Inflammation of the colon causing bloody diarrhoea and urgency. Calprotectin is the test that separates it from IBS.
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Ulcerative colitis is a lifelong inflammatory bowel disease affecting the large bowel. The inflammation starts at the rectum and extends continuously upwards, and it affects only the inner lining rather than the full thickness of the bowel wall.
It runs in flares and remissions. People can be entirely well for long periods and then have weeks of frequent, bloody, urgent diarrhoea.
The defining symptom is blood. That is what most reliably separates it from IBS, and it is why rectal bleeding should never be waved through as haemorrhoids in someone with a change in bowel habit.
Two things are unusual and worth knowing. Smoking appears to be mildly protective in ulcerative colitis, which is the opposite of Crohn's — and is emphatically not a reason to smoke. And because the disease is confined to the colon, surgery to remove the colon is potentially curative, which is not true of Crohn's.
Ulcerative colitis is not confined to the gut, and these are often what prompts the diagnosis:
The cause is not fully understood. It appears to be an abnormal immune response to the gut's own bacteria in someone genetically predisposed.
Smoking is associated with a lower risk of ulcerative colitis, and some people develop it after stopping. This is genuinely established, and it is the opposite of Crohn's disease.
It is not a reason to smoke or to restart. The cardiovascular and cancer risks vastly outweigh any effect on the colon, and no responsible clinician would trade one for the other.
Diet and stress do not cause ulcerative colitis, though both can affect how you feel during a flare. People are frequently made to feel responsible for a disease they did not bring on.
Faecal calprotectin. It is a stool test measuring inflammation in the bowel, and it is what distinguishes inflammatory bowel disease from IBS — which is the single most important fork in the road here.
A low result makes IBD very unlikely; a raised result warrants referral for endoscopy. NICE supports its use for exactly this purpose, and it avoids a great many unnecessary colonoscopies while catching the people who need one.
Diagnosis is made by colonoscopy with biopsies, which shows the continuous inflammation and how far up the colon it extends. Stool cultures are done first to exclude infection.
In a severe flare, a plain abdominal X-ray is used to look for toxic dilatation of the colon.
We have marked this as not treatable online, and that is honest. Ulcerative colitis is diagnosed by colonoscopy and managed by gastroenterology, often with immunosuppressants and biologic drugs that require specialist initiation and monitoring. No remote GP service should be managing it.
We will not prescribe loperamide for diarrhoea in a suspected or known colitis flare. Slowing the bowel in acute severe colitis risks toxic megacolon, which is a surgical emergency.
A prescription is never guaranteed. This page is information, not an offer to supply.
Acute severe colitis is a medical emergency and it is under-recognised. Seek same-day hospital assessment for:
Ulcerative colitis cannot be prevented, and nothing you did caused it. What follows is about living with it well.
This is the single most important thing. Maintenance aminosalicylates reduce flares and are also associated with a lower risk of bowel cancer. People commonly stop them when they feel fine, and that is when flares return.
There is no diet that treats ulcerative colitis, and restrictive diets adopted in desperation often cause more harm than good. During a flare, lower-fibre foods are often more comfortable. Between flares, eat normally.
Watch for iron, B12 and vitamin D deficiency, which are common and treatable.
Ulcerative colitis belongs on the NHS and we will say so plainly. Colonoscopy, gastroenterology follow-up, IBD specialist nurses, biologic drugs and surgery are all provided free, and biologics in particular are simply not available outside specialist NHS or private hospital pathways.
IBD specialist nurse helplines are one of the most valuable things the NHS provides here — direct access during a flare, without going through a GP. If you have a diagnosis and do not know your team's number, get it.
Anyone on medication for it may be entitled to free NHS prescriptions in England via a medical exemption certificate if they meet the criteria; NHS prescriptions are free in Wales.
Where private care genuinely adds something:
This page follows NICE NG130 on ulcerative colitis: management, including the approach to inducing and maintaining remission and the emphasis on continuing maintenance therapy.
The role of faecal calprotectin in distinguishing inflammatory bowel disease from irritable bowel syndrome follows NICE DG11, and it is highlighted here because it is the decision point that most often determines how quickly someone is diagnosed.
The acute severe colitis red flags reflect the Truelove and Witts criteria used in UK practice, and the caution against antimotility agents such as loperamide in acute colitis reflects the recognised risk of toxic megacolon.
Colonoscopic surveillance for colorectal cancer follows NICE CG118, with the interval determined by disease extent and duration.
Blood is the main thing. IBS does not cause rectal bleeding, does not wake you at night, and does not cause weight loss or fever. A faecal calprotectin test settles it, and it is the test to ask for.
No. Ulcerative colitis affects only the colon, continuously, and only the lining. Crohn's can affect anywhere from mouth to anus, in patches, through the full bowel wall.
Surgery to remove the colon is potentially curative, which is not the case in Crohn's. Medication controls it rather than curing it, and most people never need surgery.
No — this is the commonest reason flares return. Maintenance treatment prevents flares and is linked to lower bowel cancer risk. Discuss any change with your team rather than stopping.
Smoking is associated with a lower risk of ulcerative colitis, and that is genuinely established — but it is not a treatment and it is not advice. The overall harm is not remotely worth it.
Yes, with long-standing extensive disease — which is exactly why surveillance colonoscopy is offered from around 8 to 10 years after diagnosis. Attending those is one of the most useful things you can do.
No. Neither causes ulcerative colitis, though both can affect how you feel. You did not bring this on yourself.
September 8, 2026
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Twenty unhurried minutes and a comprehensive assessment. A written treatment plan is included, along with any prescription, sick note or referral letter arising from the consultation, at no extra charge.
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It means the diagnosis can usually be made from your history and photographs, and that treatment can be arranged safely without examining you. Where a condition is not marked treatable online, it is because examination is the diagnosis — listening to a chest, feeling an abdomen, examining an ear or a joint — or because a procedure or device is needed.
Yes, where there is a genuine bacterial infection — cellulitis, impetigo, bacterial urine infections, confirmed strep throat. We will also frequently tell you that you do not need one. Most sore throats, coughs, colds and earaches are viral, and an antibiotic gives you the side effects with none of the benefit.
If your problem turns out to be genuinely outside what we can do remotely, the doctor will tell you straight away, point you to the right service, and refund your fee in full. We would rather do that than fill twenty minutes to justify the charge.
Call 999 or go to A&E — do not book an online appointment and do not wait for a reply to an email. For urgent problems that are not emergencies, NHS 111 is available 24 hours a day, online or by phone, and can direct you to the right service.
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