Ulcerative Colitis

What is ulcerative colitis?

Ulcerative colitis is an inflammatory condition of the inner layers of the large bowel.  It involves the rectum (distal part of the large bowel) and can advance to involve the proximal colon (caecum). The area of inflammation is continuous and involves ulceration of the bowel lining and abscess formation. Chronic inflammation of the bowel increases the risk of colorectal cancer.  Other organ systems can be involved including the eyes, liver, skin and joints.

What is the cause of ulcerative colitis?

The cause is unknown but may involve genetic/familial, environmental and autoimmune factors. 

What are the symptoms of ulcerative colitis?

Symptoms of ulcerative colitis may be continuous or intermittent and range from mild to life threatening requiring hospitalisation.

Intestinal features:

  • Passage of blood and mucous in the faeces

  • Abdominal pain

  • Diarrhoea and faecal urgency

Extra-intestinal features include:

  • Inflammation of the eyes (iritis, episcleritis)

  • Skin changes lesions (pyoderma gangrenosum)

  • Joint pain (arthritis)

  • Liver disease (sclerosing cholangitis)

How is it diagnosed?

A thorough history will be taken by the surgeon.  If ulcerative colitis is suspected a colonoscopy is recommended to visualise the bowel lining and take biopsies of the bowel and any other concerning features.  The pathologist examines the samples, confirming ulcerative colitis. Whilst some blood tests and imaging may show inflammation, they are not diagnostic.  Due to the high risk of colorectal cancer, regular colonoscopies should be performed as per guidelines.

How is ulcerative colitis treated?

Ulcerative colitis is medically managed initially with steroids to induce remission and then maintenance therapy in continued with steroid sparing agents including oral 5-ASA agents (sulfasalazine/mesalazine) or thiopurines (azathioprine) depending on the location and severity of the disease. Biological agents including infliximab is used for severe disease.  If this fails then surgery is required.


When is surgery needed?

Colonoscopies are required as part of regular surveillance for detection of pre-malignant or malignant change as well as response to medical therapy.


Surgery is required which involves removing the large bowel with either a permanent ileostomy (bag) or re-joining the bowel with a ‘pouch’ operation when:

  • Medical treatment no longer controls the symptoms which are severely affecting quality of life.

  • Pre-malignant or malignant changes detected on colonoscopy biopsies.

  • Complications occur including bleeding, severe inflammation, bowel perforation and cancer.


What can I expect after surgery?

Following removal of the large bowel, ulcerative colitis is essentially cured and no further medication should be required.  You should continue to follow up with your surgeon, particularly if your bowel was joined in a ‘pouch’ operation as the end of the large bowel will need to be monitored via endoscopy.  You will have several loose but usually continent bowel motions a day as the large bowel was where most of the fluid was absorbed from the faecal content prior to surgery.  Otherwise you can expect a return to your regular activities and normal life expectancy.