Ulcerative Colitis

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Overview

Ulcerative colitis is a condition that affects the inner lining of the large intestine. It is one of two main types of inflammatory bowel disease (IBD) conditions. 

Unlike Crohn's disease, ulcerative colitis does not skip parts of the colon. It always starts in the rectum and spreads further into the colon as the disease progresses.

Ulcerative colitis usually begins in adolescence and early adulthood. Some people with the condition do not experience their first symptoms until age 50 or 60. Symptoms can begin after the age of 70 in rare cases. Ulcerative colitis is slightly more common in females than in males. It is a lifelong condition that often has periods of flare-ups (symptoms) followed by periods of remission (no symptoms). 

Our care

Learn more about the specialized care provided at Mount Sinai Hospital for IBD.

This content is intended for informational purposes only and is not intended to be used or relied upon for any diagnostic or treatment purposes. It does not replace the need for consultation with a health-care professional. Please speak with your health-care professional for questions about your health.

Diagnosis

The symptoms of ulcerative colitis vary from person to person and can include:

Diarrhea, sometimes with the loss of blood
Frequent and urgent bowel movements that may involve spasms or cramping
Abdominal pain
Fever
Weight loss

If you are experiencing symptoms of ulcerative colitis, your family physician or an IBD specialist may recommend some of the following tests:

Blood tests
Stool tests
An endoscopic test, like a colonoscopy to look at your rectum and colon
A biopsy to test a small sample of inflamed tissue
Medical imaging, such as X-rays or CT scans

Treatment

Ulcerative colitis can be managed with medication, surgery and lifestyle changes. We will work with you to decide on a care plan that is specific to your needs. Our recommendations will depend on your age, general health, the severity of your condition and other life factors.

Monitoring

Ongoing monitoring is an important part of the management of ulcerative colitis. You will have regular follow-up appointments with our IBD specialists to watch for changes in your disease and adjust your care plan as needed.

You can expect regular testing that may include:

• Blood and stool tests
• Endoscopic procedures
• Medical imaging

Medication

Medication is used to help control chronic intestinal inflammation. We work with each patient to choose medication that will lessen or eliminate symptoms and cause minimal side effects.

Corticosteroids help control the immune system and lessen the inflammation and symptoms of ulcerative colitis over the short term. They are not recommended for long-term use due to side effects.

Aminosalicylates: anti-inflammatory medications that decrease inflammation at the intestinal wall. They can be used over the long term to both reduce symptoms and maintain remission.

Immunomodulators: modify the activity of the immune system to prevent ongoing inflammation. They can be used over the long term to maintain remission in some patients.

Advanced therapies (such as biologics and small oral molecules) are the newest treatments for IBD. Your care team will work with you to determine the best treatment plan.

Surgery

Some patients with ulcerative colitis disease require surgery.

Proctocolectomy and ileostomy

In this procedure, the surgeon removes the colon and rectum and then makes a small cut in the abdomen for bodily waste to pass directly from the last part of the small intestine into a bag outside of the body (ostomy). This surgery has a low complication rate compared to other procedures. The most common complications are related to the ostomy and perineal wound.

Pelvic pouch or ileoanal anastomosis procedure (J-Pouch)

Mount Sinai Hospital was instrumental in pioneering this procedure for patients with ulcerative colitis. These procedures can happen after a patient has recovered from a proctocolectomy, if appropriate.

The surgeon constructs a small pouch to collect bodily waste within your body so you can control your own bowel movements. Our colorectal surgeons use a minimally invasive (laparoscopic) approach to this procedure whenever possible.

View this video for helpful information on surgical treatment for ulcerative colitis by TVASurg - The Toronto Video Atlas of Surgery.

Ostomy

An ostomy, also referred to as a stoma, is a surgically created opening that allows for the drainage of bodily waste. It is usually on the abdominal wall.

Temporary stomas may be used in for:

Emergency or semi-urgent surgeries, where resection and joining of the bowel is unsafe due to an infection in the abdomen
Perianal sepsis or infection that requires bodily waste to be diverted to allow for healing
Post-surgery complications, such as leaks from areas where the bowel has been joined

Permanent stomas may be needed if the rectum and anus are severely affected by disease.