Ulcerative Colitis

Ulcerative colitis (UC) is a chronic inflammatory condition of the lining of the large intestine (colon and rectum). Unlike Crohn's, it is limited to the colon and affects only the inner lining. It comes in flares (active symptoms) and remissions (feeling well). Modern treatment allows most people to live full, active lives.

Symptoms

• Loose stools with blood and mucus — the hallmark.
• Urgency to pass stool; sometimes incontinence.
• Lower abdominal cramps relieved by passing stool.
• Tiredness, low-grade fever, weight loss in flares.
• Occasional joint, eye, skin inflammation.
• Severe flares can cause many bloody bowel movements a day, dehydration, and anaemia.

Red flags — hospital

• Severe flare — 6 or more bloody stools a day with fever, fast heartbeat, or low haemoglobin.
• Severe belly distension or pain (toxic megacolon — emergency).
• Severe dehydration.

Diagnosis and India context

Colonoscopy with biopsies is the key test. Because intestinal TB can present with similar symptoms in Indian patients, a careful evaluation to distinguish UC from TB is essential before starting immune-suppressing treatment. Stool tests for infection also come first.

Treatment

• 5-ASA medicines — first-line for mild-to-moderate disease.
• Steroids for flares — short courses.
• Immunomodulators and biologics — for moderate-to-severe or treatment-resistant disease; increasingly available in India.
• Surgery (colectomy) — for severe disease that doesn't respond, or long-standing UC where cancer risk rises.
• Colon cancer surveillance — after 8-10 years of disease, regular colonoscopy is recommended because long-standing UC raises cancer risk.

Living with UC

• Take medicines even in remission — stopping commonly triggers a flare.
• Keep a flare-warning plan with your Health Expert.
• Reduce stress; regular exercise; don't smoke (smoking has complex effects — discuss).
• Iron, B12, vitamin D checks — deficiencies are common.
• Most women with UC can have healthy pregnancies with planning.