Ulcerative Colitis

Ulcerative colitis is an inflammation of the colon and rectum, which usually affects only the superficial mucosa. The inflammation spreads upwards to varying degrees. If the inflammation is restricted to the rectum, it is called proctitis. If the inflammation affects the entire colon, the so-called full-blown clinical picture has manifested.


The reasons for the development of the disease are not fully understood yet; in addition to a genetic predisposition, infections with viruses and bacteria as well as eating habits and e.g. smoking may play a role. It is believed that ulcerative colitis is caused by several factors; this is called a multifactorial process.

It must be considered as proven that environmental factors play a role, as ulcerative colitis increases in frequency and is much more common in the high-tech countries than in all other regions of the world. The contribution of psychological factors is controversial.

The majority opinion is that psychological stress can indeed trigger a bout of the existing disease process, but is not the initial cause of inflammatory bowel disease.

Numerous studies suggest that based on an individual disposition immune reactions are directed against components naturally occurring in the intestine.

From twin and family studies, we know that heredity factors play an important role in inflammatory bowel disease. Thus, for identical twins of affected persons the risk of also developing inflammatory bowel disease is increased by up to 40 %. In siblings and children of affected persons, the risk is only 2–5 %.


In addition to general symptoms, such as decreasing vitality, fatigue, loss of appetite and sometimes fever, the main symptoms are directly related to the intestines.

Most frequent is bleeding during bowel movements. The stool is usually dark and mixed with mucus. Emission of blood without stool may also occur. The stool frequency can be 10 to 20 times per day. In addition, pain is felt in the colon, in the middle of the lower abdomen or in the sacral region. The patients often feel pain before or immediately after defecation (tenesmus).

As iron is lost with the blood, the bone marrow lacks the necessary iron for the production of new blood. The result is so-called iron deficiency anaemia.

The symptoms occur intermittently.

An acute episode may last up to two months and occur several times a year. In between, there are phases that are almost free of symptoms. The general condition worsens; fatigue and pallor indicate anaemia and protein deficiency. Later amblyopia (uveitis), painful skin lesions on the lower legs (erythema nodosum), and joint inflammation may occur. But in rare cases spontaneous healing is also possible.


Although no specific form of diet is recommended for chronic inflammatory bowel disease, on the nutritional side it is an obvious measure to do everything not to irritate the bowel and to sufficiently supply the body with all necessary nutrients.

  • Structure the daily routine on the basis of fixed, regular meals, not interspersing the meals between events of the day
  • Eat slowly – chew and salivate sufficiently
  • Do not eat what you have no appetite to; stop eating just before satiety
  • Drink plenty of liquid – no alcohol
  • Physical activity contributes to reducing stress and improving the mood
  • Foods that have a soothing effect on the stomach and intestines: Yoghurt, flax seed, apples, fennel, bananas, asparagus, cranberries and blueberries as far as they are tolerated
  • Unfavourable: Legumes, vegetables of the cabbage family, hard-shelled fruit, acid-rich foods, coarsely ground grain, heavily carbonated drinks

The most important information for the doctor is the symptoms and their impact on everyday life. So it is worthwhile to prepare a weekly protocol with information on the frequency of bowel move-ments, stool consistency (hard, soft or watery), blood in the stool, abdominal pain, general health, weight, and body temperature.

A template for such a weekly protocol can be downloaded here.