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What exactly is a

Ulcerative colitis?

Ulcerative colitis is one of the most common chronic inflammatory bowel diseases (IBD), which is characterized by inflammation and ulcers in the mucous membrane of the colon and rectum. It belongs to the group of inflammatory bowel diseases (IBD) and is regarded as an autoimmune disease in which the immune system mistakenly attacks the body’s own tissue. Typical symptoms are abdominal pain, diarrhea (often with blood), rectal bleeding, weight loss and fatigue. These often occur in episodes, alternating with phases of little or no discomfort.

About the symptoms
Patient mit colitis ulcerosa

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Important facts about ulcerative colitis

Symptoms and consequences of ulcerative colitis:

  • Abdominal pain and cramps (especially in the left lower abdomen)
  • Flatulence
  • Recurrent diarrhea, often with blood impurities
  • Urgent urge to defecate and tenesmus (painful, unproductive urge to defecate)
  • Rectal bleeding
  • Decreased appetite and weight loss
  • Tiredness and exhaustion
  • Fever (in severe cases)
  • Nausea and vomiting (in case of severe inflammation)

  • Growth disorders in children
  • Joint pain and inflammation (concomitant disease in some patients)
  • Skin rashes (concomitant disease in some patients)
  • Anemia (in case of chronic blood loss)

What is the course of ulcerative colitis?

Ulcerative colitis is a chronic disease that generally progresses in phases. In the relapse phases (or acute phases), acute inflammation occurs in the colon and rectum, accompanied by the symptoms mentioned (or only some of them). After the relapses, there may be phases in which the symptoms subside or disappear(remission phase). While some patients experience more severe flare-ups, some patients may have continuous, mild inflammation that is hardly manifested by acute flare-ups.

In some cases, potentially life-threatening complications can occur, such as intestinal perforation, intestinal bleeding, intestinal obstruction or the development of colon cancer. Appropriate medical care, regular check-ups and adherence to the treatment plan are important to monitor the course of the disease and prevent complications.

Patientin mit Darmerkrankung

What forms of ulcerative colitis are there?

There are various forms of ulcerative colitis, which differ depending on the extent and localization of the inflammatory changes in the colon:

  • Proctitis: This form only affects the rectum. This is the mildest and most common form of ulcerative colitis.
  • Left-sided colitis: In this form, the inflammation extends from the rectum to the left part of the large intestine (left colon). The sigmoid colon (S-loop), which is located at the end of the large intestine, is usually affected.
  • Extensive colitis: The entire large intestine is inflamed, from the rectum to the cecum. This is an extensive form of ulcerative colitis.
  • Pancolitis: This form affects the entire large intestine, including the rectum, colon and cecum. This is the most severe form of ulcerative colitis.

What are the causes of ulcerative colitis?

The causes of chronic inflammatory bowel disease are not fully understood. However, there are risk factors for inflammatory bowel disease in general, such as genetic predisposition, disorders of the intestinal mucosal barrier and disorders of the microbiome, as well as environmental factors that increase the likelihood of occurrence.

How is ulcerative colitis diagnosed?

The diagnostic procedure for chronic inflammatory bowel disease generally involves a combination of a detailed medical history, physical examinations, stool analysis, imaging procedures and endoscopy with biopsy. In order to differentiate ulcerative colitis from other intestinal diseases, such as Crohn’s disease, the following characteristics are examined:

Limited to the colon and rectum and continuous spread from the rectum

Coherent inflammation that affects the entire affected section of the intestine

Typically, only the inner mucous membrane of the intestine is affected (inflammation of the mucous membrane)

Untersuchung Bauchbereich

When can ulcerative colitis be considered acute?

If you have symptoms that indicate an acute flare-up, you should contact your doctor immediately.

Sudden worsening of symptoms

Increased signs of inflammation

Severe symptoms

What to do with ulcerative colitis?

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Treatment plan

Based on a precise diagnosis, an individual treatment plan is drawn up based on the severity, symptoms and state of health. This may include anti-inflammatory drugs, immunosuppressants and biologics, as well as dietary advice and lifestyle changes to improve health and the course of the disease. In severe cases, surgery may be required to remove the affected colon and rectum. Although there is no cure for ulcerative colitis, with appropriate treatment and ongoing medical care, most sufferers can lead an active and fulfilling life.

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Self-management and support

It is beneficial to maintain a healthy lifestyle, including sufficient exercise, stress management and smoking cessation. Involvement in self-help groups or online communities offers the opportunity to share experiences and provide mutual support. Regular follow-up examinations are also important to monitor the course of the disease and adjust treatment if necessary. The doctor offers information about the disease and psychological support.


Please note that all content provided regarding individual medical conditions, treatments, procedures, etc. is general information and may vary depending on the physician:in and individual case and initial situation.
For more detailed information, please always consult your doctor.

S3 guideline of the German Society for Gastroenterology, Digestive and Metabolic Diseases: Ulcerative colitis - Living Guideline (status: 2021)

Berufsverband Deutscher Internisten e.V.: Ulcerative colitis & its causes

Berufsverband Deutscher Internisten e.V.: Ulcerative colitis: Symptoms

Wehkamp, J. et al: Chronic inflammatory bowel diseases: Crohn's disease and ulcerative colitis. Dtsch Arztebl Int 2016; 113: 72-82