Ulcerative Colitis:
Your Questions Answered (FAQ)

A: Ulcerative colitis is a chronic inflammatory bowel disease that affects the inner lining of the rectum and colon. It causes inflammation, small ulcers, and symptoms such as bloody diarrhoea, urgency and abdominal pain. Most people are diagnosed as young adults, typically between 20 and 40. ¹

A: Yes. Ulcerative colitis is considered an autoimmune condition. ¹ The immune system mistakenly attacks the healthy lining of the colon, which causes long-term inflammation. It cannot be passed from person to person.

A: The exact cause of ulcerative colitis (UC) is not fully understood. It is thought to be a mix of genetic risk, gut bacteria, environmental factors and an immune system that overreacts. Having a close relative with UC or Crohn's disease increases your risk. ¹²

A: ulcerative colitis (UC) is not caused by any single trigger. However, once you have UC, flares can be triggered by infections, some medications (such as non-steroidal anti-inflammatories), stress, and stopping your UC medication too early. Stress does not cause UC but can make 
symptoms worse. ¹

There is no medical cure for ulcerative colitis. ¹ However, treatments today can control inflammation, heal the bowel lining, and keep many people in long-term remission. Surgery to remove the colon is sometimes called a "surgical cure" because it removes the affected organ. ³

Ulcerative colitis affects only the rectum and colon and causes continuous inflammation of the inner lining. ¹ Crohn's disease can affect any part of the digestive tract, in patches, and can go through the full thickness of the bowel wall. Both are types of inflammatory bowel disease.²

A: No. Ulcerative colitis (UC) and irritable bowel syndrome (IBS) are different conditions. UC causes visible inflammation, ulcers and bleeding. IBS does not cause inflammation or bowel damage, though symptoms like diarrhoea and pain can overlap. ¹

A: No. Ulcerative colitis is not contagious. ¹ You cannot catch it from another person through food, physical contact, or sexual contact.

A: Ulcerative colitis (UC) is diagnosed using a combination of medical history, blood and stool tests, and a colonoscopy with biopsy. ⁶ No single test confirms UC on its own. Your doctor will also rule out infections and other causes of inflammation.

A: Faecal calprotectin is a protein released into the stool when the bowel lining is inflamed. A simple stool sample can show whether inflammation is present in the gut, which helps your doctor decide if further tests or treatment changes are needed. ⁶

A: A colonoscopy is a procedure where a flexible tube with a small camera is gently passed into the colon. ⁶ The doctor looks at the lining of the bowel and takes small tissue samples (biopsies). Most colonoscopies in ulcerative colitis are done with sedation and take 20 to 40 minutes.

A: The Mayo Endoscopic Score is a scoring system used by doctors to describe how inflamed the colon looks on a colonoscopy in ulcerative colitis. It ranges from 0 (normal) to 3 (severe inflammation with spontaneous bleeding and ulceration). A score of 0 or 1 is usually considered endoscopic remission. ⁷

A: No, a blood test alone cannot diagnose ulcerative colitis. ⁶ Blood tests can show inflammation (CRP, ESR), anaemia, or low iron levels, but ulcerative colitis is confirmed on colonoscopy and biopsy.

A: A ulcerative colitis diagnosis can take a few weeks to several months. The time depends on how quickly symptoms appear, local access to colonoscopy, and whether other conditions need to be ruled out. Bring a symptom diary to appointments to help your doctor decide on tests quickly.

A: Ulcerative colitis (UC) treatment includes aminosalicylates (5-ASAs), corticosteroids, immunomodulators, biologics, small molecule therapies and surgery.⁵⁹ The choice depends on how severe your UC is, how much of the colon is affected, and how you respond. Some people use a combination over time.⁵

A: Biologics are medicines made from living cells that target specific proteins driving inflammation in ulcerative colitis (UC).⁹ They are used for moderate to severe UC, or when other treatments have not worked. The main classes used in UC include anti-TNF, integrin inhibitors, and interleukin (IL-12/23 and IL-23) inhibitors.⁷¹⁰

A: Biologics are complex medicines made from living cells. A biosimilar is a highly similar version of an existing biologic approved after the original's patent ends. Biosimilars are tested to ensure they work and are safe in the same way as the original biologic, often at a lower cost.¹¹⁹

A: Your doctor may suggest switching biologics if your current treatment is not working well enough, if you have lost response over time, or if you are having side effects. ⁷ The decision is based on blood tests, drug levels, faecal calprotectin and colonoscopy findings — not just how you feel.

A: Small molecule therapies, including JAK inhibitors, are ulcerative colitis (UC) medicines taken as tablets. ⁹ They work inside immune cells to block the signals that drive inflammation. They are an option for moderate to severe UC, often when biologics have not worked.

A: Most people with ulcerative colitis (UC) do not need surgery. ³ Surgery is considered when medication cannot control inflammation or when complications develop. The most common operation removes the colon (colectomy). Because UC only affects the colon, removing it is sometimes described as a surgical cure.

A: There is no strong scientific evidence that homeopathic remedies can treat ulcerative colitis (UC). ¹ Some lifestyle habits (a balanced diet, stress management, exercise, and quitting smoking) can support your treatment plan. Always tell your doctor before starting any herbal supplement, as some can interact with UC medicines.

A: There is no single diet that cures or causes ulcerative colitis. ¹³ What you eat can still affect how you feel during flares and remission. A dietitian with IBD experience can help you build a plan that fits your culture and lifestyle.

A: There is no universal list of foods to avoid with ulcerative colitis. Many people find that high-fibre foods, spicy food, dairy, and very fatty food are harder to tolerate during a flare. Keep a food diary to spot your personal triggers.¹³

A: Alcohol is not banned in ulcerative colitis (UC), but it can irritate the bowel and interact with some UC medications. ¹³ Many people find beer and sugary mixers are the hardest to tolerate. If you drink, drink small amounts and speak to your doctor about your medication.

A: Smoking affects ulcerative colitis (UC) differently than it affects Crohn's disease. Some studies suggest smoking may reduce UC symptoms, but the overall health risks of smoking (cancer, heart disease, lung disease) far outweigh any small benefit. ¹ Talk to your doctor before making any changes related to smoking.

A: Yes, regular moderate exercise is safe and helpful for most people with ulcerative colitis. Walking, swimming and yoga are gentle starting points. Exercise supports remission, mental health, and bone strength.¹

A: Yes. With planning, most people with ulcerative colitis can travel safely. Pack enough medication for your trip plus a week extra. Carry a doctor's letter for airport security. Research nearby hospitals and pharmacies, and avoid tap water and raw foods in regions with food-safety risks. ¹⁴

A: Yes. Most people with ulcerative colitis can have children, especially when the disease is well controlled. ¹⁵ Planning pregnancy during remission is recommended. Speak to your gastroenterologist before you try to conceive.

A: Ulcerative colitis (UC) in remission does not usually affect fertility. ¹⁵ Active UC or pelvic surgery for UC can reduce fertility, especially in women. Pre-conception planning with your Doctor is recommended if you are thinking about starting a family.

A: Pregnancy is usually safe in ulcerative (UC), especially when the disease is in remission at conception. ¹⁵ Active UC during pregnancy is linked to a higher risk of complications, so staying on your treatment is often safer than stopping it. Review your plan with both your gastroenterologist and your obstetrician.

A: Many ulcerative colitis medications, including several biologics and aminosalicylates, are considered compatible with breastfeeding. ¹⁶ Always review your specific plan with your Doctor and your paediatrician before and during breastfeeding.

A: Ulcerative colitis (UC) has a genetic component, but it is not directly inherited like a single-gene disease. ¹ Having a parent with UC raises a child's risk compared with the general population, but most children of UC parents do not develop the condition.