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Colitis & Ulcerative Colitis

Colitis means inflammation of the colon. Its best-known long-term form, ulcerative colitis, is a type of inflammatory bowel disease (IBD) that causes bloody diarrhea and urgency. Modern treatment aims for lasting, steroid-free remission and a healed bowel lining.

Get emergency care (call 911 or go to an emergency room) if you have:

  • Heavy rectal bleeding, severe belly pain, a high fever, vomiting that won’t stop, or signs of dehydration — the Crohn’s & Colitis Foundation says to contact your care team right away or seek emergency care (Crohn’s & Colitis Foundation). Severe rectal bleeding from ulcerative colitis sometimes needs emergency surgery (NIDDK).
  • Many bloody bowel movements a day with a fever or a racing heart. In the most severe (fulminant) form, people can have more than 10 bloody bowel movements a day, often with fever, a rapid heart rate and severe anemia; it needs hospital care and can lead to other life-threatening problems (NIDDK).
  • A swollen, painful belly with fever and a fast heartbeat — possible signs of toxic megacolon, a rapid widening of the colon that needs immediate treatment and surgery (Crohn’s & Colitis Foundation), or of a hole (perforation) in the colon, which is also life-threatening (NIDDK).

Contact your care team promptly if you:

If you have thoughts of harming yourself, call the 988 Lifeline at 988, call 911 or go to the nearest emergency room (Crohn’s & Colitis Foundation).

What is ulcerative colitis?

Colitis simply means inflammation of the colon (large intestine). It has many causes, including infections, Crohn’s disease, ulcerative colitis, poor blood flow and past radiation (MedlinePlus); see Other kinds of colitis below.

Ulcerative colitis (UC) is a long-term disease in which abnormal reactions of the immune system cause inflammation and ulcers on the inner lining of the large intestine. Symptoms come and go: most people have flares separated by periods of remission that can last weeks or years (NIDDK). It almost always starts in the rectum and may spread continuously up the colon, without skipping areas (MedlinePlus). Doctors describe how far it reaches: ulcerative proctitis (rectum only), left-sided colitis, or extensive colitis affecting the whole colon (Crohn’s & Colitis Foundation). Limited disease can spread over time — up to 46% of people with proctitis and 70% with left-sided colitis may later develop extensive colitis (ACG guideline, 2025).

Who gets it, and why?

CDC figures put the number of Americans with IBD (UC and Crohn’s together) at 2.4 to 3.1 million, and the number is rising (CDC). Estimates for UC alone range from about 600,000–900,000 people (NIDDK) to about 1.25 million, based on newer insurance data (ACG guideline, 2025). UC is more likely to start between ages 15 and 30, though it can begin at any age, and is more common in people with a parent, sibling or child with IBD and in people of Jewish descent (NIDDK). MedlinePlus notes a second, later peak between ages 50 and 80 (MedlinePlus).

Doctors aren’t sure what causes it; genes, abnormal immune reactions, the gut microbiome and environment may all play a part (NIDDK). Stress and certain foods can trigger symptoms, but they don’t cause UC (MedlinePlus).

Symptoms, in the gut and beyond

Common symptoms are diarrhea, blood in the stool, cramping belly pain, mucus or pus in the stool, an urgent need to go, and tenesmus — a constant feeling of needing a bowel movement even when the bowel is empty. Mild disease may mean fewer than four bowel movements a day with occasional blood; severe disease, more than six a day with blood most of the time. Tiredness, fever, nausea and weight loss are more likely when UC is more severe or widespread (NIDDK). About half of people with UC have mild symptoms (Crohn’s & Colitis Foundation).

Between 25% and 40% of people with IBD have problems outside the intestines (Crohn’s & Colitis Foundation):

Diagnosis

Doctors use your history, a physical exam, blood tests, stool tests and endoscopy of the large intestine with biopsies (colonoscopy or flexible sigmoidoscopy) to confirm UC, judge how severe and widespread it is, and rule out infections, IBS and Crohn’s disease (NIDDK). The American College of Gastroenterology (ACG) recommends a stool test to rule out C. diff infection whenever UC is suspected. Fecal calprotectin, blood tests and, newly, intestinal ultrasound help track how well treatment is working (ACG guideline, 2025).

Colon cancer checks

UC raises the risk of colorectal cancer, more so when it affects more of the colon, is more severe, started at a younger age or has lasted longer, and in people who also have PSC or a family history of colorectal cancer. Doctors typically recommend a colonoscopy every 1 to 3 years, starting 8 years after UC began (NIDDK). The Crohn’s & Colitis Foundation advises surveillance every 1 to 2 years once you’ve had IBD for 8 to 10 years, and more often with PSC (Crohn’s & Colitis Foundation); proctitis alone isn’t linked to a higher cancer risk (Crohn’s & Colitis Foundation). Your gastroenterologist will set your schedule. For general screening, see our colorectal cancer screening section.

Side by side

Six approaches compared

For every condition we look at the same six approaches: what each involves, what it typically costs, and what a patient can realistically expect.

ApproachWhat it involves Estimated costWhat to expect
Conventional medicine (AMA) Medicines chosen by how severe and widespread UC is — aminosalicylates (5-ASA) for mild to moderate disease, short courses of steroids, immunomodulators, biologics and small-molecule pills for moderate to severe disease — plus colonoscopy checks and, when needed, surgery (often a J-pouch). IBD care often costs $9,000–$12,000 a person a year, and much more on biologics or with surgery. Biosimilars may cost less; Medicare Part D caps out-of-pocket drug costs at $2,100 in 2026; maker and charity programs can help. Medicines can bring on and keep remission; the goal is steroid-free remission with a healed colon lining. Most people need lifelong treatment unless the colon is removed, which MedlinePlus says cures UC.
Chiropractic No role in treating ulcerative colitis. Spinal care can’t reach the inflammation in the colon lining. Not a treatment for colitis, so no cost is listed. We found no studies of chiropractic for UC. Back pain and stiffness can be IBD-related arthritis of the spine, so tell your gastroenterologist about it.
Acupuncture Acupuncture, sometimes with moxibustion (heat near acupuncture points), used alongside standard medical treatment. About $90–$185 a follow-up visit and $125–$230 for a first private visit; community clinics about $50–$90. Medicare doesn’t cover it for colitis. Many trials, mostly low quality; reviews say the evidence isn’t strong enough to rely on. Never a replacement for medicines that control inflammation.
Herbal medicine Curcumin added to mesalamine has the most trial evidence; aloe vera gel, Boswellia and psyllium have small studies. Probiotics are debated; a guideline suggests one product only for pouchitis. Cost estimate being researched. Possible add-on benefit, but none of the evidence is high certainty and no supplement replaces your prescribed medicine. Check every product for interactions first.
Massage therapy Gentle massage for relaxation as one part of managing stress — not a treatment for the disease. About $60–$120 for 45–60 minutes with a private therapist, or $50–$90 at clinics, gyms and spas. We found no research on massage for ulcerative colitis. Avoid pressure on a tender belly, a stoma or a healing wound.
MBHA Wellness Coach A food and symptom diary to share with an IBD-focused dietitian, fluids during flares, pacing fatigue, stress and mood, taking medicines as prescribed, school and work accommodations, support groups, and planning around restrooms. Cost estimate being researched. Practical habits that support your medical care — alongside, never instead of, your gastroenterologist.

Approach 1 of 6

Conventional medicine (AMA)

UC medicines reduce inflammation in the large intestine and help bring on and keep remission. Most people need lifelong treatment unless they have surgery to remove the colon and rectum; severe and fulminant UC are usually treated in a hospital (NIDDK). The ACG’s goal is lasting steroid-free remission, with healing of the colon lining seen on endoscopy, which lowers the chance of hospital stays and surgery (ACG guideline, 2025).

1. Mild to moderate UC

  • Aminosalicylates (5-ASA), such as mesalamine and sulfasalazine, are a mainstay for inducing and maintaining remission in mild to moderate UC. They come as pills or as enemas and suppositories, are often well tolerated and aren’t linked to a higher risk of infection or cancer. People with a sulfa allergy shouldn’t take sulfasalazine, and because these medicines very rarely injure the kidneys, kidney tests are done routinely (Crohn’s & Colitis Foundation).
  • For disease limited to the rectum or left side, rectal 5-ASA is recommended, sometimes with an oral 5-ASA. Once-daily dosing works as well as several doses a day, and the ACG stresses taking medicine as prescribed: missed doses are common and raise the risk of a flare. Rarely, 5-ASA can paradoxically worsen diarrhea (ACG guideline, 2025).
  • If 5-ASA isn’t enough, a steroid (such as budesonide in a colon-release form, or prednisone) can be added for a short time. People whose UC doesn’t respond to 5-ASA should be treated as having moderate to severe disease (ACG guideline, 2025).

2. Moderate to severe UC

Infections and vaccines: more than 70% of people with IBD take immune-modifying medicines at some point, which raises the risk of infections that vaccines can prevent (ACG preventive care guideline, 2025). Ask about flu, pneumonia, shingles and hepatitis vaccines; live vaccines are avoided on some of these medicines (Crohn’s & Colitis Foundation).

For pain: acetaminophen is preferred for mild pain; avoid NSAIDs such as ibuprofen, naproxen and aspirin, which can make symptoms worse (NIDDK). Ask your provider before using an anti-diarrhea medicine (MedlinePlus).

3. In the hospital (acute severe UC)

Treatment includes steroids through a vein, testing for C. diff, medicine to prevent blood clots, and a surgeon’s opinion if there’s no improvement within about 3 days; infliximab or cyclosporine can be used as rescue therapy (ACG guideline, 2025). Blood transfusions and IV fluids may be needed (NIDDK).

4. Surgery

Surgery may be recommended for cancer or precancerous changes (dysplasia), life-threatening problems such as severe bleeding, toxic megacolon or perforation, symptoms medicines don’t control, or reliance on steroids. Surgeons usually remove the colon and rectum and either build an internal pouch from the end of the small intestine, joined to the anus (ileoanal reservoir or “J-pouch”, usually 2 or 3 operations), or create an ileostomy, where stool leaves through an opening in the belly into a bag (NIDDK). MedlinePlus states that removing the colon cures UC and removes the threat of colon cancer (MedlinePlus).

  • After J-pouch surgery, people may at first have up to 12 bowel movements a day, settling to about 6 to 8 a day several months later. Inflammation of the pouch (pouchitis) is the most common complication and is treated with antibiotics. Allow up to a year to adjust; most people return to work and normal activities (Crohn’s & Colitis Foundation).

What it costs

Find a medical doctor in our directory

Approach 2 of 6

Chiropractic

Chiropractic care has no role in treating ulcerative colitis. We found no studies testing it for UC, and spinal adjustment can’t reach the inflammation in the colon lining that medicines treat.

When back pain is part of IBD

IBD can cause arthritis of the lower spine and sacroiliac joints, and a more severe form, ankylosing spondylitis, affects 2% to 3% of people with IBD (Crohn’s & Colitis Foundation). Bones can also thin, partly from steroids (NIDDK). If you have UC and new back pain or stiffness, tell your gastroenterologist; see our Ankylosing Spondylitis guide. As a precaution, MBHA suggests telling any chiropractor that you have UC, take steroids, or have been told you have low bone density.

Find a chiropractor in our directory

Approach 3 of 6

Acupuncture

Acupuncture is sometimes used alongside standard treatment for UC. The Crohn’s & Colitis Foundation lists it among mind-body therapies that may help reduce stress and improve well-being (Crohn’s & Colitis Foundation). The ACG’s 2025 UC guideline doesn’t include it.

What the research says

  • A 2024 overview of 10 systematic reviews of acupuncture and moxibustion for UC found many problems with the design and quality of the studies and a lack of high-quality evidence, and urged caution in drawing conclusions (Wang et al., 2024).
  • A 2025 network meta-analysis pooled 76 randomized trials (7,484 people) of many acupuncture-related therapies, including combinations with medicines or Chinese herbs. Some combinations ranked well on symptom scores, but the authors call their findings only preliminary guidance (Zhang et al., 2025).

In short: acupuncture may help some people feel better, but the evidence is low quality. Keep taking the medicines that control inflammation.

Safety

Relatively few complications have been reported; problems have come from non-sterile needles and poor technique (NCCIH). As a precaution, MBHA suggests telling your acupuncturist if you take an immune-suppressing medicine, and avoiding needles or heat near a stoma or a healing surgical wound.

What it costs

Published examples run about $125–$230 for a first private visit and $90–$185 for follow-ups; community clinics about $50–$90 a visit (The Pricer). Medicare covers acupuncture only for chronic low back pain (Medicare.gov).

Find an acupuncturist in our directory

Approach 4 of 6

Herbal medicine

Don’t stop or replace your prescribed medicine with a supplement, and talk with your provider before starting one (Crohn’s & Colitis Foundation, NIDDK). Supplements can be sold without FDA approval, so claims about them are largely unproven (Crohn’s & Colitis Foundation). We don’t list doses here.

Turmeric (curcumin)

Probiotics

Aloe vera, Boswellia and psyllium

Interactions with immune-suppressing medicines

Vitamins and minerals do have a role when tests show you’re low; your doctor may recommend calcium and vitamin D to protect your bones (NIDDK).

Approach 5 of 6

Massage therapy

We found no research on massage therapy for ulcerative colitis, and it does not treat the inflammation. Relaxation techniques are among the stress-management strategies the Crohn’s & Colitis Foundation suggests (Crohn’s & Colitis Foundation), and some people may find a gentle massage helps them relax.

Safety

The risk of harm from massage appears to be low, but rare serious problems have been reported, sometimes with vigorous or deep-tissue massage (NCCIH). MBHA suggests:

  • No pressure on a tender or swollen belly, or near a stoma or a healing surgical wound.
  • Tell the therapist if you have joint pain, low bone density or skin sores.
  • Never use massage to put off care for severe belly pain or the warning signs at the top of this page.

What it costs

About $60–$120 for 45–60 minutes with a private therapist, or $50–$90 at clinics, gyms and spas (CostHelper).

Find a massage therapist in our directory

Approach 6 of 6

MBHA Wellness Coach

An MBHA Wellness Coach can help you turn your gastroenterologist’s and dietitian’s advice into daily habits — alongside, never instead of, your medical care.

A food diary and an IBD-focused dietitian

Fluids

Drink enough to keep your urine light yellow (Crohn’s & Colitis Foundation). During a flare you lose fluids and electrolytes faster: sip steadily through the day, use an oral rehydration solution or broth, and limit caffeine and alcohol (Crohn’s & Colitis Foundation).

Smoking

You may read that UC is less common in current smokers. The Crohn’s & Colitis Foundation says the many harms of smoking, such as cancer and heart disease, largely outweigh any benefit for people with UC (Crohn’s & Colitis Foundation). Recently quitting is one possible trigger of a flare (ACG guideline, 2025), so MBHA suggests letting your gastroenterologist know when you quit — but quitting is still recommended, and the ACG includes smoking-cessation screening in routine IBD care (ACG preventive care guideline, 2025). Free coaching is available at 1-800-QUIT-NOW (CDC).

Fatigue, stress and mood

Pace tasks across the day, rest before you’re exhausted, and ask your doctor to check for anemia, a common, treatable cause of fatigue (Crohn’s & Colitis Foundation). Anxiety and depression are more likely during active UC, and the ACG recommends screening for both (ACG guideline, 2025). Cognitive behavioral therapy is an evidence-based treatment for depression and anxiety (Crohn’s & Colitis Foundation), and stress-management techniques may help (Crohn’s & Colitis Foundation).

School, work and getting out

Support groups

Social support can help with the stress of illness (MedlinePlus). The Crohn’s & Colitis Foundation runs support groups for people with UC or Crohn’s and their caregivers (Crohn’s & Colitis Foundation), and its IBD Help Center is at 1-888-MY-GUT-PAIN (Crohn’s & Colitis Foundation). For more on living with IBD, see our Crohn’s Disease guide.

Another approach

Other kinds of colitis

Not all colitis is ulcerative colitis. Treatment and outlook depend on the cause (MedlinePlus).

Microscopic colitis

A long-term inflammation of the colon lining that can only be seen under a microscope; its two types are lymphocytic and collagenous colitis. About 700,000 Americans have it, most often older adults (average age at diagnosis 60 to 65) and women. Unlike UC, it doesn’t raise the risk of colon cancer (NIDDK). The main symptom is chronic, watery, non-bloody diarrhea, sometimes at night. Smoking and some medicines — including NSAIDs, acid-reducing proton pump inhibitors, SSRI antidepressants and statins — are linked to a higher risk (NIDDK). Treatment may include quitting smoking, changing a medicine that could be the cause, and medicines such as budesonide; medicines usually work well (NIDDK).

Infectious colitis, including C. diff

Viruses, bacteria and parasites can inflame the colon (MedlinePlus). C. diff is a germ that causes diarrhea and colitis and can be life-threatening. Most cases happen during or soon after a course of antibiotics; symptoms include diarrhea, fever, belly pain or tenderness, nausea and poor appetite. It is diagnosed with a stool test and usually treated with specific antibiotics. Wash hands with soap and water after using the bathroom and before eating (CDC). In people with UC, C. diff is linked to more hospital stays and surgery, so flares are checked for it (ACG guideline, 2025).

Ischemic colitis

Injury to the colon from reduced blood flow (MedlinePlus, MSD Manual). It mainly affects people 60 or older and is more common with heart and blood-vessel disease. It usually causes belly pain, often on the left, and loose stools with dark red clots or bright red blood; doctors use a CT scan or colonoscopy to tell it apart from infection or IBD. People are treated in the hospital, and nearly all improve within 1 to 2 weeks, though a few need surgery (MSD Manual). New bloody stools with belly pain always need prompt medical care.

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This page is for education only and is not medical advice. Costs are typical U.S. ranges and estimates; yours will depend on your provider, location and insurance. Talk with your doctor before starting, stopping or combining any treatment. In an emergency, call 911. See our disclaimer.

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