Symptoms of ulcerative colitis

Common symptoms of ulcerative colitis include:

diarrhoea, which may contain blood, mucus or pus
tummy pain, particularly in the lower-left part of your tummy – this may get better after pooing
needing to poo frequently, urgently or during the night
feeling like you need to poo even though your bowel is empty
bleeding from your bottom
farting a lot or feeling bloated

Other symptoms may include constipation, feeling very tired (fatigue), feeling less hungry than usual and losing weight without trying to.

Flare-ups

Sometimes you may have no symptoms or only mild symptoms of ulcerative colitis for a period of time (remission), and then have an episode of very bad symptoms. This is called a flare-up (relapse).

A flare-up can last anywhere from a few days to several months.

As well as the common symptoms of ulcerative colitis, during a flare-up you may get symptoms in other parts of your body such as:

swollen or painful joints
a high temperature
swollen and red or darker patches of skin (erythema nodosum) – redness may be harder to seen on black or brown skin
red eyes, which may be itchy or painful
mouth ulcers

Flare-ups may be triggered by things such as:

stress
infections
changes in medicines
taking NSAIDs (non-steroidal anti-inflammatory drugs), such as ibuprofen or aspirin
certain foods

Sometimes there is no obvious trigger.

When and where to get medical help

Get medical help if you think you have symptoms of ulcerative colitis. Some symptoms need urgent help.

Non-urgent advice: See a GP if:

you think you have symptoms of ulcerative colitis

Urgent advice: Ask for an urgent GP appointment of get help from NHS 111 if:

You have symptoms of ulcerative colitis and:

very bad diarrhoea or bloody diarrhoea
a high temperature, or you feel hot, cold or shivery
a fast heartbeat
you cannot fart or poo
you're worried about them

If you've been diagnosed with ulcerative colitis and are having a severe flare-up, you can also contact your care team.

Immediate action required: Call 999 or go to A&E if:

you have severe tummy pain
you're bleeding non-stop from your bottom
there's a lot of blood or you see large blood clots when you poo
you're vomiting blood or poo, or your sick looks like coffee grounds or soil

Do not drive to A&E. Ask someone to drive you or call 999 and ask for an ambulance.

Bring any medicines you take with you.

Tests for ulcerative colitis

Ulcerative colitis is usually diagnosed in hospital by a specialist in digestive system conditions (gastroenterologist).

Tests for ulcerative colitis may include:

blood tests
testing a sample of your poo
scans, such as an X-ray, CT scan or ultrasound
a colonoscopy – where a thin, flexible tube with a camera on the end is passed into your bottom to check your bowel
taking a very small sample of the lining of your bowel for testing (biopsy) – done during a colonoscopy

Find out more

Getting a diagnosis (Crohn's and Colitis UK)

Treatment for ulcerative colitis

Treatment for ulcerative colitis aims to relieve symptoms during a flare-up and reduce the chances of them coming back.

Your treatment will depend on your symptoms and how much of your bowel is affected.

Medicines

You may be given different types of medicine or a combination of medicines to reduce inflammation, including:

medicines for inflammation and to reduce the chance of flare-ups, called aminosalicylates (ASAs), such as mesalazine and sulfasalazine
steroids, such as prednisolone – usually used for a short time to treat a flare-up
medicines to calm or control your body's immune system (immunosuppressants)
medicines that block specific proteins that cause inflammation (biologics and targeted medicines)

Your doctor may also suggest other medicines that can help with other symptoms of ulcerative colitis, such as:

medicines to relax the muscles in your gut (antispasmodics) – to help with pain and cramps
medicine to help you poo (laxatives), to help with constipation – some types may also be used to help your bowels work normally if you have diarrhoea
painkillers
supplements, such as calcium or vitamin B12 – ulcerative colitis can stop you getting enough vitamins and minerals from your food

Surgery

You may be recommended surgery for ulcerative colitis if:

it's significantly affecting your life
your bowel is severely damaged
your symptoms keep coming back
other treatments have not helped

You may also need emergency surgery if you have a very bad flare-up.

The surgery for ulcerative colitis is called a colectomy (or bowel resection), where part or all of your large bowel is removed.

This stops your ulcerative colitis from coming back but means your body needs a different way to pass out poo. This is done by either:

an ileostomy – where your small bowel is connected to a hole in your tummy (stoma) and poo is collected in bags attached to the hole
an ileo-anal pouch ("J pouch") – where an internal pouch is made using part of your small bowel and connected to your bottom, so you can poo normally

Your care team will discuss the benefits and risks of surgery with you, and help you decide what the best option is for you.

Find out more

How ulcerative colitis affects your life

Ulcerative colitis is a lifelong condition that affects everyone differently depending on the severity of your symptoms and how often you get flare-ups.

It's common to feel stressed, anxious or embarrassed about the symptoms and how they may affect things like your social life, travel and sex.

Ulcerative colitis can be unpredictable, but treatment and lifestyle changes should help, and there's lots of support available.

You should be offered regular check-ups with a GP and specialist care team to check how well your treatment is working, monitor any possible complications and talk to you about any other changes you can make that might help.

Depending on your symptoms, you may also be referred to other specialists to help manage your condition.

This can include a:

dietitian
joint specialist (rheumatologist)
skin specialist (dermatologist)
eye specialist (ophthalmologist)

Find out more

Complications of ulcerative colitis

Ulcerative colitis is rarely life-threatening, but if you have a severe flare-up you may need emergency treatment in hospital.

Other serious complications can include:

not getting enough vitamins and minerals because your bowel is not able to digest food properly
delayed puberty or stunted growth in children
anaemia
increased risk of bowel cancer – you will be offered regular bowel cancer screening if you have ulcerative colitis
weakened bones (osteoporosis)
depression and anxiety

Things you can do yourself to help ulcerative colitis

There are some things you can do yourself to help with ulcerative colitis.

Do

take medicines you've been prescribed, even if you're currently feeling well and do not have symptoms
keep a food diary – this can help you work out if certain foods make your symptoms worse, but speak to your doctor or care team before making any dietary changes
drink plenty of fluids to stay hydrated if you have diarrhoea
have any vaccinations you're offered – some medicines for ulcerative colitis can make you more likely to get infections
go to bowel cancer screening appointments when you're invited
try ways to manage stress, such as breathing exercises
eat a balanced diet
exercise regularly

Don’t

do not take NSAIDs (non-steroidal anti-inflammatory drugs), such as ibuprofen or aspirin, unless prescribed by a doctor
do not drink more than 14 units of alcohol a week – alcohol can irritate your digestive system

NHS Better Health has free tools and support to help you get active, eat better and drink less

Visit the NHS Better Health website

Causes of ulcerative colitis

Ulcerative colitis is one of a group of conditions called inflammatory bowel disease (IBD). It's thought to be an autoimmune condition, which is where your body's natural defence system (immune system) attacks healthy parts of your body.

It's not known what causes ulcerative colitis or other inflammatory bowel conditions.

Anyone can get ulcerative colitis, but you might be more likely to get it if:

someone else in your family has ulcerative colitis
you used to smoke

Support for ulcerative colitis

Ulcerative colitis can be difficult to live with both physically and emotionally. It's common to feel frustrated or isolated if you have a long-term condition that affects your life.

As well as support from your doctor and care team, there are national charities that can offer information, help and support.

You may find it helpful to get support from other people with ulcerative colitis, either at a local support group or online.

You can also refer yourself directly to an NHS talking therapies service without needing a referral from a GP.

Crohn's and Colitis UK

Dedicated information, advice and wide-ranging support for anyone affected by ulcerative colitis.

Ileostomy and Internal Pouch Association

Advice, information and peer support for people needing bowel surgery or living with an ileostomy or internal pouch, and their families, friends and carers.