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Children's Health System - Alabama

Children's of Alabama
Healthcare as amazing as their potential
www.childrensal.org
1600 7th Avenue South
Birmingham, AL 35233
(205) 638 - 9100


Ulcerative Colitis

What Is Ulcerative Colitis?

Ulcerative colitis causes the inner lining of the large intestine (colon) to get red and swollen with sores called ulcers. It's a chronic condition, which means it lasts a long time or constantly comes and goes.

Ulcerative colitis is a type of inflammatory bowel disease (IBD) that happens only in the colon.

What Are the Signs & Symptoms of Ulcerative Colitis?

The most common symptoms of ulcerative colitis are cramping belly pain and diarrhea. Other symptoms include:

  • blood in the toilet, on toilet paper, or in the stool (poop)
  • urgent need to poop
  • a fever
  • low energy
  • weight loss

Ulcerative colitis can cause other problems, such as rashes, eye problems, joint pain and arthritis, and liver disease. Kids with ulcerative colitis may not grow as well as other kids their age and puberty may happen later than normal.

What Causes Ulcerative Colitis?

The exact cause of ulcerative colitis is not clear. It is probably a combination of genetics, the immune system, and something in the environment that causes inflammation in the gastrointestinal tract. Diet and stress may make symptoms worse, but probably don't cause ulcerative colitis.

Ulcerative colitis tends to run in families. But not everyone with ulcerative colitis has a family history of ulcerative colitis or IBD. Ulcerative colitis can happen at any age, but is usually diagnosed in teens and young adults.

How Is Ulcerative Colitis Diagnosed?

Doctors diagnose ulcerative colitis with a combination of blood tests, stool (poop) tests, and X-rays. They will check stool samples for blood. They also might do imaging tests, such as CT scans and MRI. 

Doctors can look at the colon using an endoscope, a long, thin tube with a camera attached to a TV monitor:

  • In a colonoscopy, the tube goes in through the anus.
  • In an upper endoscopy, the tube passes down the throat.

The doctor can see inflammation, bleeding, or ulcers in the esophagus, stomach, small intestine and on the wall of the colon. During the procedure, the doctor might do a biopsy, taking small tissue samples for testing in a lab.

How Is Ulcerative Colitis Treated?

Ulcerative colitis is treated with medicines and sometimes surgery. The goal of treatment is to relieve symptoms, prevent other problems and flare-ups, and possibly heal the intestines.

The doctor may recommend:

  • anti-inflammatory drugs to ease inflammation
  • immunosuppressive agents to prevent the immune system from causing more inflammation
  • biologic agents to block proteins that cause inflammation

Because some medicines make it harder to fight infections, it's important that your child be tested for tuberculosis and have all the recommended vaccines before starting treatment.

Poor appetite, diarrhea, and poor digestion of nutrients can make it hard for people with ulcerative colitis to get the calories and nutrients the body needs. Kids and teens should eat a variety of foods, get plenty of fluids, and learn to avoid foods that make symptoms worse. Some may need supplements, like calcium or vitamin D. Kids who are not growing well may need special formulas to boost calories and nutrition.

Surgery may be necessary if:

  • the bowel develops a hole
  • the bowel widens and swells up (called toxic megacolon) 
  • the bleeding can't be stopped
  • symptoms don't respond to treatment

What Else Should I Know?

People with ulcerative colitis are at risk for colon cancer, which is related to chronic inflammation. So they should get a colonoscopy every 1-2 years, starting about 10 years after diagnosis.

Kids and teens with ulcerative colitis may feel different and not be able to do the things their friends can do, especially during flare-ups. Some struggle with a poor self-image, depression, or anxiety. They may not take their medicine or follow their diet. It's important to talk to the doctor or a mental health provider if you're concerned about your child's mood, behavior, or school performance.

Parents can help teens take on more responsibility for their health as they get older. Encourage teens to take their medicine, take care of themselves, and manage stress in positive ways. Yoga, meditation, breathing and relaxation techniques, music, art, dance, writing, or talking to a friend can help.

You also can find more information and support online at:

Reviewed by: J. Fernando del Rosario, MD
Date reviewed: January 2022