Ulcerative Colitis: Symptoms, Causes & Treatment Guide

What Is Ulcerative Colitis?

Ulcerative colitis is a chronic inflammatory bowel disease (IBD) that causes long-lasting inflammation and ulcers (sores) in the innermost lining of the large intestine (colon) and rectum. It is an autoimmune condition where the body's immune system mistakenly attacks the colon's lining, leading to symptoms such as bloody diarrhea, abdominal pain, and urgent need to defecate.

Ulcerative colitis belongs to a group of conditions known as inflammatory bowel diseases (IBD). The other main type of IBD is Crohn's disease. While both cause chronic inflammation in the digestive tract, they affect different areas and have distinct characteristics. Understanding these differences is crucial for proper diagnosis and treatment.

The inflammation in ulcerative colitis always begins in the rectum and can extend continuously up through the colon. Unlike Crohn's disease, which can cause patchy inflammation anywhere from the mouth to the anus and affects all layers of the intestinal wall, ulcerative colitis only affects the innermost layer (mucosa) of the colon and rectum. This distinction has important implications for treatment options and potential complications.

When the colon becomes inflamed, it cannot properly absorb water from digestive contents, leading to diarrhea. The ulcers that develop in the intestinal lining can bleed, causing blood and mucus to appear in the stool. The inflammation also triggers the colon to empty frequently, causing the urgent need to have a bowel movement that is characteristic of this condition.

Ulcerative colitis is classified based on how much of the colon is affected. Ulcerative proctitis involves only the rectum and is often the mildest form. Proctosigmoiditis affects the rectum and sigmoid colon (the lower end of the colon). Left-sided colitis extends from the rectum up through the left side of the colon. Pancolitis involves the entire colon and is often associated with more severe symptoms.

Who Gets Ulcerative Colitis?

Ulcerative colitis affects approximately 1-2 million people in the United States and millions more worldwide. The condition can develop at any age, but most people are diagnosed between ages 20 and 40, with a second smaller peak occurring between ages 50 and 70. Men and women are affected equally.

The incidence of ulcerative colitis varies significantly by geographic location, with higher rates in Western and Northern Europe, North America, and Australia. Interestingly, rates are increasing in developing countries as they adopt more Western lifestyles, suggesting environmental factors play a significant role in disease development.

Ulcerative Colitis vs. Crohn's Disease

While both ulcerative colitis and Crohn's disease are inflammatory bowel diseases, they have important differences. Ulcerative colitis affects only the colon and rectum, causes continuous inflammation limited to the innermost lining, and can be cured by removing the colon. Crohn's disease can affect any part of the digestive tract, causes patchy inflammation that can penetrate all layers of the intestinal wall, and cannot be cured by surgery since it can recur in remaining intestinal tissue.

In some cases (about 10-15%), it may be difficult to distinguish between ulcerative colitis and Crohn's disease. This is called indeterminate colitis or IBD-unclassified (IBD-U). Further testing and observation over time may help clarify the diagnosis.

What Are the Symptoms of Ulcerative Colitis?

The most common symptoms of ulcerative colitis include bloody diarrhea (often with mucus), abdominal pain that improves after bowel movements, urgency to defecate, fatigue, and unintentional weight loss. Symptoms typically develop gradually and vary in severity from mild to severe, occurring in episodes called flares separated by periods of remission.

Ulcerative colitis symptoms vary considerably between individuals and can range from mild to severe. The pattern of symptoms also varies - some people experience constant low-level symptoms, while others have periods of severe symptoms (flares) alternating with periods of few or no symptoms (remission). Understanding your symptom patterns can help you and your healthcare team manage the disease more effectively.

The hallmark symptom of ulcerative colitis is bloody diarrhea. The blood comes from ulcers in the colon's lining and may range from bright red streaks to darker blood mixed throughout the stool. Mucus may also be present in the stool due to increased mucus production by the inflamed colon. The frequency of bowel movements can increase dramatically during flares, with some people having more than 10 bowel movements per day.

Abdominal pain and cramping are common symptoms, often occurring in the lower left side of the abdomen where the sigmoid colon and rectum are located. Many people notice that pain improves temporarily after having a bowel movement. The pain results from inflammation and from the colon contracting more frequently as it tries to empty its contents.

Urgency - the sudden, intense need to have a bowel movement - is one of the most disruptive symptoms. This urgency can be so severe that people may have difficulty making it to the bathroom in time (incontinence), which can significantly impact quality of life, work, and social activities. Tenesmus, the feeling of needing to have a bowel movement even when the bowel is empty, is also common.

Gastrointestinal Symptoms

• Bloody diarrhea: Loose, watery stools with visible blood and/or mucus
• Increased stool frequency: More bowel movements than normal, sometimes exceeding 10 per day during flares
• Abdominal pain: Cramping, typically in the lower left abdomen, often relieved by bowel movements
• Urgency: Sudden, intense need to defecate that cannot be delayed
• Tenesmus: Feeling of incomplete evacuation or constant need to pass stool
• Rectal bleeding: Blood may appear in the toilet bowl or on toilet paper
• Nighttime symptoms: Being awakened to have bowel movements

Systemic Symptoms

Ulcerative colitis doesn't just affect the colon - it can cause symptoms throughout the body due to chronic inflammation and nutrient loss:

• Fatigue: Persistent tiredness that doesn't improve with rest, often due to anemia and chronic inflammation
• Weight loss: Unintentional weight loss due to reduced appetite, malabsorption, and fluid loss
• Anemia: Low red blood cell count from chronic bleeding, causing weakness, shortness of breath, and pale skin
• Fever: Low-grade fever may occur during flares, indicating active inflammation
• Loss of appetite: Reduced desire to eat, sometimes due to fear of triggering symptoms

Extra-Intestinal Manifestations

About 25-40% of people with ulcerative colitis experience symptoms outside the digestive tract. These extra-intestinal manifestations can sometimes be as troublesome as the intestinal symptoms:

• Joint problems: Pain, stiffness, and swelling in joints, particularly in the knees, ankles, and wrists
• Skin conditions: Erythema nodosum (painful red bumps on shins) and pyoderma gangrenosum (ulcers)
• Eye inflammation: Uveitis or episcleritis causing redness, pain, and light sensitivity
• Liver and bile duct disease: Primary sclerosing cholangitis affects bile ducts and can be serious
• Bone loss: Osteoporosis or osteopenia due to inflammation and corticosteroid use

What Causes Ulcerative Colitis?

The exact cause of ulcerative colitis is unknown, but it results from an abnormal immune system response where the body attacks its own intestinal tissue. A combination of genetic predisposition, environmental triggers, and changes in gut bacteria likely contribute to disease development. Having a first-degree relative with IBD increases your risk significantly.

Despite decades of research, the exact cause of ulcerative colitis remains unclear. Scientists believe it develops through a complex interaction between genetic susceptibility, environmental factors, immune system dysfunction, and alterations in the gut microbiome. No single factor causes the disease; rather, multiple factors must come together in a susceptible individual.

The current understanding is that in genetically predisposed individuals, an environmental trigger (possibly an infection or dietary factor) initiates an abnormal immune response against the normal bacteria and tissue in the colon. Instead of stopping once the trigger is eliminated, this immune response continues indefinitely, causing chronic inflammation.

Genetic Factors

Genetics play a significant role in ulcerative colitis susceptibility. Research has identified more than 200 genetic variants associated with inflammatory bowel disease. Having a first-degree relative (parent, sibling, or child) with IBD increases your risk 10-25 times compared to the general population. However, most people with ulcerative colitis have no family history of the disease, indicating that genetics alone don't determine who develops the condition.

Certain ethnic groups have higher rates of ulcerative colitis. The disease is most common among Caucasians, particularly those of Ashkenazi Jewish descent. However, incidence is increasing in other populations worldwide, suggesting environmental factors are also important.

Immune System Dysfunction

In ulcerative colitis, the immune system malfunctions and attacks the cells of the colon's lining as if they were foreign invaders. This triggers inflammation that persists even when there is no infection or other obvious reason for immune activation. The inflammation becomes self-perpetuating, with inflammatory chemicals attracting more immune cells to the area, causing further damage.

Researchers believe that the immune system may be reacting to normal gut bacteria or their products. In healthy individuals, the immune system tolerates the trillions of bacteria living in the gut. In ulcerative colitis, this tolerance is lost, leading to an inappropriate immune attack.

Environmental Factors

Several environmental factors have been associated with ulcerative colitis risk:

• Geographic location: Higher rates in Western and Northern countries, with increasing rates in developing nations adopting Western lifestyles
• Urban living: Higher rates in urban compared to rural areas
• Diet: Western diets high in fat, sugar, and processed foods may increase risk
• Antibiotics: Early-life antibiotic use has been associated with increased IBD risk
• Smoking: Interestingly, smoking appears to protect against ulcerative colitis (but not Crohn's disease), though smoking is never recommended due to its many other health risks
• Appendectomy: Having the appendix removed before age 20 may reduce ulcerative colitis risk

Gut Microbiome Changes

The gut microbiome - the community of trillions of bacteria, viruses, and fungi living in the intestines - appears to play a crucial role in ulcerative colitis. People with the disease have different bacterial compositions than healthy individuals, with reduced diversity and alterations in specific bacterial species. Whether these changes cause the disease or result from it remains unclear, but manipulating the microbiome is an active area of research for new treatments.

How Is Ulcerative Colitis Diagnosed?

Ulcerative colitis is diagnosed through a combination of medical history, physical examination, blood tests, stool tests, and colonoscopy with biopsy. Colonoscopy is the gold standard diagnostic test as it allows direct visualization of the colon and collection of tissue samples to confirm inflammation characteristic of ulcerative colitis.

Diagnosing ulcerative colitis requires ruling out other conditions that can cause similar symptoms, such as infections, irritable bowel syndrome, or other forms of colitis. Your doctor will use a combination of tests to confirm the diagnosis, determine the extent and severity of disease, and distinguish ulcerative colitis from Crohn's disease.

The diagnostic process typically begins with a thorough medical history and physical examination. Your doctor will ask about your symptoms, their duration and severity, family history of digestive diseases, recent travel, medication use, and other relevant factors. A physical exam includes checking your abdomen for tenderness and may include a rectal examination.

Blood Tests

Blood tests help assess inflammation levels and detect complications:

• Complete blood count (CBC): Checks for anemia (low red blood cells) from bleeding and elevated white blood cells indicating infection or inflammation
• C-reactive protein (CRP) and erythrocyte sedimentation rate (ESR): Markers of inflammation in the body
• Liver function tests: Screen for liver and bile duct problems, including primary sclerosing cholangitis
• Electrolytes and kidney function: Assess for dehydration and electrolyte imbalances from diarrhea
• Iron studies: Evaluate iron deficiency anemia common in ulcerative colitis

Stool Tests

Stool tests serve two main purposes: ruling out infections and measuring intestinal inflammation:

• Stool culture: Tests for bacterial infections like Salmonella, Shigella, Campylobacter, and E. coli that can mimic ulcerative colitis
• Clostridioides difficile testing: Checks for C. diff infection, which can occur in IBD patients
• Fecal calprotectin: A protein released by white blood cells; elevated levels indicate intestinal inflammation and can help distinguish IBD from irritable bowel syndrome
• Fecal lactoferrin: Another marker of intestinal inflammation

Colonoscopy and Biopsy

Colonoscopy is the most important diagnostic test for ulcerative colitis. During this procedure, a gastroenterologist uses a long, flexible tube with a camera (colonoscope) to examine the entire colon and rectum. This allows direct visualization of the intestinal lining to assess the pattern, extent, and severity of inflammation.

During colonoscopy, the doctor takes small tissue samples (biopsies) from multiple areas of the colon, even areas that appear normal. These biopsies are examined under a microscope by a pathologist to confirm the presence of inflammation characteristic of ulcerative colitis and rule out other conditions, including colorectal cancer.

Typical findings in ulcerative colitis include continuous inflammation starting from the rectum, loss of normal blood vessel patterns, swelling and redness of the intestinal lining, ulcers, and in severe cases, bleeding and pus. The inflammation affects only the innermost layer of the colon wall, unlike Crohn's disease where deeper layers may be involved.

Additional Imaging Tests

In some cases, additional imaging may be needed to assess disease extent or rule out complications:

• MRI or CT enterography: Can help distinguish ulcerative colitis from Crohn's disease by evaluating the small intestine
• Abdominal X-ray: May be used in severe flares to check for toxic megacolon (dangerous colon dilation)
• Abdominal ultrasound: Non-invasive way to assess bowel wall thickness and inflammation
• Capsule endoscopy: A swallowed camera that takes pictures of the small intestine to help distinguish from Crohn's disease

How Is Ulcerative Colitis Treated?

Ulcerative colitis treatment aims to induce remission (control active symptoms) and maintain remission (prevent flares). Most people are treated with medications including 5-aminosalicylates (5-ASA), corticosteroids, immunomodulators, and biologics. Surgery to remove the colon (colectomy) is reserved for people who don't respond to medications or develop complications.

Treatment for ulcerative colitis has two main goals: first, to achieve remission by reducing active inflammation and controlling symptoms during a flare; second, to maintain remission by preventing future flares. The treatment approach depends on the severity and extent of disease, how well you respond to different medications, and your personal preferences.

Treatment strategies have evolved significantly in recent years, with earlier use of more effective medications (biologics and targeted therapies) and a "treat-to-target" approach that aims for complete healing of the intestinal lining (mucosal healing), not just symptom control. This approach has been shown to reduce complications, hospitalizations, and the need for surgery.

5-Aminosalicylates (5-ASA)

5-ASA medications are usually the first-line treatment for mild to moderate ulcerative colitis. They work by reducing inflammation directly in the colon's lining. These medications are effective for both inducing and maintaining remission in many patients.

Common 5-ASA medications include mesalamine (Asacol, Lialda, Pentasa, Delzicol), sulfasalazine (Azulfidine), balsalazide (Colazal), and olsalazine (Dipentum). They're available in various forms including oral pills, rectal suppositories, and enemas. For disease limited to the rectum or left side of the colon, topical (rectal) formulations are often very effective.

5-ASA medications are generally well-tolerated. Common side effects include headache, nausea, and abdominal pain. Rare but serious side effects include kidney problems and allergic reactions. Regular monitoring with blood tests may be recommended.

Corticosteroids

Corticosteroids (steroids) are powerful anti-inflammatory medications used to quickly control moderate to severe flares. They are not appropriate for long-term use due to significant side effects. The goal is to use steroids to gain control of active inflammation, then transition to other medications for maintenance.

Common corticosteroids include prednisone (oral), budesonide (Uceris - oral with less systemic absorption), and hydrocortisone (rectal enemas or suppositories). Treatment typically starts at higher doses and is gradually tapered as symptoms improve.

Short-term side effects include mood changes, insomnia, increased appetite, weight gain, and elevated blood sugar. Long-term use can cause serious problems including osteoporosis, cataracts, high blood pressure, diabetes, and increased infection risk. This is why doctors work to minimize steroid use.

Immunomodulators

Immunomodulators suppress the immune system to reduce intestinal inflammation. They take several weeks to months to become effective and are typically used for maintaining remission in people who don't respond adequately to 5-ASA medications or who require repeated steroid courses.

Common immunomodulators include azathioprine (Imuran), 6-mercaptopurine (Purinethol), and methotrexate. These medications require regular blood test monitoring for bone marrow suppression and liver problems. They also increase infection risk and have potential long-term effects on cancer risk.

Biologic Therapies

Biologics are advanced medications made from living cells that target specific parts of the immune system involved in inflammation. They're typically used for moderate to severe ulcerative colitis that doesn't respond to conventional treatments. Biologics have transformed the treatment of ulcerative colitis, helping many people achieve remission who previously had limited options.

Types of biologics used for ulcerative colitis include:

• Anti-TNF agents: Infliximab (Remicade), adalimumab (Humira), golimumab (Simponi) - block tumor necrosis factor alpha
• Anti-integrin agents: Vedolizumab (Entyvio) - gut-selective, blocks immune cells from entering the intestine
• Anti-IL-12/23 agents: Ustekinumab (Stelara) - blocks interleukin-12 and interleukin-23

Biologics are given by intravenous infusion or subcutaneous injection. Side effects include increased infection risk, injection site reactions, and rare but serious effects including increased cancer risk and reactivation of dormant infections like tuberculosis.

Small Molecule Therapies

Newer oral medications called small molecule therapies (also known as targeted synthetic therapies) offer another option for moderate to severe ulcerative colitis:

• JAK inhibitors: Tofacitinib (Xeljanz), upadacitinib (Rinvoq) - block Janus kinase enzymes involved in inflammation
• S1P receptor modulators: Ozanimod (Zeposia), etrasimod - prevent immune cells from leaving lymph nodes to reach the colon

These medications are taken as pills, which many patients prefer over injections or infusions. However, they also carry risks including serious infections and other side effects that require monitoring.

Symptom-Relief Medications

In addition to disease-modifying treatments, medications may be used to relieve specific symptoms:

• Anti-diarrheal medications: Loperamide (Imodium) may help reduce diarrhea frequency, but should be used with caution during active flares
• Pain medications: Acetaminophen (Tylenol) is preferred; NSAIDs like ibuprofen and aspirin should be avoided as they may trigger flares
• Iron supplements: May be needed for anemia from chronic bleeding
• Fiber supplements: May help firm up stools during remission

When Is Surgery Needed for Ulcerative Colitis?

Surgery to remove the colon (colectomy) may be needed when medications fail to control the disease, complications develop (such as toxic megacolon or perforation), dysplasia or cancer is found, or quality of life remains poor despite treatment. Unlike Crohn's disease, surgery can cure ulcerative colitis since the disease only affects the colon.

While most people with ulcerative colitis can be managed with medications, approximately 15-20% will eventually require surgery. The decision to have surgery is significant and should be made carefully with your gastroenterologist, colorectal surgeon, and other healthcare team members after discussing all options.

Surgery may be recommended in several situations: failure to respond to or intolerable side effects from medications; complications such as toxic megacolon (dangerous dilation of the colon), perforation, or severe bleeding; discovery of precancerous changes (dysplasia) or cancer during surveillance colonoscopy; or significantly impaired quality of life despite medical treatment.

Types of Surgery

The standard surgery for ulcerative colitis involves removing the entire colon and rectum. Several surgical options exist:

Proctocolectomy with ileal pouch-anal anastomosis (IPAA or J-pouch): This is the most common surgery. The surgeon removes the colon and rectum, creates an internal pouch from the end of the small intestine, and connects it to the anal canal. Most patients have 4-6 bowel movements daily after recovery and can maintain continence. A temporary ileostomy (external bag) is usually needed for several months while the pouch heals.

Proctocolectomy with permanent ileostomy: The colon and rectum are removed, and a permanent opening (stoma) is created in the abdominal wall where waste empties into an external bag. This may be chosen by patients who prefer not to have a J-pouch, have compromised anal sphincter function, or have other medical conditions.

Total colectomy with ileorectal anastomosis: The colon is removed but the rectum is preserved and connected to the small intestine. This is less common because leaving the rectum means continued UC risk in that area.

Life After Surgery

After successful surgery, ulcerative colitis is essentially cured since the diseased organ has been removed. However, adjustments are needed:

With a J-pouch, most people have more frequent bowel movements than before their disease (typically 4-8 per day) but can live active, normal lives without an external bag. Some people experience complications like pouchitis (inflammation of the pouch) which can usually be treated with antibiotics.

With a permanent ileostomy, people wear an external bag that collects waste. Modern ostomy bags are discreet and allow full participation in work, sports, swimming, and other activities. Many people find their quality of life improves significantly compared to living with uncontrolled ulcerative colitis.

How Can I Live Well with Ulcerative Colitis?

Living well with ulcerative colitis involves taking medications as prescribed, maintaining regular healthcare appointments, managing stress, eating a balanced diet (avoiding personal trigger foods during flares), staying physically active, and building a support network. Many people with ulcerative colitis lead full, active lives with proper management.

Being diagnosed with a chronic illness like ulcerative colitis can be overwhelming, but most people learn to manage their condition effectively and maintain good quality of life. Success involves understanding your disease, partnering with your healthcare team, and making lifestyle modifications that help you feel your best.

Medication Adherence

Taking your medications consistently as prescribed is the most important thing you can do to stay healthy. Stopping or skipping medications is a leading cause of disease flares. If you're having trouble with side effects, cost, or the inconvenience of your treatment regimen, talk to your doctor about alternatives rather than stopping on your own.

Keep a medication schedule, use pill organizers or phone reminders, and maintain a supply of medications so you don't run out. Know which medications need to be taken with food, and understand what to do if you miss a dose.

Diet and Nutrition

There is no specific diet that treats ulcerative colitis, and dietary recommendations vary significantly between individuals. However, some general principles can help:

During flares, many people benefit from a low-fiber, low-residue diet that is gentler on the inflamed colon. This means limiting raw fruits and vegetables, whole grains, nuts, and seeds. Small, frequent meals may be better tolerated than large meals.

During remission, a balanced, nutritious diet is important for maintaining health and preventing nutrient deficiencies. Some people find that certain foods trigger symptoms even in remission - common culprits include dairy products, spicy foods, fatty foods, caffeine, and alcohol. Keeping a food diary can help identify your personal triggers.

Stay well-hydrated, especially during diarrhea episodes, to prevent dehydration. If you have extensive diarrhea, you may need electrolyte replacement drinks. Consider working with a registered dietitian who specializes in IBD to optimize your nutrition.

Stress Management

While stress doesn't cause ulcerative colitis, it can trigger flares or worsen symptoms in many people. Developing effective stress management strategies is an important part of living well with the condition.

Techniques that help many people include regular exercise, meditation and mindfulness practices, deep breathing exercises, adequate sleep, counseling or therapy, and engaging in enjoyable activities. Find what works for you and make it a regular part of your routine.

Physical Activity

Regular physical activity benefits overall health and may help manage ulcerative colitis symptoms. Exercise can reduce stress, improve mood, maintain bone health (important since UC and some treatments increase osteoporosis risk), and help with weight management.

During remission, most forms of exercise are safe. During flares, you may need to reduce intensity or switch to gentler activities. Listen to your body and don't push through severe symptoms. If you have an ostomy, most exercises including swimming are still possible with proper preparation.

Regular Medical Care

Maintain regular appointments with your gastroenterologist, even when you feel well. These visits allow monitoring of disease activity, adjustment of medications as needed, and screening for complications. Regular lab tests monitor medication side effects and disease status.

If you've had ulcerative colitis for 8-10 years, you'll need surveillance colonoscopies regularly (typically every 1-3 years) to screen for dysplasia and colorectal cancer. Don't skip these important screenings.

Building Support

Living with a chronic illness is easier with support. Consider telling trusted friends, family members, and employers about your condition so they can understand and support you. Support groups and patient organizations connect you with others who understand what you're going through and can share practical advice.

What Are the Complications of Ulcerative Colitis?

Potential complications of ulcerative colitis include colorectal cancer (increased risk with long-standing disease), toxic megacolon, severe bleeding, bowel perforation, primary sclerosing cholangitis, blood clots, and osteoporosis. Regular monitoring and proper treatment significantly reduce the risk of serious complications.

While most people with ulcerative colitis do well with treatment, complications can occur, particularly with long-standing or poorly controlled disease. Understanding these risks allows for appropriate monitoring and early intervention.

Colorectal Cancer

People with ulcerative colitis have an increased risk of developing colorectal cancer, especially those with extensive disease (affecting most or all of the colon) and longer disease duration. The risk increases significantly after 8-10 years of disease. Chronic inflammation appears to promote the development of cancer over time.

Regular surveillance colonoscopies can detect precancerous changes (dysplasia) early when they can be treated. If high-grade dysplasia or cancer is found, colectomy (colon removal) is typically recommended. Good disease control with medications that achieve mucosal healing may reduce cancer risk.

Toxic Megacolon

Toxic megacolon is a rare but life-threatening complication where the colon becomes severely dilated and stops functioning. Symptoms include severe abdominal pain and distension, high fever, rapid heart rate, and dehydration. This requires emergency hospitalization and often emergency surgery.

Other Intestinal Complications

• Severe bleeding: Heavy bleeding from ulcers may require hospitalization for blood transfusion and intensive treatment
• Bowel perforation: A hole in the colon wall is a surgical emergency
• Strictures: Narrowing of the colon from scarring (more common in Crohn's disease)

Extra-Intestinal Complications

• Primary sclerosing cholangitis (PSC): Inflammation and scarring of bile ducts, which can lead to liver damage
• Blood clots: Increased risk of deep vein thrombosis and pulmonary embolism, especially during flares
• Osteoporosis: Bone loss from inflammation and corticosteroid use
• Anemia: From chronic bleeding and poor absorption

Can I Have a Healthy Pregnancy with Ulcerative Colitis?

Yes, most women with ulcerative colitis can have healthy pregnancies. The key is achieving remission before conception, as active disease increases risks for both mother and baby. Many UC medications are safe during pregnancy. Work closely with your gastroenterologist and obstetrician to plan your pregnancy and manage your condition.

Ulcerative colitis itself does not prevent pregnancy or necessarily make it high-risk. The most important factor for a healthy pregnancy is disease control. Women who conceive while in remission are most likely to stay in remission throughout pregnancy. Those who conceive during a flare have about a one-third chance each of staying the same, improving, or worsening.

Fertility is generally not affected by ulcerative colitis itself. However, certain surgeries (particularly J-pouch surgery) can affect fertility in women by causing adhesions around the fallopian tubes. If you may want children in the future, discuss this with your surgeon when considering surgical options.

Many ulcerative colitis medications are safe during pregnancy, including 5-ASA medications, corticosteroids (short courses), and several biologics. Some medications should be avoided, including methotrexate and some JAK inhibitors. Never stop your medications without consulting your doctor, as uncontrolled disease poses risks to pregnancy. Your treatment plan may need adjustment, so inform your gastroenterologist when planning pregnancy or as soon as you know you're pregnant.

Men taking sulfasalazine should know it can reduce sperm count and quality. This effect is reversible when the medication is stopped or switched to another 5-ASA.

Frequently Asked Questions About Ulcerative Colitis