Ulcerative Colitis – Patient Education

1. What It Is

Ulcerative colitis (UC) is a long-term disease that causes swelling (inflammation) and sores (ulcers) in the inside lining of your large intestine (colon) and rectum.
It happens when your immune system attacks the healthy lining of your colon by mistake. UC comes and goes — you may have times when symptoms are better (remission) and times when symptoms get worse (flare-ups).

2. Causes and Risk Factors

The exact cause is unknown, but it may be due to a mix of immune system problems, genetics, and environmental triggers.
You may have a higher risk if:

• A family member has UC or another inflammatory bowel disease (IBD).
  
  

• You are between ages 15–30 or 50–70.
  
  

• You are White or of Jewish descent.
  
  

• You eat a diet high in processed foods and low in fiber.
  
  

• You have frequent infections or a history of gut bacteria imbalance.
  
  

3. Signs and Symptoms (Including Early Warning Signs)

Early warning signs:

• Loose stools more often than usual.
  
  

• Blood in stool.
  
  

• Feeling tired or weak without reason.
  
  

Other common symptoms:

• Frequent diarrhea, often with blood or mucus.
  
  

• Belly pain or cramping.
  
  

• Needing to go to the bathroom urgently.
  
  

• Weight loss.
  
  

• Fever during flares.
  
  

• Feeling very tired (fatigue).
  
  

4. Complications If Untreated or Not Following Care Plan

If UC is not treated or if you do not follow your doctor’s plan, it can cause:

• Severe blood loss (anemia).
  
  

• Dehydration.
  
  

• Holes (perforations) in the colon.
  
  

• Severe swelling that may require surgery.
  
  

• Higher risk of colon cancer over time.
  
  

• Malnutrition.
  
  

• Hospitalization for severe flares.
  
  

5. Treatment and Self-Care Measures

Medical Treatments:

• Aminosalicylates (5-ASA drugs): Reduce inflammation (e.g., mesalamine, sulfasalazine).
  
  

  • Side effects: Headache, nausea, rash.
    
    

• Corticosteroids: Used short-term to quickly control inflammation during a flare (e.g., prednisone).
  
  

  • Side effects: Weight gain, high blood sugar, mood changes, weaker bones.
    
    

• Immunosuppressants: Calm the immune system (e.g., azathioprine, cyclosporine).
  
  

  • Side effects: Increased infection risk, nausea.
    
    

• Biologic therapies: Target specific immune system parts (e.g., infliximab, adalimumab).
  
  

  • Side effects: Injection/infusion reactions, infection risk.
    
    

• Antidiarrheal and pain medicines: For symptom relief — only use as your doctor advises.
  
  

Self-Care:

• Take medicines exactly as prescribed, even when feeling better.
  
  

• Keep follow-up appointments and lab tests.
  
  

• Watch for and report side effects early.
  
  

6. Dietary Needs

• Eat small, frequent meals.
  
  

• Stay hydrated — aim for at least 8 glasses of water per day.
  
  

• Limit high-fat, greasy foods.
  
  

• Avoid foods that worsen symptoms — for some people, this may include dairy, raw vegetables, beans, caffeine, alcohol, or spicy foods.
  
  

• During a flare:
  
  

  • Choose low-fiber, bland foods.
    
    

  • Avoid whole grains, nuts, and seeds.
    
    

7. Lifestyle Changes

• Reduce stress (deep breathing, gentle exercise, meditation).
  
  

• Quit smoking if you smoke.
  
  

• Get enough rest and sleep.
  
  

• Keep a symptom and food diary to find triggers.
  
  

8. Safety Considerations

• UC can cause dehydration — watch for dizziness, dry mouth, or dark urine.
  
  

• Long-term steroid use can weaken bones — get bone density checks if advised.
  
  

• Increased infection risk with certain medications — wash hands often and avoid sick contacts.
  
  

9. Prevention and Maintenance Tips

• Take medicines daily as prescribed.
  
  

• Keep regular doctor visits.
  
  

• Get colon cancer screening as recommended.
  
  

• Get vaccines your doctor suggests (especially before starting immune-suppressing drugs).
  
  

• Manage stress and avoid known food triggers.
  
  

When to Call for Help

Call Your Home Health Agency or Doctor If:

• You have diarrhea more than 6 times in 24 hours.
  
  

• You see blood or mucus in your stool for more than 2 days.
  
  

• You have a low-grade fever (100–101°F) that lasts more than 24 hours.
  
  

• You have new or worsening belly pain.
  
  

• You lose more than 2–3 pounds in a week without trying.
  
  

• You notice side effects from your medications.
  
  

Go to the Emergency Room or Call 911 If:

• You have severe belly pain that does not go away.
  
  

• You have a high fever (over 102°F).
  
  

• You pass large amounts of blood in stool or feel faint/dizzy.
  
  

• You have trouble breathing or chest pain.
  
  

• You cannot keep fluids down for more than 24 hours.
  
  

© 2025 Judith Regan / K.N.O.W. – Knowledge for Nurturing Optimal Well-Being. All rights reserved. | Educational use only | Not a substitute for medical advice | In emergencies call 911

Patient Homework / Assessment

Instructions: Read each statement below and write “True” if correct, or “False” if wrong. If false, correct the statement so it is true.

1. True or False: Ulcerative colitis only affects the small intestine.
   
   

2. True or False: Blood in the stool can be an early sign of ulcerative colitis.
   
   

3. True or False: UC is caused by the immune system attacking the colon by mistake.
   
   

4. True or False: Eating greasy fast food can sometimes trigger flare-ups.
   
   

5. True or False: UC can increase the risk of colon cancer over time.
   
   

6. True or False: You should stop taking your medicine when you feel better.
   
   

7. True or False: Staying hydrated is important to prevent complications.
   
   

8. True or False: UC can be cured with antibiotics.
   
   

9. True or False: Some people may need surgery if medicines do not work.
   
   

10. True or False: Keeping a food diary can help find trigger foods.
    
    

11. True or False: Low-fiber foods may be helpful during a flare.
    
    

12. True or False: Fever and belly pain should be reported to your doctor.
    
    

13. True or False: Steroid medicines can weaken your bones if taken long-term.
    
    

14. True or False: Stress has no effect on UC symptoms.
    
    

15. True or False: Skipping colon cancer screening is safe for UC patients.
    
    

16. True or False: Aminosalicylates are used to reduce inflammation in UC.
    
    

17. True or False: Severe blood loss from UC may require hospitalization.
    
    

18. True or False: Caffeine and alcohol can make UC symptoms worse in some people.
    
    

19. True or False: Regular follow-up visits are important even in remission.
    
    

20. True or False: Dehydration is not a problem in UC.
    
    

Individualized Patient Questions

(For discussion with patient to personalize their care plan)

1. What symptoms do you notice before your UC flares up?
   
   

2. Have you found any foods that seem to trigger your symptoms?
   
   

3. What medicines are you currently taking for UC?
   
   

4. Do you take your UC medications every day, even when you feel well?
   
   

5. Have you experienced any side effects from your medications?
   
   

6. How often do you have bowel movements during a flare?
   
   

7. Have you had any recent blood work? What did your doctor say about the results?
   
   

8. Are you currently anemic or have you been told your iron is low?
   
   

9. Do you drink enough fluids each day? What kinds?
   
   

10. How do you manage stress in your daily life?
    
    

11. Have you had a colonoscopy in the past year or as recommended?
    
    

12. Do you smoke or drink alcohol?
    
    

13. Have you noticed weight changes recently?
    
    

14. Do you know what to do if you have severe bleeding or dehydration?
    
    

15. Do you have a support person who knows about your UC care plan?