How does ulcerative colitis progress?
UC is a chronic, relapsing condition. Chronic means that it is persistent and ongoing. Relapsing means that there are times when symptoms flare-up (relapse), and times when there are few or no symptoms (remission). The severity of symptoms, and how frequently they occur, varies from person to person. The first episode (flare-up) of symptoms is often the worst.
UC starts in the rectum in most cases. This causes a proctitis, which means 'inflammation of the rectum'. In some cases it only affects the rectum, and the colon is not affected. In others, the disease spreads up to affect some, or all, of the colon. Between flare-ups the inflamed areas of colon and rectum heal, and symptoms go away.
About half of people with UC have mild and infrequent symptoms. The other half have more frequent flare-ups with moderate or severe symptoms. During a flare-up, some people develop symptoms gradually. In others, the symptoms develop quite quickly.
What are the symptoms during a flare-up of ulcerative colitis?
Diarrhoea. This varies from mild to severe. The diarrhoea may be mixed with mucus or pus. An urgency to get to the toilet is common. A feeling of wanting to go to the toilet but with nothing to pass is also common (tenesmus). Water is not absorbed so well in the inflamed colon, which makes the diarrhoea watery.
Blood mixed with diarrhoea is common ('bloody diarrhoea').
Crampy pains in the abdomen.
Pain when passing stools.
Proctitis. Symptoms may be different if a flare-up only affects the rectum, and not the colon. You may have fresh bleeding from the rectum, and you may form normal stools rather than have diarrhoea. You may even become constipated, but with a frequent feeling of wanting to go to the toilet.
Feeling generally unwell is typical if the flare-up affects a large amount of the large intestine, or lasts a long time. Fever, tiredness, feeling sick, weight loss, and anaemia may develop.
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