Ulcerative Colitis
A chronic condition you can manage well with the right plan.
Ulcerative colitis can be unpredictable, but modern treatments help most patients live full, comfortable lives between flares.
Ulcerative colitis (UC) is a chronic inflammatory bowel disease that causes ongoing inflammation and ulcers along the inner lining of the colon and rectum. Symptoms tend to develop gradually and can intensify over time without proper treatment. The condition typically follows a pattern of flares (periods of active inflammation and symptoms) followed by remission. The exact cause isn't fully understood, but genetic predisposition, immune system dysfunction, and environmental factors like stress and diet all play a role.
Ulcerative Colitis at a Glance
Affects
Colon and rectum only
Pattern
Continuous inflammation
Course
Flares and remissions
Onset age
Most common 15 to 30
How It Differs from Crohn's Disease
UC and Crohn's disease are both inflammatory bowel diseases (IBD), and they share many symptoms. The key differences: UC affects only the colon and rectum, with continuous inflammation along the lining. Crohn's can affect any part of the digestive tract, with patches of inflammation that can extend deeper into the bowel wall. Distinguishing between them is important because treatment approaches differ.
UC is sometimes named by where it affects the colon: ulcerative proctitis (rectum only), proctosigmoiditis (rectum and lower colon), left-sided colitis, or pancolitis (entire colon). The extent influences treatment choices and follow-up.
Common Symptoms
Symptoms vary depending on the severity and location of inflammation, but typically include:
Abdominal pain and cramping
Persistent diarrhea, often containing blood or mucus
Rectal bleeding and discomfort
Urgent and frequent need to use the bathroom
Weight loss
Fatigue
Fever during flares
Occasional constipation, especially in proctitis
UC can also cause symptoms outside the digestive tract, including joint pain, eye inflammation, and skin problems. These can be the first signs of a flare for some patients.
How Ulcerative Colitis Is Diagnosed
During your initial visit, Dr. Chung will carefully review your medical history and symptoms. From there, several diagnostic tests can help confirm UC and distinguish it from other conditions like Crohn's disease, infection, or IBS.
Colonoscopy with biopsy
The most definitive test. A scope examines the colon directly and tissue samples are taken to confirm UC and rule out other causes.
Blood tests
Check for anemia, inflammation markers, and signs of infection. Helps gauge severity.
Stool tests
Rule out infectious causes of diarrhea and assess inflammation markers like fecal calprotectin.
Imaging (X-ray, CT, MRI)
Used to assess the extent of inflammation, detect complications, and help differentiate UC from Crohn's disease.
Treatment Options
UC currently has no cure other than surgery, but multiple treatments effectively manage symptoms, reduce flare frequency, and help maintain remission. Most patients work through these approaches in steps.
First line
Medication management
Anti-inflammatory drugs are usually the starting point: 5-ASAs (mesalamine) for mild to moderate disease, corticosteroids for active flares, and immunomodulators or biologics (such as anti-TNF agents) for moderate to severe cases or steroid-dependent disease. The right combination depends on disease extent and severity.
Supportive
Dietary and lifestyle adjustments
Diet doesn't cause UC, but it can affect symptoms. Many patients find that during flares, limiting fiber-rich foods, dairy, spicy foods, caffeine, and alcohol helps. Hydration, balanced nutrition, regular physical activity, and stress management all support symptom control between flares.
When needed
Surgery
For severe cases that don't respond to medication, for serious complications (toxic megacolon, perforation, severe bleeding), or for precancerous changes, surgery offers a permanent solution. Because UC affects only the colon and rectum, removing them cures the disease.
Surgical Options
When surgery is the right answer, there are two main approaches. Dr. Chung will discuss which fits your situation, anatomy, and goals.
Proctocolectomy with J-pouch
Restorative surgery (IPAA)
The colon and rectum are removed, and a pouch is constructed from the small intestine and connected to the anus. Allows near-normal bowel movements without an external bag. Often the preferred option for younger, otherwise healthy patients.
Proctocolectomy with end ileostomy
Permanent ileostomy
The colon and rectum are removed, and the small intestine is brought to the abdominal wall to drain into an external pouch. Simpler procedure, no pouch complications, and reliable long-term function.
Long-term cancer surveillance: People with UC have an elevated risk of colorectal cancer over time, especially with extensive disease (left-sided or pancolitis) or longer disease duration (8+ years). Regular surveillance colonoscopies are part of long-term care. Talk to Dr. Chung about the right schedule for your situation.
Recovery and Long-term Management
For patients on medical management, the goal is to achieve and maintain remission with the lowest effective dose of medication. Regular follow-ups, symptom tracking, and adjustments based on how you're doing are part of the long game.
For surgical patients, recovery timelines vary by approach and individual factors. Dr. Chung provides detailed aftercare instructions and ongoing monitoring. Most patients return to regular activities and experience lasting symptom relief.
Get expert UC care
Whether you're newly diagnosed, struggling through a flare, or considering surgery, Dr. Chung can help you build a plan that fits your life and your disease.
Book a consultation
Call (714) 988-8690
