Mild ulcerative colitis is one of the stages of inflammatory bowel disease. Medication and lifestyle changes can help with symptom and flare management.

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Ulcerative colitis (UC) is a form of inflammatory bowel disease (IBD). It occurs when abnormal reactions in the immune system cause inflammation in the large intestine.

Most people with UC will have mild to moderate disease activity and symptoms. People with mild UC will experience periods where symptoms go into remission or become more active over weeks or years.

Management of the condition may decrease the risk of the disease becoming more severe and prevent further complications.

This article explores mild UC symptoms, causes, diagnosis, treatment, management, and when to speak with a doctor. We also provide Sarah Kay‘s story of her experience with mild UC.

UC can develop suddenly or gradually over time, with varying severity of symptoms. UC activity exists on a spectrum, so definitions of mild, moderate, or severe UC can vary. Symptoms can also differ from person to person.

However, doctors normally define mild UC as a person having the following:

  • fewer than four bowel movements per day
  • stools that may contain intermittent blood
  • mild abdominal pain

People with UC most commonly experience bloody diarrhea or loose bowel movements. They feel pain in the left side of the abdomen or rectal area. The exact location of the pain varies with the location of the inflammation that UC causes.

Other mild UC symptoms may include:

  • urgency to have a bowel movement
  • tenesmus — frequent or urgent need for a bowel movement, despite having empty bowels
  • rectal pain

In comparison, severe UC is when a person has:

  • more than six bowel movements per day
  • stools containing blood
  • fever, anemia, and rapid heart rate

Read more about the stages of UC here.

Doctors refer to the reappearance of UC symptoms as a flare. A UC flare can occur due to the following:

  • stress
  • smoking
  • dietary factors
  • incorrect doses of IBD medication, or not taking the medication at all
  • taking antibiotics

Some people develop skin rashes due to an immune system reaction, or they react to the UC medication. Learn about skin rashes with UC.

Sarah’s story: Symptoms and flares

“During any flare, I tend to get gastrointestinal issues [stomach ache, bloating, nausea, vomiting, loose stools, mucus, and blood in stools]; however, with severe ones, I get hives and temperature.

“My condition occurred due to a mixture of genetics and environmental factors (my time at university was quite stressful), and I have specific food triggers such as seafood, gluten, and dairy.”

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Diagnosing mild UC requires multiple methods to be accurate. This diagnosis will initially involve a combination of the following:

  • physical exams to check for masses, tenderness, or sounds within the abdomen
  • checks on heart rate, blood pressure, and temperature
  • digital rectal exams to check for blood in stools
  • review of a person’s and their family’s medical history, including:
    • symptoms
    • medication
    • lifestyle factors
  • blood tests
  • analysis of stool samples to check for signs of intestinal inflammation

Imaging tests

Doctors will diagnose UC using two forms of endoscopy: flexible sigmoidoscopy (which only looks at the lower part of the large intestine) or colonoscopy (which looks at the full large intestine).

In both cases, a doctor will use instruments and cameras to look inside a person’s bowels. They can then visually inspect the internal lining of the intestine to confirm UC and rule out other conditions.

Generally, doctors use a colonoscopy for people with previous extensive colitis because it is a more comprehensive examination.

Experts associate UC with an increased risk of colorectal cancer. Generally, the risk is lower in people with mild UC, and it is especially more common if the condition is severe or involves most of the colon.

Although not all people with IBD will experience colorectal cancer, early detection is critically important. Colorectal cancer is a very treatable disease when a doctor detects it early.

Doctors, therefore, will recommend regular colonoscopies to check for signs normally eight years after a UC diagnosis and then every 1–3 years.

Proteins in blood and stool — biomarkers — may be useful tests for detecting inflammation.

Sarah’s story: Monitoring

“I have blood tests every 3 months, and my care has been handed to my GP, who refers me to the specialist when my disease gets to a severe stage.”

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Treatment of UC aims to achieve long-term remission with an improvement in symptoms.

Doctors treat UC with medication or surgery to remove parts of the colon or rectum. However, people with mild UC are at low risk of requiring surgery. They can often stop symptoms from becoming severe with medication.

A doctor uses several medications for the treatment and management of mild UC. Most people with mild UC receive 5-aminosalicylates (5-ASA), a class of anti-inflammatory agents effective for maintaining UC remission, as an oral drug or enema.

People who achieve remission of UC medication will usually continue to use it over their lifetime to maintain remission. This also prevents symptoms from becoming more severe.

Learn more about UC-approved drugs here.

Some foods can make UC symptoms worse. No one diet plan will work for everyone who has UC. Healthcare professionals may customize dietary plans for each person.

Malnutrition is a common complication in people with UC as it is harder to digest food and absorb nutrients, leading to vitamin deficiencies and malnutrition.

Foods to eat and avoid

The following lifestyle changes and methods are ways to manage or reduce mild UC symptoms:

  • eating smaller meals 4–6 times per day
  • eating soft, bland foods instead of spicy food
  • reducing the amount of fried or greasy foods
  • avoiding carbonated beverages
  • restricting caffeine intake
  • eating fewer high-fiber foods such as:
    • nuts
    • seeds
    • raw vegetables
  • staying hydrated
  • using simple cooking techniques such as boiling, grilling, steaming, or poaching food

Find out what foods to eat and avoid with UC here.

People with IBD have less microbial diversity and a loss of good bacteria. Therefore people may benefit from probiotic therapy to balance good and bad bacteria.

Diets for UC

Specialized IBD diets may be an option for some people with mild UC, but they need to discuss their options with a nutritionist before starting a new diet.

Some possible diet plans may also work for certain people with mild UC, such as:

Learn more about UC and diet plans here.

Supplements for UC

Doctors may also recommend taking extra vitamins or supplements to maintain a mild condition. Find out more about B-12 and UC here.

Management of flares

Doctors may recommend lifestyle changes to manage and prevent flares, such as:

  • reducing stress
  • having regular exercise
  • taking regular medication
  • eating a balanced diet

Sarah’s story: Treating and managing the condition

“I take steroid medication and sometimes immunosuppressants. Otherwise, I take a mix of protein supplements and probiotics regularly to help my gastrointestinal system stay in optimal condition.

“I have completely cut red meat, gluten, and dairy out of my diet. I also try to take more products with natural bacteria, such as kefir and plain yogurt, to promote the growth of good gut bacteria.”

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If a person notices a change in their symptoms or worsening of others, they should consult a doctor.

Certain symptoms are more likely to occur if UC is more severe, including:

Possible complications of UC may develop over time, such as low bone mass and osteoporosis. UC can also lead to more severe symptoms, resulting in serious or life threatening complications. Therefore, a person needs to consult a gastroenterologist or IBD nurse.

People with mild ulcerative colitis will experience a range of symptoms throughout their life. A person can effectively manage their symptoms through medications, such as 5-ASA.

Most people with mild UC can maintain remission. However, if a person experiences more frequent and severe flares or changes to their symptoms, they should consult a doctor.