Ulcerative Colitis: Causes, Symptoms, and Treatment
Medically reviewed by Sumiran Racherla, MD, Internal Medicine. Last reviewed: October 23, 2026.
What kind of doctor treats Ulcerative Colitis?
A gastroenterologist, a doctor who treats diseases of the digestive system, usually treats ulcerative colitis. A colorectal surgeon, a surgeon who operates on the colon and rectum, may help if surgery is needed. A direct primary care or concierge doctor can be a first stop for an evaluation and can refer you to a specialist when needed.
What is ulcerative colitis?
Ulcerative colitis is a disease that causes inflammation in the large intestine. Inflammation means swelling and irritation. Abnormal reactions of the immune system, the body's defense system, lead to it.
Most people need lifelong treatment with medicines. The exception is people who have surgery to remove the colon and rectum.
Symptoms
Symptoms are different from person to person. Common symptoms include:
- Diarrhea.
- Passing blood with your stool, or rectal bleeding.
- Cramping and pain in the belly.
- Passing mucus or pus with your stool.
- Tenesmus, a constant urge to have a bowel movement even when your bowel may be empty.
- An urgent need to have a bowel movement.
Mild symptoms may mean fewer than four bowel movements a day, with blood sometimes. Severe symptoms may mean more than six a day, with blood most of the time.
Tiredness, fever, nausea or vomiting, and weight loss are more likely when the disease is more severe.
Remission is a time when symptoms disappear. It can last for weeks or years. After that, you may have a relapse, which is a return of symptoms.
Causes and who gets it
Doctors are not sure what causes ulcerative colitis. Experts think these may play a role:
- Genes. Ulcerative colitis sometimes runs in families.
- Abnormal immune reactions, which lead to inflammation in the large intestine.
- The microbiome, which is the bacteria, viruses, and fungi in your gut that help with digestion.
- The environment around you.
Researchers are still studying how they work together.
How doctors diagnose it
Doctors review your medical and family history. They do a physical exam and order tests. A rectal exam can check for blood in your stool. These steps confirm the diagnosis and show how severe it is. They also rule out other problems, such as infections or Crohn's disease.
Doctors may use blood tests, stool tests, and endoscopy. Blood tests check for anemia, a low red blood cell count. Stool tests check for infections. In an endoscopy, the doctor uses a thin tube with a light and a tiny camera. It shows the lining of the large intestine. Colonoscopy views the rectum and the whole colon. Flexible sigmoidoscopy views the rectum and lower colon.
Treatment
Doctors treat ulcerative colitis with medicines and surgery, based on how severe it is. Doctors most often treat severe disease in a hospital.
Medicines reduce inflammation and help bring on and keep remission. They include:
- Aminosalicylates, for mild or moderate disease and to help people stay in remission.
- Corticosteroids, also called steroids, for moderate to severe disease. They are not usually used long term because of serious side effects.
- Immunosuppressants, for moderate to severe disease.
- Biologics, for moderate to severe disease.
- A newer small molecule medicine. It is for adults with moderate to severe disease who do not respond to other medicines or have severe side effects from them.
Surgery may be advised for colorectal cancer, life-threatening complications, or symptoms that medicines do not help. Surgeons usually remove the colon and rectum. One operation makes an internal pouch from the end of the small intestine. Another is an ileostomy, in which stool leaves through an opening in the belly into a bag.
Talk with your doctor before taking any over-the-counter medicine.
When to see a doctor
Common symptoms include diarrhea, blood in your stool, and belly pain. See a doctor if you have them. If you have this disease and medicines do not help your symptoms, talk with your doctor. Surgery may be an option.
Some complications are life-threatening, such as severe rectal bleeding or a hole in the large intestine. Call 911 or go to the emergency room for severe rectal bleeding, bleeding that will not stop, severe belly pain or pressure, or fainting.
How a direct primary care or concierge doctor fits in
A direct primary care doctor charges a flat monthly fee instead of billing insurance, while a concierge doctor usually charges more and often works alongside insurance. Either kind of doctor can review your symptoms and history. They can order first blood and stool tests and refer you to a gastroenterologist. They can also coordinate your care over time.
Common questions
Do people with ulcerative colitis need medicine for life?
Usually, yes. People with ulcerative colitis typically need lifelong treatment with medicines unless they have surgery to remove the colon and rectum.
What causes ulcerative colitis?
Doctors are not sure what causes it. Experts think genes, abnormal immune reactions, the microbiome, and the environment may play a role.
Can ulcerative colitis symptoms go away?
Yes, symptoms can disappear during remission, which can last for weeks or years. After remission, symptoms can return in a relapse.
Should people with ulcerative colitis take NSAIDs for pain?
No, people with ulcerative colitis should avoid NSAIDs for pain because these medicines can make symptoms worse. NSAIDs are a group of pain medicines. For mild pain, doctors may recommend acetaminophen instead.
Sources
- National Institute of Diabetes and Digestive and Kidney Diseases - Diagnosis of Ulcerative Colitis
- National Institute of Diabetes and Digestive and Kidney Diseases - Symptoms & Causes of Ulcerative Colitis
- National Institute of Diabetes and Digestive and Kidney Diseases - Treatment for Ulcerative Colitis
Medical Disclaimer
This content is for general educational and informational purposes only and is not medical advice. It is not a substitute for professional medical advice, diagnosis, or treatment, and reading it does not create a doctor-patient relationship. Always seek the advice of your physician or another qualified health provider with any questions about a medical condition, and never disregard or delay seeking professional advice because of something you read here. If you think you may have a medical emergency, call 911 (or your local emergency number) immediately.
