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Ulcerative Colitis


Ulcerative colitis is an inflammatory bowel disease (IBD) resulting in inflammation of the rectum and colon.


It is an uncommon disease that affects males and females equally usually starting between 15 – 30 years of age.


The cause of ulcerative colitis is unknown. It can run in families so there is a genetic component. It involves an immune system dysregulation leading to an inflammation of the colon and rectum.


The inflammation always involves the rectum (proctitis) but can also extend to involve part or all of the colon (pan-colitis). Unlike Crohn’s disease, it cannot affect other parts of the digestive track.
Occasionally, ulcerative colitis can affect other organs including the eyes, joints, liver and skin.


The most common symptom is bloody diarrhoea and mucous discharge. Urgency to defaecate and lower abdominal pains can be a feature. Symptoms range from mild to very severe. The usual course is that of relapsing and remissions.


The main investigation is that of colonscopy. This can visualise the extent and severity of disease and allow biopsies to be taken to confirm the diagnosis. Blood tests are done to assess severity but are not diagnostic. In severe cases, an abdominal CT scan can look for complications arising from the disease.


The aims of treatment are firstly, to induce remission and secondly, to maintain remission. This is usually achievable with medications under the supervision of a gastroenterologist. The medications used are

  • Anti – inflammatories – 5ASA (Salazopyrim, Pentasa)
  • Steroids – hydrocortisone, prednisolone
  • Immunomodulators – azathioprine (Imuran), methotrexate
  • Biologicals – infliximab (Remicade), adalimumab (Humira)


Surgery is reserved for severe acute colitis, toxic colitis and uncontrolled bleeding. It may also be used for chronic colitis not responding to maximal medications or if cancerous changes develop. Types of surgery include

  • Total Colectomy and ileostomy – This is where the colon is removed, the rectum is left behind and a stoma (bag) is created. It is usually done in the emergency setting as a life saving measure in acute severe colitis.
  • Procto – Colectomy and ileoanal J – pouch anastomosis – This is where the whole of the colon and rectum are removed and a pouch from small intestine is created and joined to the anus. This effectively cures the disease although does create an imperfect situation and is not without risks.

Surgery for ulcerative colitis can usually be performed laparoscopically (keyhole surgery). This has the benefits of smaller wounds, less pain, earlier hospital discharge and earlier return to work.

  • Prince of Wales Private Hospital
  • The Royal Hospital For Women Foundation
  • Colorectal Surgical Society of Australia and New Zealand
Randwick Rooms

Prince of Wales Private
Suite 17, Level 7
Barker Street
Randwick NSW 2031

Phone: (02) 9099 4400
Fax: (02) 9650 4924

Double Bay

Level 1
451 New South Head Rd
Double Bay NSW 2028
(Opposite Woollahra Library Double Bay)

Phone: (02) 9096 3133
Fax: (02) 9096 3199

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