Ulcerative colitis affects the rectum and variable amounts of the rest of the colon (the large bowel or intestine). The other main inflammatory bowel disease, Crohns disease, can affect any part of the digestive tract from the mouth to the anus. In around 10% of cases, it is not possible for doctors to distinguish between ulcerative colitis and Crohns disease. For more information, please see the separate BUPA fact sheet titled Crohns disease.

Approximately 1 in 100 people are affected by ulcerative colitis. The disease affects men and women equally and can develop at any age, but most commonly affects adults aged 20-40. It is not an infectious illness.

Symptoms of Ulcerative Colitis
The main symptom of ulcerative colitis is frequent, watery diarrhea, which may be accompanied by cramping abdominal pain and the passage of blood and/or mucus. When the disease affects only the rectum - the final portion of the bowel, it is known as proctitis. When ulcerative colitis affects more of the colon than the rectum alone, symptoms are more severe. The symptoms vary according to the degree of inflammation in the bowel and whether or not the lining of the bowel has become ulcerated. In addition to the symptoms already mentioned, there may also be:

• pain on opening the bowels
• urgent and frequent need to open the bowels
• the sensation of incomplete emptying of the bowels
• diarrhea, even during the night
• nausea
• loss of appetite
• weight loss
• extreme tiredness

A number of other problems may be associated with ulcerative colitis. These are more likely when the disease is active and include skin rashes, mouth ulcers, joint pains and anemia.
Ulcerative colitis is defined as mild, moderate or severe, according to the frequency of diarrhea, the presence of blood and how generally unwell the person is.


Nutrition Guidelines for Ulcerative Colitis

Good nutrition is an important part of managing Ulcerative Colitis (UC). Malnutrition may also cause people to feel more fatigued and some medications may not be as effective when nutritional status is depleted. People with Ulcerative Colitis may be at risk for developing malnutrition and nutrient deficiencies, which makes it more difficult for the body to heal and fight infection. With proper monitoring and attention to nutrition, these complications can often be avoided.
Here are a few reasons why people with UC may be at nutritional risk:
" Decreased food intake due to decreased appetite, pain, diarrhea, or other symptoms (or fear of these symptoms)
" Increased needs for calories, protein, and some vitamins and minerals
" Diarrhea or other fluid losses can lead to dehydration if not replaced
" Some medications prescribed for UC may affect appetite, taste sensation, or nutrient absorption
" Diet restrictions (which may or may not be necessary)

Diet
The recommended diet for UC is a balanced diet focusing on adequate calories, protein, vitamins, minerals, and fluid. No specific foods are known to trigger UC or make the disease worse. Therefore, there are no specific foods that must be avoided by all patients with UC. Some individuals may have their own food intolerances or notice that certain foods cause discomfort. In such cases, those foods should be avoided. Nutrition needs may vary from person to person depending on the status of their disease, thus it is best to meet with a dietitian who can help you individualize your diet to best meet your needs.

Calories and Protein
It is important to take in enough calories each day to maintain a healthy weight. Your calorie needs may be increased when you are acutely ill. Rapid, unintentional weight loss places you at risk for malnutrition.
The inflammation caused by UC may lead to increased protein needs. Inadequate protein intake may negatively affect healing and lead to muscle loss.
A dietitian can provide more specific guidelines for your individual calorie and protein needs, as well as provide you with more information on increasing calories and protein in the diet, if needed.

Fiber
Dietary fiber is an important component of a balanced, healthy diet. Fiber is broken down in the colon into short chain fatty acids. The colon uses these short chain fatty acids as an energy source. In people with Ulcerative Colitis, there is no need to limit the intake of dietary fiber. Likewise, it is not necessary to increase fiber intake above the recommended levels for the general population. Recommended daily dietary fiber intake is 15-25 grams. Trial and error is the best way to figure out what amount of fiber you are able to tolerate in your diet. The amount of fiber tolerated varies between individuals and may also vary with an individual during a UC flare.

Vitamins and Minerals
Calcium and vitamin D are nutrients important for healthy bones. Many adults do not take in enough of these nutrients. Patients with UC are especially at risk because dairy products (which are the main source of calcium and vitamin D) are often avoided. However, such avoidance is often not necessary (see the section below on lactose and dairy products for more information).

The medication sulfasalazine may decrease absorption of the nutrient folic acid. If you are on sulfasalazine, your physician or nutritionist may recommend folic acid supplements.

Patients with UC are at risk for iron deficiency due to possible blood loss from the colon. Iron levels can be measured by a blood test; supplements may be recommended if levels become low.
Your physician or dietitian may recommend additional vitamin and/or mineral supplements based on laboratory values or other information.

Other issues

Lactose and dairy products
Lactose is a sugar found in dairy products. Some adults have difficulty digesting lactose and dairy products due to low levels of the enzyme (lactase) needed to break down lactose in the small bowel. Symptoms include cramping, bloating, gas, and/or diarrhea after consuming dairy products.

Since digestion of lactose occurs in the small intestine (not the colon which is affected by UC), patients with UC do not have a higher incidence of lactose intolerance than the general population. Therefore, routine avoidance of dairy products is not needed.

If tolerated, dairy products can be a good source of nutrition for patients with UC.

If dairy products do cause discomfort, they should be avoided or eaten in smaller amounts as tolerated. In such cases, discuss your calcium and vitamin D intake with your physician or dietitian.

More information on lactose intolerance is available from the Digestive Health Center; ask your physician or dietitian for additional handouts if needed.


Stress and Ulcerative Colitis

Stress can worsen symptoms of ulcerative colitis. When a person experiences stress, the stomach empties more slowly and secretes more acids. Regular exercise, yoga, massage and meditation are just a few ways to reduce stress.


Patients with ulcerative colitis should eliminate any foods or beverages from their diet that seem to make symptoms worse. The following suggestions may help:

• Limit dairy products; some patients benefit from lactase-fortified products.
• Try low-fat foods.
• Experiment with foods high in fiber (fresh fruits, vegetables and whole grains).
• Eat small meals.
• Drink plenty of water.
• Talk to a dietitian.

Ulcerative Colitis and Pregnancy

It is suggested to wait until a woman's disease is in remission before becoming pregnant. Based on the general population, women with ulcerative colitis have about the same chance as women without it, of having a healthy baby. Women generally have normal pregnancies if they were in remission at the time of conception. But, becoming pregnant with the disease is active creates a chance of the symptoms getting worse. You will be treated for the ulcerative colitis to control your symptoms as much as possible.

There have been reports of ulcerative colitis starting during pregnancy. The disease does not become worse just because of when it occurred. Even if one of your pregnancies was complicated by ulcerative colitis, it doesn't necessarily mean your next one will. Also, with your fluctuating hormones and emotions, it's possible these factors may cause your symptoms to get worse.

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