lower part of your colon. They’ll put a
bendable tube into your lower colon through your bottom. The tube has a small light and
camera on the end. Your doctor might also use a small tool to take a piece of the lining of
your lower colon. This is called a biopsy. A doctor in a lab will look at the sample under a
microscope.
 Colonoscopy is the same process as flexible sigmoidoscopy, only your doctor will look at
your whole colon, not just the lower part.
 X-rays are less common for diagnosing the disease, but your doctor may want you to have
one in special cases. (WebMD, 2016)
 Endoscopy

- sigmoidoscopy allows your doctor to examine the extent of the inflammation in your

lower colon and rectum.
- A total colonoscopy is a similar to the sigmoidoscopy, but this procedure allows your
doctor to examine your entire colon.
 Chromoendoscopy
- During a chromoendoscopy, a blue liquid dye is sprayed into the colon to highlight and
detect slight changes in the lining of the intestine.
- Polyps can then be removed and/or biopsied.
- It is common to have blue bowel movements following this procedure.
 Biopsy the doctor may get a biopsy of the colon while performing an endoscopy. During
the biopsy, a small piece of tissue is removed from the inside of the intestine for further
testing and analysis

Different tests can help a doctor diagnose UC. UC mimics other bowel diseases such as Crohn’s
disease. A doctor will order multiple tests to rule out other conditions. (Higuera, 2021)

Tests to diagnose UC often include:

 Blood tests. Blood tests are often useful in the diagnosis of UC. A complete blood count
looks for signs of anemia (a low red blood cell count). Other tests indicate inflammation,
such as a high level of C-reactive protein and a high sedimentation rate. A doctor may
also order specialized antibody tests.
 Stool test. A doctor examines your stool for certain inflammatory markers, blood,
bacteria, and parasites.
 CT scan. This is a specialized X-ray of your abdomen and pelvis.
 Endoscopy. A doctor uses a flexible tube to examine your stomach, esophagus, and
small intestine.
 Biopsy. A surgeon removes a tissue sample from your colon for analysis.
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 Flexible sigmoidoscopy. Flexible sigmoidoscopy is a type of endoscopy. During this test,
a doctor inserts a long, flexible tube into your rectum so that they can examine it, the
sigmoid colon, and part of the descending colon. Flexible sigmoidoscopy is also known
as sigmoidoscopy.
 Colonoscopy. During a colonoscopy, a doctor inserts a lighted scope called a
colonoscope into your rectum to examine the inside of your colon. It’s also a type of
endoscopy.

MANAGEMENT

The goal of medication is to induce and maintain remission, and to improve the quality of life
for people with ulcerative colitis. Healthcare providers use several types of medications to calm
inflammation in your large intestine. Reducing the swelling and irritation lets the tissue heal. It
can also relieve your symptoms so you have less pain and less diarrhea. For children, teenagers
and adults, your provider may recommend: (Cleveland Clinic)

 Aminosalicylates: For mild to moderate ulcerative colitis, your healthcare provider may

prescribe sulfasalazine (Azulfidine®). Let your provider know if you’re allergic to sulfa.
He or she can prescribe a sulfa-free aminosalicylate instead, such
as mesalamine (Canasa®, Delzicol®, Asacol® HD, Pentasa®, Lialda®, Apriso®). The
medications come in both pill form and enema or suppository form, which can better
reach the inflammation low down in the colon or rectum.
 Corticosteroids: If you have a severe form of ulcerative colitis, you may need a
corticosteroid such as prednisone (Deltasone®) or budesonide (Entocort® EC, Uceris®).
Because corticosteroids have serious side effects, healthcare providers only recommend
them for short-term use. Other medications will be used to help maintain the remission.
 Immunomodulators: Your healthcare provider may recommend an immunomodulator.
These medicines include 6-mercaptopurine (Purixan®,
Purinethol®), azathioprine (Azasan® and Imuran®), or methotrexate (Trexall®). These
medications help calm the overactive immune system.
 Biologics: Biologics treat moderate to severe ulcerative colitis by targeting parts of the
immune system to quiet it down. Medications
like infliximab (Remicade®), adalimumab (Humira®), golimumab (Simponi®),
certolizumab pegol (Cimzia ®), vedolizumab (Entyvio®), and ustekinumab (Stelara®) are
biologics.
 Janus kinase (JAK) inhibitors: Drugs like tofacitinib (Xeljanz®) stop one of your body’s
enzymes (chemicals) from triggering inflammation.

UC treatment has two main goals. The first is to make you feel better and give your colon a chance
to heal. The second is to prevent more flare-ups. You may need a combination
of diet changes, medication, or surgery to reach those goals. (WebMD, 2016)
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 Diet. Some foods can make the symptoms worse. You might find that soft, bland food
doesn’t bother you as much as spicy or high-fiber dishes. If you can’t digest the sugar in milk
called lactose (meaning you’re lactose intolerant), your doctor may tell you to stop eating
dairy products. A balanced diet with plenty of fiber, lean protein, fruits, and veggies should
provide enough vitamins and nutrients.
 Medicine. Your doctor may prescribe a few different kinds of drugs, including:
o Antibiotics. These fight infections and let your large intestine heal.
o Aminosalicylates. These drugs have something called 5-aminosalicylic acid (5-ASA)
that fights inflammation and helps control symptoms. You might get pills to swallow
or an enema or suppository to put in your bottom.
o Corticosteroids. If aminosalicylates don’t work or your symptoms are severe, your
doctor might give you these anti-inflammatory drugs for a short time.
o Immunomodulators. These help stop your immune system’s attack on your colon.
They can take a while to take effect. You might not notice any changes for up to 3
months.
o Biologics. These are made from proteins in living cells instead of chemicals. They’re
for people with severe ulcerative colitis.
o Janus kinase inhibitors (JAK inhibitors). These are oral medicines that can work
quickly to get and maintain a remission in ulcerative colitis.
o Sphingosine 1-phosphate (S1P) receptor modulators. This is an oral medication for
patients with moderately to severely active UC.
o Loperamide. This can slow or stop diarrhea. Talk to your doctor before taking it.
 Surgery. If other treatments don’t work or your UC is severe, you might need surgery to
remove your colon (colectomy) or colon and rectum (proctocolectomy). If you have a
proctocolectomy, your doctor might make a small pouch out of your small intestine and
attach it to your anus. This is called ileal pouch-anal anastomosis (IPAA). It lets your body
expel waste normally, so you don’t need to wear a bag to collect stool.

Surgery is an option if medications aren’t working or you have complications, such as bleeding
or abnormal growths. You might develop precancerous lesions, or growths that can turn
into colorectal cancer. A doctor can remove these lesions with surgery (a colectomy) or during a
colonoscopy. (Cleveland Clinic)

Research shows that about 30% of people with ulcerative colitis need surgery sometime during
their life. About 20% of children with ulcerative colitis will need surgery during their childhood
years.

There are two kinds of surgery for ulcerative colitis:

Proctocolectomy and ileoanal pouch

The proctocolectomy and ileoanal pouch (also called J-pouch surgery) is the most common
procedure for ulcerative colitis. This procedure typically requires more than one surgery, and
there are several ways to do it. First, your surgeon does a proctocolectomy — a procedure that
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removes your colon and rectum. Then the surgeon forms an ileoanal pouch (a bag made from a
part of the small intestine) to create a new rectum. While your body and newly made pouch is
healing, your surgeon may perform a temporary ileostomy at the same time. This creates an
opening (stoma) in your lower belly. Your small intestines attach to the stoma, which looks like
a small piece of pink skin on your belly.

Proctocolectomy and ileostomy

If an ileoanal pouch won’t work for you, your healthcare team might recommend a
permanent ileostomy (without an ileoanal pouch). Your surgeon does a proctocolectomy to
remove your colon and rectum. The second part of this surgery, done at the same time, is to
perform a permanent ileostomy

According to Crohns & Colitis Foundation

The primary goal in treating ulcerative colitis is to help patients regulate their immune system
better. While there is no known cure for ulcerative colitis and flare ups may recur, a
combination of treatment options can help you stay in control of your disease and lead a full
and rewarding life.

Currently, there’s no nonsurgical cure for UC. Treatments for the inflammatory disease aim to
extend periods of remission and make flare-ups less severe. For people with severe UC, curative
surgery is a treatment option. Removing the entire large intestine (as in a total colectomy) will
end the symptoms of UC. This procedure requires the doctor to create a pouch on the outside
of the body where waste can empty. This pouch can become inflamed and cause side effects.
For that reason, some people choose to have only a partial colectomy. In this surgery, the
doctor only removes the parts of the colon that are affected by UC. While these surgeries can
help ease or end symptoms of UC, they can have adverse effects and possible long-term
complications. (Higuera, 2021)

Combination Therapy
In some circumstances, a health care provider may recommend adding an additional therapy
that will work in combination with the initial therapy to increase its effectiveness.  For example,
combination therapy could include the addition of a biologic to an immunomodulator. As with
all therapy, there are risks and benefits of combination therapy. Combining therapies can
increase the effectiveness of IBD treatment, but there may also be an increased risk of
additional side effects and toxicity.

Diet & Nutrition

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Many people with ulcerative colitis find that soft, bland foods cause less discomfort than spicy
or high-fiber foods. While diet can remain flexible and should include a variety of foods from all
food groups, doctor will likely recommend restricting the intake of dairy foods if you are found
to be lactose-intolerant.

Hospitalization
If your symptoms are severe, you’ll need to be hospitalized to correct the effects of dehydration
and loss of electrolytes that diarrhea causes. You may also need to replace blood and to treat
any other complications. (Higuera, 2021)

Natural remedies for ulcerative colitis

Some of the medications prescribed to treat UC can have serious side effects. When traditional
treatments are not well tolerated, some people turn to natural remedies to manage UC.
Natural remedies that may help relieve UC symptoms include:
 Boswellia. This herb is found in the resin underneath Boswellia serrata tree
bark. Research suggests it stops some of the chemical reactions in the body that can
cause inflammation.
 Bromelain. This enzyme mixture is found naturally in pineapples, but it’s also sold as a
supplement. It may help ease symptoms of UC and reduce flares.
 Probiotics. Your intestines and stomach are home to billions of bacteria. When the
bacteria are healthy, your body is better able to ward off inflammation and symptoms of
UC. Eating foods with probiotics or taking probiotic supplements can help boost the
health of the microbial flora in your gut.
 Psyllium. This fiber supplement can help keep bowel movements regular. This may
alleviate symptoms, prevent constipation, and make eliminating waste easier. However,
many people with IBD can experience worsening abdominal cramping, gas, and bloating
when they consume fiber during a flare-up.
 Turmeric. This golden yellow spice is chock-full of curcumin, an antioxidant that’s been
shown to reduce inflammation.
Keep in mind that these natural remedies have not undergone clinical trials and are not
necessarily endorsed by professional organizations or their clinical guidelines.
Many of these natural remedies can be used in conjunction with other UC treatments. Discover
which ones might be safe for you and what questions you should ask your doctor.
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Ulcerative colitis diet

There’s no specific diet for UC. Each person reacts to food and drink differently. However, a few
general rules may be useful for people trying to avoid a flare-up:
 Eat a low fat diet. It’s not clear why a low fat diet is beneficial, but it’s known that foods
high in fat commonly cause diarrhea, especially in people with IBD. Eating more low fat
foods may delay flare-ups. When you do eat fat, pick healthier options like olive oil and
omega-3 fatty acids.
 Take in more vitamin C. This vitamin may have a protective effect on your intestines
and help them heal or recover faster after a flare-up. People who eat diets rich in
vitamin C have prolonged periods of UC remission. Vitamin C-rich foods include parsley,
bell peppers, spinach, and berries.
 Eat more fiber. During a flare-up, bulky, slow-moving fiber is the last thing you want in
your intestines. During remission, however, fiber can help you stay regular. It may also
improve how easily you can eliminate waste products during bowel movements.
Making a food diary
Creating a food diary is a smart way to begin to understand which foods affect you. For several
weeks, closely track what you eat and how you feel in the hours after. Record details of bowel
movements or any symptoms you might experience.
In that span of time, you can likely detect trends between discomfort or stomach pain and
certain problematic foods. Try removing those foods from your diet to see if your symptoms
improve.

Diet
According to the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK),
some dietary measures may help relieve symptoms, including:
 eating smaller, more regular meals, such as five or six small meals per day
 drinking plenty of fluids, especially water, to prevent dehydration
 avoiding caffeine and alcohol, which can both increase diarrhea
 avoiding sodas, which can increase gas
 keeping a food diary to identify which foods make symptoms worse
A doctor may suggest temporarily following a specific diet depending on symptoms, such as:
 a low fiber diet
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 a lactose-free diet
 a low fat diet
 a low salt diet

Natural medicine (Medical News Today)

Here are some options that people may use:
 Probiotics: A 2019 review suggests that some probiotics may help manage IBD.
 Herbal remedies: Other research from 2019 found that some herbal remedies may help
reduce symptoms and manage the condition. Examples include aloe vera gel
and wheatgrass juice.
 Fruits and other plant-based foods: Some earlier research shows that ingredients
naturally present in blueberries, black raspberries, cocoa, Indian quince, green
tea, grapes, olive oil, and Indian gooseberries may have a beneficial effect.
 Spices: Garlic, ginger, fenugreek, saffron, turmeric, and Malabar tamarind may help with
IBD symptoms.
Research has not yet confirmed the possible benefits of the options above, but moderate
amounts appear safe to add to the diet. However, it is worth checking with a healthcare
professional first.
Lifestyle options
Scientists have also found that the following may help:
Education: The more a person knows about a health condition, the more in control they tend to
feel. Learning about ulcerative colitis can help ease anxiety and lead to effective coping and
management techniques, research from 2017 shows.
Exercise: Some research suggests that aerobic exercise may have an anti-inflammatory effect,
which could benefit people with ulcerative colitis. One 2019 study, for example, found that
combining exercise with an anti-inflammatory diet could have a positive effect. Check with a
healthcare professional before changing an exercise routine, however, as 20% of participants
with ulcerative colitis in a 2016 study experienced a worsening of symptoms after doing intense
exercise.
Mindfulness: In a 2020 study, 37 people with ulcerative colitis engaged in a mindfulness-based
intervention that involved four online therapy and four face-to-face sessions. After 6 months,
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the participants had lower markers of inflammation than 20 participants who did not have the
sessions.
Support
Developing a virtual or face-to-face support network that includes members of a community
and medical professionals can make managing ulcerative colitis easier for people and their
loved ones.

PREVENTION
There’s no solid evidence indicating that your diet affects whether you develop UC. You may
find that certain foods and drinks aggravate your symptoms when you have a flare-up, though.
Practices that may help include: (Higuera, 2021)
 drinking small amounts of water throughout the day
 eating smaller meals throughout the day
 limiting your intake of high fiber foods
 avoiding fatty foods
 lowering your intake of milk if you’re lactose intolerant

Roles of HCT

Gastroenterologist a doctor who specializes in the digestive system — should oversee the care
for adults
Nutritionist to come up with a personalized diet plan and may recommend supplemental
nutrition or vitamins

References

NHS website. (2021, August 17). Ulcerative colitis. Nhs.Uk. Retrieved from

https://www.nhs.uk/conditions/ulcerative-colitis/

Ulcerative colitis - Symptoms and causes. (2021, February 23). Mayo Clinic. Retrieved from

https://www.mayoclinic.org/diseases-conditions/ulcerative-colitis/symptoms-causes/syc-

20353326
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Ulcerative Colitis (UC). (2016, February 9). WebMD. Retrieved from

https://www.webmd.com/ibd-crohns-disease/ulcerative-colitis/what-is-ulcerative-colitis

Higuera, V. (2021, September 30). What Is Ulcerative Colitis? Healthline. Retrieved from

https://www.healthline.com/health/ulcerative-colitis