Ulcerative Colitis
Ulcerative colitis is an inflammatory bowel disease of the large bowel lining, starting at the rectum and spreading upwards. It causes bloody diarrhoea and urgency in flares. Most people do well with medicines that keep it quiet, and surgery can cure it if needed.
Symptoms
- Diarrhoea with blood or mucus, urgency, and needing to go at night
- Cramping tummy pain, tiredness, low iron
- Joint pain, red eyes, skin rashes or liver problems (PSC) in some
Go to hospital the same day with 6 or more bloody stools a day plus fever, a racing heart, feeling very unwell, or a swollen tender tummy. This can be acute severe colitis, which needs urgent treatment.
Diagnosis
- Bloods, faecal calprotectin and stool tests for infection
- Colonoscopy with biopsies confirms it and shows how much bowel is involved
Treatment
Usually led by a gastroenterologist, with your GP.
- Step 1 · Mild to moderateMesalazine (5-ASA): tablets plus suppositories or enemasRectal treatment works fast for rectal and left-sided disease; combining both works best.
- Works
- Induces and keeps remission in most people with mild to moderate UC
- Cost
- $25 PBS script
- How long
- Long term
- Watch for
- Rarely kidney problems: yearly kidney blood test.
The enema isn’t glamorous. It is effective.
- Step 2 · FlaresSteroids: budesonide MMX or prednisoloneShort courses only.
- Works
- Settle most flares
- Cost
- Low cost
- How long
- Weeks
- Watch for
- Not for long-term use.
- Step 3 · MaintenanceAzathioprine or mercaptopurineWhen steroids are needed too often.
- Works
- Keep remission in many
- Cost
- $25 PBS script
- How long
- Long term
- Watch for
- Blood monitoring.
- Step 4 · SpecialistBiologics and small-molecule tablets: infliximab, adalimumab, golimumab, vedolizumab, ustekinumab, mirikizumab, tofacitinib, upadacitinib, ozanimod and othersFor moderate to severe disease.
- Works
- Many reach remission
- Cost
- PBS-subsidised for eligible people
- How long
- Long term
- Watch for
- Infection risk; screening first.
- Step 5 · SurgeryRemoving the large bowel (colectomy)For disease that won’t respond, emergencies or cancer risk. Often with an internal pouch.
- Works
- Cures the colitis
- Cost
- Public or private
- How long
- One-off, sometimes staged
- Watch for
- Pouch problems, more frequent bowel motions.
Costs are rough Australian prices and vary by pharmacy and provider. PBS co-payment: $25, or $7.70 with a concession card. Results are typical figures from trials, not promises.
Long term
- Bowel cancer risk rises after about 8 years of widespread colitis: regular surveillance colonoscopies
- Vaccines and bone health checks on immune-lowering treatment
- Smoking seems to protect against UC, oddly, but the harms far outweigh it
Common questions
What is ulcerative colitis?
An inflammatory bowel disease affecting the lining of the large bowel, continuously from the rectum upwards. It causes bloody diarrhoea, urgency and cramps in flares.
What is the first treatment for ulcerative colitis?
For mild to moderate disease, mesalazine tablets plus suppositories or enemas. Steroids are used short term for flares, and other medicines for more severe disease.
Can ulcerative colitis be cured?
Surgery to remove the large bowel cures the colitis. Most people instead manage well long term with medicines.
Helpful resources
- Crohn’s & Colitis AustraliaInformation, support and helpline. Free.
Evidence and more information
- Crohn’s & Colitis Australia: About IBD
- Raine T et al. ECCO guidelines on therapeutics in ulcerative colitis (2022)
maladywise.com/ulcerative-colitis/