The cause is unknown, and it may affect any age group although there are peaks at ages 15 to 30 and then again at ages 50 to 70.

The disease usually begins in the rectal area and may eventually extend through the entire large bowel. Repeated episodes of inflammation lead to thickening of the wall of the intestine and rectum with scar tissue. Death of colon tissue or sepsis may occur with severe disease. The symptoms vary in severity and their onset may be gradual or sudden. Attacks may be provoked by many factors, including respiratory infections or stress.

Risk factors include a family history of ulcerative colitis or Jewish ancestry. The incidence is 10-15 out of 100,000 people.

• Diarrhea of between 10 and 25 times a day; blood and mucus may be present
• Abdominal pain and cramping that usually subsides after a bowel movement
• Abdominal sounds (borborygmus, a gurgling or splashing sound heard over the intestine)
• Fever
• Weight loss
• Stools - foul smelling
• Tenesmus

Additional symptoms that may be associated with this disease:

• Nausea and vomiting
• Joint pain
• Gastrointestinal bleeding

• Colonoscopy with biopsy
• Barium enema

The goals of treatment are to control the acute attacks, prevent recurrent attacks, and promote healing of the colon. Hospitalization is often required for severe attacks. Corticosteroids are prescribed to reduce inflammation.

Medical therapy options to decrease the frequency of attacks include 5-aminosalicylates (such as mesalamine) and immunomodulators (azathioprine, 6-mercaptopurine).

Surgery may be indicated in refractory disease. Removal of the colon is curative and removes the threat of colon cancer. Patients may have an ostomy or may have a procedure (ileal pouch anal anastomosis) to connect the small intestine to the anus and gain more normal bowel function.

The course of the disease varies with remissions and exacerbations over a period of years, or the disorder can present as a fulminant disease. A permanent and complete cure is unusual. The risk of colon cancer increases in each decade after the diagnosis.

• Perforation of the colon
• Carcinoma
• Massive colonic hemorrhage
• Colon stricture
• Inflammation of the joints
• Ankylosing spondylitis
• Lesions in the eye
• Mouth ulcers
• Liver disease
• Impaired growth and sexual development in children
• Pyoderma gangrenosum
• Complications of corticosteroid therapy

Call your health care provider if persistent abdominal pain, new or increased bleeding, or other symptoms of ulcerative colitis are present.

Call your health care provider if ulcerative colitis symptoms worsen or do not improve with treatment, or if new symptoms develop.

Because the cause is unknown, prevention is also unknown.

In patients with ulcerative colitis, nonsteroidal anti-inflammatory drugs (NSAID's) may exacerbate symptoms.

As a prevention strategy for the risk of colon cancer, surveillance colonoscopy is recommended after 8 years of disease.