Ulcerative colitis: ask an expert – a Crohn’s and Colitis Awareness Week Special

Written by: Dr Michael Mendall
Edited by: Cal Murphy

Ulcerative colitis is an inflammatory bowel disease that can make life miserable for patients. Due to the nature of the illness, it is often not talked about, and rarely gets the same kind of attention as other diseases. For Crohn’s and colitis Awareness Week, Top Doctors talked to expert gastroenterologist Michael Mendall, who answered all the questions you might have about UC.

What is Ulcerative Colitis

Ulcerative colitis (UC) is an unexplained inflammatory condition that just affects the colon – not other parts of the bowel like Crohn’s. It always starts at the lower part of the colon, involving the rectum, but can extend much further round the colon to involve the whole thing.


Top 3 symptoms of UC

  1. Ulcerative colitis virtually always presents with bloody diarrhoea. It is easy to diagnose because of that.
  2. Variable amounts of abdominal pain - the severity can vary greatly from being an inconvenience to being life-threatening. The reason for this is unknown. UC tends to be worse if it begins at a younger age, and you’ll often find that initial presentation can be most severe attack, but we don’t know why it varies so much.
  3. Joint pain/back pain

While the above three ulcerative colitis symptoms are the most common, problems with the eyes, skin and liver can also occur. It can make you anaemic, and by virtue of having it, it can make you feel depressed.


What causes UC?

We have no idea! It seemed to appear for the first time in modern times – in the 1930s and 40s, and no one is sure if it existed before that. It didn’t use to occur in developing countries, but now it is starting to appear there as well.

It’s twice as common as Crohn’s and it can be very difficult to distinguish between it and Crohn’s in some cases.


Ulcerative colitis treatments:

Treatment for ulcerative colitis greatly depends on the severity.

In less severe cases:

  • Mesalazine is often prescribed (as tablets or enemas)

In more severe cases:

  • Steroids may be recommended (as enemas or tablets)
  • Immunomodulatory drugs – tablets

Even more severe:

  • biologic drugs or anti-TNF drugs (as infusions or injections)
  • Anti-integrin medications (as infusions)
  • Ciclosporin is sometimes used.


There are also newer, more experimental treatments, such as faecal transplants, experimental surgeries, such as removing the appendix, and new drugs which modulate the immune system in a different way. Current thinking is that diet doesn’t play any role in ulcerative colitis.

At the end of the day UC can be cured by surgery to remove the whole colon. Nowadays, you can have an artificial rectum made so you don’t have to have a bag/colostomy.

If you are suffering from symptoms of an inflammatory bowel disease, see your doctor or a specialist.

By Dr Michael Mendall

Dr Michael Mendall is a renowned London-based gastroenterologist who qualified from Cambridge University. He has made a number of important contributions to his field of expertise. He is internationally recognised with nearly 100 peer reviewed publications. He was the first to show that Helicobacter pylori infection of the stomach is mainly caught in childhood, and, more recently, was the first to show that obesity can be a cause of Crohn's disease.

He specialises in endoscopy, inflammatory bowel disease, dyspepsia (indigestion) and IBS, among others, and has written extensively on the role of diet in Crohn's, about IBS, the treatment of dyspepsia and reflux and Helicobacter pylori infection. He is currently lead for gastroenterology at Croydon University Hospital, as well as a senior lecturer at St George's Medical School and a member of various medical organisations. He was named one of the top UK Consultants in the Tatler Guide 2013.

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