Ulcerative Colitis: The Good, the Bad, and the Ugly Colon

Ulcerative Colitis: The Good, the Bad, and the Ugly Colon

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Created for Greatist by the experts at Healthline. Read more

Ulcerative colitis (UC) is a chronic, lifelong condition that affects the large intestine (aka the colon) and the inner lining of the rectum.

It's a form of irritable bowel disease (IBD) in which your immune system attacks your intestines, causing inflammation, sores, and ulcers in your lower digestive tract.

If you're dealing with UC, know that you're not alone and many treatment options are available.

Symptoms of UC

The signs and symptoms of UC vary depending on how severe the inflammation is and where in your intestine it occurs.

They include:

  • diarrhea, sometimes with blood or pus
  • abdominal pain and cramping
  • rectal pain
  • loose and urgent bowel movements
  • inability to relieve your bowels
  • weight loss
  • fatigue
  • nausea
  • fever
  • anemia
  • delayed growth and development in children


The causes of UC are still a bit of a mystery. Diet and stress can aggravate the condition, although they do not cause it. Heredity is sometimes a factor, but most people with UC don't have a family history.

An immune system glitch could be the culprit, since UC often first appears when the immune system tries to fight off bacteria or a virus and ends up attacking the digestive tract instead.

The good news is…

UC itself isn't life-threatening. While there's no cure for UC, treatment can greatly reduce symptoms. Months and even years of remission are possible. Most people with the condition can expect a full life span.

In rare cases and without proper treatment, UC can lead to serious complications, which could spell trouble.

Can UC be fatal?

According to a 2003 Danish study, some complications of UC can impact life expectancy, but the outcomes vary based on age and the severity of UC at the time of diagnosis.

Study participants over age 50 with severe UC had an increased mortality rate within the first 2 years after diagnosis. This was generally due to complications after surgery or comorbidities (having multiple chronic conditions at the same time).

However, a 2016 study found that, due to improvements in treatment, people with UC can expect to live as long as those without it.

Steroid medications alone have reduced the mortality rate for people with acute severe colitis (a serious complication that affects around 25 percent of people with the condition) from 30 to 60 percent to 1 to 2.9 percent. (That's huge!)

Untreated UC

UC is a progressive condition that can't get better on its own. Without treatment, the symptoms will usually get worse, leading to increased inflammation throughout the colon.

Each flare-up risks further damage to your body, and the more damage there is, the harder it is to treat.

Untreated UC may cause:

  • fever
  • weight loss
  • nutritional deficiencies
  • rapid heartbeat
  • appetite loss
  • abdominal swelling
  • fatigue
  • anemia
  • rectal bleeding
  • increased risk of colon cancer
  • perforated bowel (a hole in the intestinal wall)

UC can also cause physical and mental health complications like:

  • eye inflammation
  • problems with the kidneys and liver
  • bone loss
  • skin issues
  • depression
  • stress or anxiety
  • arthritis

Children with untreated UC may experience stunted growth and overall development issues.

The importance of treatment and sticking to it

The only cure for UC is the surgical removal of your colon. But proper diet and medication can help relieve symptoms and slow the condition's progress.

Medications prescribed for UC can reduce inflammation in the intestine and, if successful, can lead to long periods of remission.


The earlier you start treatment, the more effective it will be - so don't put it off!

Once you've found a treatment plan that helps, stick with it. A 2014 review of studies found that people in UC remission who stuck to their treatment plan reduced their flare-ups by 40 percent! Those who didn't had a five-times-greater risk of relapse.

Not surprisingly, the more severe your UC is, the more important it is to seek treatment as quickly as possible to prevent complications.

Long-term inflammation in your large intestine can cause colonic dysplasia, colorectal cancer, and a slew of other conditions you don't want.

Life-threatening complications

Though UC is usually not life-threatening, some of its complications can be dangerous.

Possible complications include:

  • intestinal bleeding
  • blood clotting
  • colorectal cancer
  • primary sclerosing cholangitis
  • gastrointestinal perforation (a hole or tear in your intestine)
  • toxic megacolon
  • osteoporosis (as a result of steroid use)

Toxic megacolon

Toxic megacolon is the most severe complication of UC. It involves swelling of your large intestine, which causes gas to become trapped in your colon. This can eventually cause your colon to burst, spreading dangerous bacteria throughout your body.

Toxic megacolon affects up to 10 percent of people with UC, with mortality rates ranging from 19 to 45 percent. Mortality rates are highest if the colon ruptures and it isn't treated immediately.


Some of the symptoms of toxic megacolon are:

  • stomach pain
  • stomach swelling
  • frequent diarrhea
  • bloody diarrhea
  • rapid heartbeat
  • fever
  • dehydration

Without immediate medical attention, toxic megacolon can be deadly. Complications include:

  • perforation (a hole or tear) of the intestine
  • bleeding and blood loss
  • sepsis
  • shock (when blood stops flowing to your organs and other tissues)

Signs of shock include:

  • weak pulse
  • dilated pupils
  • confused mental state
  • clammy skin
  • shallow/rapid breathing


Treatments for toxic megacolon include:

  • medications to help reduce inflammation and to treat or prevent infection
  • bowel rest and decompression to relax your bowels and remove excess gas from your colon
  • intravenous (IV) fluids and electrolytes to treat dehydration and low blood pressure
  • surgery to remove part or all of your large intestine

If you're being treated for toxic megacolon, make sure to tell your doctor about any medications you're taking.

Certain medications can worsen the condition, including:

  • opioids
  • nonsteroidal anti-inflammatory drugs (NSAIDs)
  • anti-diarrhea medications
  • antidepressants
  • anticholinergic medicines

Perforation of the colon

Persistent ulcers and intestinal inflammation can weaken your colon's lining, eventually leading to holes or tears.

When this happens, bacteria and whatever else is floating around in your large intestine can leak into your stomach, causing your peritoneum - a fancy word for “stomach lining” - to become extremely inflamed (this is called peritonitis).

Peritonitis can cause your stomach to fill with fluid, which can lead to sepsis, or blood poisoning. Sepsis is fatal in about 30 percent of cases, so it's really important to monitor your symptoms and seek medical attention if you notice any signs.


To prevent peritonitis and sepsis, it's crucial to know the symptoms of colon perforation. They include:

  • nausea
  • vomiting
  • severe stomach pain
  • chills
  • fever


A tear in your colon is always considered a medical emergency and requires surgery. After surgery, your doctor will most likely give you oral and/or intravenous antibiotics to treat and prevent infection.

You can also expect you doctor to send you for:

  • X-rays
  • a CT scan
  • blood tests to check for signs of infection and blood loss

In some cases, a surgeon must perform a colostomy or ileostomy, which allows the contents of your intestines to empty into a bag through a hole in your abdomen called a stoma.

Some colostomies can be reversed with a second surgery once your intestines heal. But for some people the colostomy is permanent.

Colorectal cancer

According to the Crohn's and Colitis Foundation, 5 to 8 percent of people with UC get colorectal cancer within 20 years of their diagnosis, compared with 3 to 6 percent of people without UC.

As always, be proactive when it comes to your health. Colorectal cancer is highly treatable if diagnosed early but can be fatal if it goes untreated and spreads.

People with severe UC (those who have had the condition for 8 to 10 years) and those who haven't received treatment for UC are at a higher risk of developing colorectal cancer. This is partly due to their risk of developing precancerous polyps, or dysplasia.

Colorectal cancer precautions

The Crohn's and Colitis Foundation recommends taking these preventive measures to reduce your risk of colorectal cancer:

  • Always take your prescribed meds, even if you're feeling better.
  • Tell your doctor if anyone in your family has had colorectal cancer.
  • Have a colonoscopy every 1 to 2 years.
  • See a gastroenterologist at least once a year.
  • Discuss symptoms and concerns during regular checkups.
  • Stick to a healthy, low-fat diet.
  • Exercise regularly.
  • Avoid red meat (beef, pork, lamb, or liver) and processed meats (like hot dogs and cold cuts).
  • Limit alcohol consumption.
  • Don't smoke.


People with colorectal cancer might have some of these symptoms:

  • diarrhea or constipation that lasts for more than a few days
  • bright red blood bleeding from the rectum
  • a constant feeling of having to go #2 (and not feeling better afterward)
  • dark stools
  • stomach pain
  • stomach cramps
  • unintentional weight loss
  • weakness
  • fatigue

Blood clotting

People with IBD (irritable bowel disease) have a higher risk than other people of developing thrombosis, or blood clots.

When a blood clot blocks a vein (usually in your leg or arm), you get something called deep vein thrombosis (DVT). In worst-case scenarios, part of that clot can travel to your lungs, causing a potentially fatal complication called a pulmonary embolism.

According to a 2015 review of studies, people with IBD are three times more likely to develop thrombosis than those without IBD.

Though doctors aren't sure why IBD increases the risk of thrombosis, it's possible that chronic inflammation can trigger a chemical reaction that causes your blood to thicken, increasing the chance that it will clot.

Research has shown that the following factors increase the risk of blood clots in people with IBD:

  • surgery
  • oral contraceptives
  • hormone replacement therapy (HRT)
  • steroid therapy
  • prolonged inactivity
  • vitamin deficiencies
  • dehydration
  • hyperhomocysteinemia
  • central venous catheters
  • cigarette smoking


Symptoms of DVT include:

  • red or blue skin discoloration
  • limb tenderness
  • limb swelling
  • a limb that's warm to the touch

Symptoms of pulmonary embolism include:

  • a cough with bloody mucus
  • sudden shortness of breath
  • rapid heart rate
  • sharp or stabbing chest pain that worsens with deep breathing

If you have any of these symptoms, seek medical attention immediately.

Primary sclerosing cholangitis

Primary sclerosing cholangitis (PSC) is a condition that affects your bile ducts, usually causing inflammation and damage.

Bile ducts carry the digestive liquid bile from your liver to your small intestine, but PSC causes inflammation and scarring in your bile ducts, making them hard and narrow. This can gradually cause serious damage to your liver.

PSC generally happens only if the bowel disease is severe. It's chronic and starts out slow but can increase your risk of potentially fatal complications.


PSC symptoms usually include:

  • jaundice (when your eyes and skin turn yellow)
  • depression
  • intense itching (especially on the soles of your feet or palms of your hands)
  • chills
  • fatigue
  • fever

As PSC progresses, you may experience symptoms of intensive liver disease, including:

  • stomach pain
  • vomiting blood
  • breathing difficulties
  • confusion
  • anemia
  • personality or mood changes
  • difficulty concentrating
  • changes in sleep patterns
  • forgetfulness
  • seizures
  • black stools
  • hernias
  • slurred speech
  • slow movement

If you have any of these symptoms, seek immediate medical attention.


Now that we've made it through the less-than-comforting encyclopedia of intestinal complications, let's take a deep breath and shift our focus to all the treatments that can help you avoid them.

Many treatment options are available to relieve UC symptoms and help you maintain remission.

The best treatment for you will depend on how advanced your UC is and its location in your intestine.

Medical treatments

  • Aminosalicylates can help control inflammation in people with mild to moderate symptoms. They're often the first step in treatment for UC.
  • Antidiarrheal medications are used to stop or reduce diarrhea, usually in the short term. Use them with caution - and never without asking your doctor first.
  • Antibiotics may be necessary if untreated UC has caused infected abscesses or ulcers.
  • Corticosteroids are often prescribed short-term to cause remission or help relieve severe symptoms
  • Biologics are antibodies that affect specific parts of your immune system. Doctors usually turn to biologics only if other treatment methods aren't successful.
  • Dietary supplements can help with nutritional deficiencies such as anemia.
  • Immunomodulators suppress your immune system to help reduce intestinal inflammation. They might be used if an aminosalicylate treatment is unsuccessful, but they can be very risky.
  • A doctor may recommend surgery if your UC is severe or difficult to treat. This may mean removing part or all of your large intestine.

Clinical trials

The Mayo Clinic lists several clinical trials currently taking place to investigate methods for managing UC. Trials range from new medications to innovative treatments like the use of hyperbaric oxygen.

Lifestyle and diet changes

Adjusting some lifestyle and food choices may also help you manage your UC symptoms. Research suggests that eating a low-fat diet with plenty of vegetables can help reduce the risk of worsening UC.

Other lifestyle hacks that may help your symptoms include:

  • eating small, frequent meals
  • drinking lots of liquid (avoiding fizzy drinks like soda)
  • limiting high-fat and high-fiber foods, especially if you're dealing with flare-ups
  • keeping a food journal to track how you feel after eating and see if any particular foods trigger flare-ups


Ulcerative colitis is a lifelong, chronic condition that can vary in intensity over time.

There's no cure (other than surgically removing your intestine), but many treatments and lifestyle changes can help you relieve symptoms and maintain remission.

UC itself is not life-threatening, but it can lead to complications that are. If left untreated, it can have devastating effects on your body that become progressively difficult to address.

That's why it's so important to see a doctor, know what to look for, and be proactive with your treatment.