Ulcerative Colitis

Understanding and managing ulcerative colitis

What is ulcerative colitis?

Ulcerative colitis (UC) is one of the two main forms of inflammatory bowel disease (IBD). It causes chronic inflammation and ulceration of the inner lining of the large bowel (colon and rectum) only. It always involves the rectum and extends a variable distance around the colon — from proctitis (rectum only) to pancolitis (the whole colon). Like Crohn's disease, it runs a course of flares and remission. There is no cure yet, but modern therapy keeps most people well, and surgery to remove the colon can be curative when needed.

Common symptoms

• Diarrhoea with blood and mucus — the hallmark symptom

• Urgency, needing to rush to the toilet, and sometimes incontinence

• Feeling of incomplete emptying, or passing blood/mucus alone (especially in proctitis)

• Abdominal cramping, fatigue, weight loss and fever during flares

• Symptoms outside the gut: joint pains, eye inflammation, skin rashes

Diagnosis and monitoring

Diagnosis is made by colonoscopy (or sigmoidoscopy) with biopsies, supported by blood tests, stool tests to exclude infection, and faecal calprotectin. Calprotectin is also our key tool for monitoring — it tells us whether the bowel lining is truly healed, which is the best predictor of staying well long term.

Treatment

• 5-ASA medications (mesalazine) are the foundation for mild-to-moderate UC — available as tablets/granules and as enemas or suppositories. Rectal mesalazine is highly effective and important even if you also take tablets, because it delivers medicine directly where UC is most active

• Corticosteroids settle flares quickly but are not for long-term use

• Biologic and targeted therapies (e.g. infliximab, vedolizumab, ustekinumab, and oral JAK inhibitors such as upadacitinib) are very effective for moderate-to-severe UC; most are PBS-subsidised

• Surgery (removal of the colon, usually with a 'J-pouch' reconstruction) is curative for UC and is an important option for severe disease not responding to medication

Take maintenance therapy consistently even when you feel well — stopping mesalazine is one of the most common causes of relapse.

Living well with UC

• A severe flare (frequent bloody motions, fever, feeling unwell) can be a medical emergency — contact us promptly or attend hospital

• Because long-standing colitis slightly increases bowel cancer risk, we arrange surveillance colonoscopies, generally starting about 8 years after diagnosis, at intervals tailored to you

• Stay up to date with vaccinations and skin checks, particularly on immune-suppressing therapy

• Iron deficiency is common and worth treating — fatigue is not something you simply have to accept

• Pregnancy is very achievable with UC — plan conception during remission and talk to us early; most IBD medicines are safe to continue

• Crohn's & Colitis Australia (crohnsandcolitis.org.au) offers excellent support and resources

⚠ Contact us promptly if you have More than six bloody bowel motions a day with fever or feeling unwell — this needs same-day assessmentA flare not improving after a few days of treatmentSigns of dehydration, severe pain, or persistent vomitingSignificant rectal bleedingQuestions before stopping or changing any IBD medication

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This information is general and not a substitute for personalised medical advice. Please discuss any questions with your gastroenterologist or GP. If you develop severe symptoms, call 000 or go to your nearest emergency department.