A 35 yoa male patient came for a treatment at my practice complaining of LBP. I didn’t feel comfortable to offer him a treatment because he reported blood in his stools 2 days ago. He also said that he was diagnosed with Ulcerative Colitis more than 10 years ago. My main concern was that his recent flare-up might have been caused by more sinister condition such as bowel cancer. I was also concerned about doing any HVT manipulations in case there were signs of osteoporosis due to the use of corticosteroids.

Therefore I suggested that he should make an appointment to see his GP as soon as possible.


Ulcerative colitis is a long-term condition where the colon and rectum become inflamed.

The colon is the large intestine (bowel), and the rectum is the end of the bowel where stools are stored.

Small ulcers can develop on the colon's lining, and can bleed and produce pus.

Symptoms of ulcerative colitis

The main symptoms of ulcerative colitis are:

  • recurring diarrhoea, which may contain blood, mucus or pus
  • tummy pain
  • needing to empty your bowels frequently

You may also experience fatigue (extreme tiredness), loss of appetite and weight loss.

The severity of the symptoms varies, depending on how much of the rectum and colon is inflamed and how severe the inflammation is.

For some people, the condition has a significant impact on their everyday lives.

Symptoms of a flare-up

Some people may go for weeks or months with very mild symptoms, or none at all (remission), followed by periods where the symptoms are particularly troublesome (flare-ups or relapses).

During a flare-up, some people with ulcerative colitis also experience symptoms elsewhere in their body.

For example, some people develop:

  • painful and swollen joints (arthritis)
  • mouth ulcers
  • areas of painful, red and swollen skin
  • irritated and red eyes

In severe cases, defined as having to empty your bowels 6 or more times a day, additional symptoms may include:

  • shortness of breath
  • a fast or irregular heartbeat
  • a high temperature (fever)
  • blood in your stools becoming more obvious

In most people, no specific trigger for flare-ups is identified, although a gut infection can occasionally be the cause. Stress is also thought to be a potential factor.

Find out more about living with ulcerative colitis

When to seek medical advice

You should see your GP as soon as possible if you have symptoms of ulcerative colitis and you have not been diagnosed with the condition.

They can arrange blood or stool sample tests to help determine what may be causing your symptoms.

If necessary, they can refer you to hospital for further tests.

Find out more about diagnosing ulcerative colitis

If you have been diagnosed with ulcerative colitis and think you may be having a severe flare-up, contact your GP or care team for advice.

You may need to be admitted to hospital.

If you cannot contact your GP or care team, call NHS 111 or contact your local out-of-hours service.

What causes ulcerative colitis?

Ulcerative colitis is thought to be an autoimmune condition. This means the immune system (the body's defence against infection) goes wrong and attacks healthy tissue.

The most popular theory is that the immune system mistakes harmless bacteria inside the colon for a threat and attacks the tissues of the colon, causing it to become inflamed.

Exactly what causes the immune system to behave in this way is unclear. Most experts think it's a combination of genetic and environmental factors.

Find out more about the causes of ulcerative colitis

Who's affected

It's estimated around 1 in every 420 people living in the UK has ulcerative colitis. This amounts to around 146,000 people.

The condition can develop at any age, but is most often diagnosed in people aged from 15 to 25 years old.

It's more common in white people of European descent, especially those descended from Ashkenazi Jewish communities, and black people.

The condition is rarer in people from Asian backgrounds, although the reasons for this are unclear.

Both men and women seem to be equally affected by ulcerative colitis.

How ulcerative colitis is treated

Treatment for ulcerative colitis aims to relieve symptoms during a flare-up and prevent symptoms from returning (maintaining remission).

In most people, this is achieved by taking medication such as:

Mild to moderate flare-ups can usually be treated at home. But more severe flare-ups need to be treated in hospital.

If medications are not effective at controlling your symptoms or your quality of life is significantly affected by your condition, surgery to remove your colon may be an option.

During surgery, your small intestine will either be diverted out of an opening in your abdomen (an ileostomy), or used to create an internal pouch that's connected to your anus called an ileo-anal pouch.

Find out more about treating ulcerative colitis

Complications of ulcerative colitis

Complications of ulcerative colitis include:

  • primary sclerosing cholangitis – where the bile ducts inside the liver become damaged
  • an increased risk of developing bowel cancer
  • poor growth and development in children and young people

Also, some of the medications used to treat ulcerative colitis can cause weakening of the bones (osteoporosis) as a side effect.

Find out more about the complications of ulcerative colitis


Inflammatory bowel disease (IBD) is a term mainly used to describe 2 conditions that cause inflammation of the gut (gastrointestinal tract).

They are:

IBD should not be confused with irritable bowel syndrome (IBS), which is a different condition and requires different treatment.


NHS Health A to Z (2019) “Ulcerative Colitis” Available online at: <> Accessed on 26th July 2019