Stomach pain, urgent trips to the bathroom and ongoing diarrhea are easy to brush off as stress or a "sensitive stomach." But for some people, these symptoms may be signs of ulcerative colitis, a chronic inflammatory disease that affects the colon and can worsen without treatment.
Ulcerative colitis (UC) is a type of inflammatory bowel disease (IBD) that affects the colon. The inflammation starts in the rectum and can extend upwards throughout the large intestine. When the lining of the colon becomes inflamed, small ulcers appear — leading to rectal bleeding and changes in bowel habits that can disrupt daily life.
Getting the right diagnosis early matters, since effective treatment can quiet inflammation and reduce long‑term risks.
"Ulcerative colitis is essentially an autoimmune attack on your own intestinal cells," says Dr. Hassan Dakik, a gastroenterologist at Houston Methodist. "It often develops in young adulthood, but it can flare up at any age."
What are the symptoms of ulcerative colitis?
Early symptoms often follow a common pattern. You might notice:
- Rectal bleeding
- Changes in bowel habits, such as looser stools
- A feeling of urgency to go to the bathroom
- An increase in frequency of bowel movements
"Eventually, you might start to feel abdominal pain," Dr. Dakik says. "It might start in the pelvic region and progress to the left abdomen, or it might be a more generalized pain that gets worse as the disease progresses."
Some patients also experience "extra-intestinal" symptoms. These autoimmune reactions occur outside the digestive tract, including:
- Joint pain or arthritis
- Skin rashes
- Eye inflammation or vision changes
- Mouth sores
- Low bone density
"Because ulcerative colitis is autoimmune, it doesn't just affect the colon," says Dr. Dakik. "Sometimes the first signs are actually in the skin, joints or eyes."
Most people with UC have flare-ups and periods of remission, and most have disease progression before the disease stabilizes. Some people go into a deep clinical remission, although this is generally more common later in life.
What causes ulcerative colitis?
Doctors don't fully understand what causes ulcerative colitis, but research points to a combination of factors.
- Immune system dysfunction: UC is considered an autoimmune condition. The immune system mistakenly attacks healthy intestinal cells, causing inflammation.
- Environmental triggers: Certain infections, stress, medications (nonsteroidal anti-inflammatory drugs, or NSAIDs), smoking and diet may trigger flare-ups in people who are genetically susceptible.
- Gut bacteria imbalance: Changes in gut microbiome health may also play a role.
"There's definitely a genetic predisposition as well," says Dr. Dakik. "UC tends to cluster in families. Even identical twins can be affected differently."
(Related: Why Knowing Your Family Health History Matters)
How is ulcerative colitis different from other bowel disorders?
Ulcerative colitis and Crohn's disease are the two main types of inflammatory bowel disease. They differ based on where the disease appears:
- UC affects only the inner lining of the colon. It typically originates in the rectum and progresses upward.
- Crohn's disease can affect any part of the digestive tract. It often involves deeper, patchy inflammation rather than small ulcers.
UC is also different from irritable bowel syndrome (IBS), which isn't characterized by inflammation.
(Related: IBS vs. IBD: What's the Difference?)
When should you see your doctor about gut health issues?
If you notice symptoms like abrupt changes in bowel habits, blood or mucus in the stool, or unexplained severe pain, it's important to talk with a doctor. These "red flag" symptoms strongly suggest that something inflammatory is occurring and requires a closer look. (Related: 7 Signs It's Time to See a Gastroenterologist)
"Many people first assume it's hemorrhoids or irritable bowel syndrome, or they might be misdiagnosed," says Dr. Dakik. "Any change in bowel habits that feels abnormal for you is worth discussing with a doctor. Early evaluation can make a huge difference."
How are UC and other bowel conditions diagnosed?
Evaluation typically starts with noninvasive tests, such as:
- Blood tests to check for markers of inflammation and rule out anemia or active bleeding
- Stool tests that look for increasingly specific markers of inflammation in the gut
- Imaging tests such as CT scans or ultrasounds to visually assess the intestine for obvious signs of inflammation
Testing can also help your doctor distinguish UC from functional, benign bowel diseases such as IBS. If your provider suspects UC, a colonoscopy with biopsies will confirm the diagnosis.
"A lot of people are anxious about getting a colonoscopy, but we can often do the noninvasive tests first," says Dr. Dakik.
(Related: Should You Do a Gut Microbiome Test?)
What treatment options are available for UC?
Treatment for ulcerative colitis focuses on controlling inflammation, healing the colon and preventing flare-ups. Every patient's treatment plan is personalized based on severity, lifestyle, age and pregnancy status.
- Mesalamine therapy: This is a topical medication for milder symptoms that targets the rectum and left colon. It's usually administered through a suppository or enema, and it's a safe option with few side effects.
- Biologic therapies: These are now the mainstay for moderate to severe UC. These therapies focus on defined steps in the "inflammatory cascade" using agents that target specific proteins, cytokines and cell receptors that cause inflammation.
- Immunomodulators: Medications like methotrexate, azathioprine and 6-mercaptopurine are sometimes used alongside biologics for a more profound response but are rarely used as a standalone treatment.
"We plan your treatment to match your life," says. Dr. Dakik. "We consider factors such as work, travel or family planning. We aim for most effective regimen with the lowest risk."
(Listen: What to Do If Digestive Problems Are Giving Your Gut Grief)
What kind of ongoing appointments are needed to manage UC?
Once treatment begins, ongoing monitoring is essential. Follow-up typically includes:
- Lab tests several times a year
- Medication response checks
- Screening for side effects
- Nutrient deficiency monitoring
- Regular colonoscopies, typically every one or two years after eight to 10 years of disease
"With modern therapies, many visits can even be done by video," says Dr. Dakik. "People don't need to worry that they'll be in the doctor's office every month."
(Related: Gut Health: Signs of an Unhealthy Gut & How to Improve It)
Is there a link between UC and colon cancer?
People who live with an inflammatory bowel disease such as UC or Crohn's have a higher risk of developing colorectal cancer. This is because chronic colon inflammation increases the risk of precancerous and cancerous cell changes.
A crucial part of managing UC is surveillance for colorectal cancer. Patients will need routine screenings for pre-cancerous changes more often and start earlier than the general population.
"Cancer risk is related to how much inflammation there is over time," says Dr. Dakik. "With good disease control and regular screening, we can lower that risk significantly."
(Related: Why Even Young Adults Should Care About Colorectal Cancer Screening)
Can lifestyle modifications help alleviate UC symptoms?
Lifestyle changes can't replace medical therapy, but they can help reduce flare-ups, support remission and boost overall gut health. Some proven strategies include:
- Avoid NSAID pain relievers such as ibuprofen and naproxen
- Limit alcohol and stop smoking
- Manage stress with sleep, mindfulness and supportive routines
- Stay hydrated
- Identify food triggers such as dairy, high-fat foods and processed sugar
"There's no universal UC diet," says Dr. Dakik. "Most patients learn what triggers their symptoms and adjust over time."
Exercise is also beneficial for people who live with ulcerative colitis. It can help to:
- Stimulate metabolism by moving unwanted substances through the system more efficiently
- Modulate stress hormones such as cortisol, which influence gut motility and can affect inflammatory pathways
(Related: What Is the Gut-Brain Axis?)
Talk with your doctor about unusual symptoms
If you notice persistent changes in your bowel habits or bleeding, urgency or unexplained abdominal pain, don't wait to be evaluated. Early testing is often noninvasive and can quickly clarify what is going on.
With today's targeted treatments — plus healthy lifestyle choices and regular follow‑up — most people with UC can reach remission.
"If something about your digestion doesn't feel normal, don't ignore it," says Dr. Dakik. "We have many tools to help — you don't have to suffer in silence."
