Ulcerative colitis: symptoms, flare-ups, diet, treatment and tests

The NHS lists the common symptoms of ulcerative colitis as follows. Other symptoms may include constipation, feeling very tired, feeling less hungry than usual and losing weight without trying to.

• Diarrhoea, which may contain blood, mucus or pus.

• Tummy pain, particularly in the lower left part of your tummy, which may get better after pooing.

• Needing to poo frequently, urgently or during the night.

• Feeling like you need to poo even though your bowel is empty.

• Bleeding from your bottom.

• Farting a lot or feeling bloated.

Sometimes you may have no symptoms or only mild symptoms for a period of time (remission), and then an episode of very bad symptoms, called a flare-up or relapse. The NHS says a flare-up can last anywhere from a few days to several months.

During a flare-up you may get symptoms elsewhere in the body, such as swollen or painful joints, a high temperature, swollen and red or darker patches of skin (erythema nodosum), red eyes that may be itchy or painful, and mouth ulcers.

Flare-ups may be triggered by stress, infections, changes in medicines, taking NSAIDs such as ibuprofen or aspirin, and certain foods. Sometimes there is no obvious trigger. NHS inform describes flare-up symptoms as diarrhoea 6 or more times a day, blood or mucus in the poo, severe tummy pain and symptoms in other parts of the body, with severe flare-ups also causing shortness of breath, a fast or irregular heartbeat and a high temperature.

The NHS says to ask for an urgent GP appointment or get help from NHS 111 if you have symptoms of ulcerative colitis and any of the following. If you have been diagnosed and are having a severe flare-up, you can also contact your care team.

• Very bad diarrhoea or bloody diarrhoea.

• A high temperature, or you feel hot, cold or shivery.

• A fast heartbeat.

• You cannot fart or poo.

• You are worried about your symptoms.

• Call 999 or go to A&E for severe tummy pain, bleeding non-stop from your bottom, a lot of blood or large blood clots when you poo, or vomiting blood or poo, or sick that looks like coffee grounds or soil.

• Do not drive to A&E: ask someone to drive you or call 999, and bring your medicines.

The NHS says treatment aims to relieve symptoms during a flare-up and reduce the chances of them coming back, and depends on your symptoms and how much of your bowel is affected. NHS inform says mild flare-ups can usually be treated at home, whereas severe flare-ups usually need hospital treatment.

The NHS says surgery may be recommended if ulcerative colitis is significantly affecting your life, your bowel is severely damaged, symptoms keep coming back or other treatments have not helped. You may also need emergency surgery for a very bad flare-up.

The operation is called a colectomy (or bowel resection), where part or all of the large bowel is removed. This stops ulcerative colitis coming back but means the body needs a different way to pass poo: either an ileostomy, where the small bowel is connected to a stoma on the tummy and poo is collected in a bag, or an ileo-anal pouch (J pouch), where an internal pouch made from part of the small bowel is connected to the bottom so you can poo normally. Your care team will discuss the benefits and risks.

Crohn's & Colitis UK says there is no clear evidence that specific foods cause, cure or treat the inflammation in colitis, and that it is important to try to eat a healthy, balanced diet that gives you all the nutrients you need. Some people find that what they eat has little effect, while others find certain foods trigger symptoms and cutting down helps. There is no particular diet that works for everyone.

The NHS suggests keeping a food diary to work out whether certain foods make symptoms worse, but speaking to your doctor or care team before making any dietary changes. Crohn's & Colitis UK advises getting advice from your IBD team or a dietitian before making major changes, and says you may need supplements if you have low vitamin or mineral levels. It says around 1 in 3 people with colitis have low iron levels.

The NHS also advises drinking plenty of fluids if you have diarrhoea, eating a balanced diet and not drinking more than 14 units of alcohol a week, as alcohol can irritate the digestive system.

The NHS says it is not known what causes ulcerative colitis or other inflammatory bowel conditions. It is thought to be an autoimmune condition, where the body's immune system attacks healthy parts of the body. Anyone can get ulcerative colitis, but you might be more likely to if someone else in your family has it or you used to smoke.

Crohn's & Colitis UK says researchers believe a mix of genes, bacteria in the gut and the environment probably cause colitis. It says environmental factors that may increase risk include viruses, bacteria, stress and medicines such as antibiotics and NSAIDs, and that colitis is more common in non-smokers.

NHS inform says your GP will ask about your pattern of symptoms, diet, any recent travel (as travellers' diarrhoea can cause similar symptoms), medicines, family history and past health problems. They may examine your tummy, ask for a stool sample to check for blood, infection or inflammation (including a faecal calprotectin test) and arrange blood tests for inflammation or anaemia.

The NHS says ulcerative colitis is usually diagnosed in hospital by a specialist in digestive conditions (a gastroenterologist). Tests may include blood tests, a stool sample, scans such as X-ray, CT or ultrasound, a colonoscopy, and a biopsy of the bowel lining taken during the colonoscopy.

The NHS describes ulcerative colitis as a lifelong condition that affects everyone differently, and says it is common to feel stressed, anxious or embarrassed about the symptoms. You should be offered regular check-ups with a GP and specialist care team, and may be referred to a dietitian, rheumatologist, dermatologist or ophthalmologist.

The NHS says ulcerative colitis is rarely life-threatening, but a severe flare-up may need emergency hospital treatment. Other possible complications include not getting enough vitamins and minerals, delayed puberty or stunted growth in children, anaemia, an increased risk of bowel cancer (with regular bowel cancer screening offered), weakened bones and depression and anxiety.

Self-help includes taking prescribed medicines even when well, having vaccinations you are offered, going to bowel cancer screening appointments, managing stress and avoiding NSAIDs unless prescribed.

NHS inform says ulcerative colitis can affect people of all ages but is usually diagnosed between 15 and 40. Crohn's & Colitis UK says colitis can occur at any age, and nearly 1 in 5 people told them they were diagnosed with Crohn's or colitis before the age of 18. Symptoms are similar to those in adults and many of the medicines used for adults can also be used for children.

The NHS lists delayed puberty or stunted growth in children among the possible complications of ulcerative colitis.

On the NHS, ulcerative colitis is managed by IBD teams, which Crohn's & Colitis UK says are likely to include a gastroenterologist, IBD nurse specialists and surgeons, and some include a dietitian, pharmacist and psychologist. They should support you through diagnosis, treatment and rapid care during flare-ups.

Private gastroenterology can offer quicker consultations or colonoscopy, and some people seek a second opinion about medicines or surgery. Ask how care will be coordinated with your NHS IBD team, particularly for monitoring blood tests, bowel cancer screening and vaccinations.