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What is ulcerative colitis?

Ulcerative colitis is a type of inflammatory bowel disease in which the inner lining of the large intestine (colon) and rectum become inflamed. Inflammation usually begins in the rectum and lower large intestine and spreads upward, potentially involving the entire colon. Ulcerative colitis causes diarrhea and frequent emptying of the colon. As cells on the surface of the colon die and fall off, ulcers (open sores) form, leading to pus, mucus, and bleeding.

Ulcerative colitis may occur at any age but is most common in older children and young adults and may run in some families. Although there is no cure, the right treatment plan can minimize or eliminate ulcerative colitis symptoms with medication, lifestyle changes, and, in some cases, surgery. The condition also can go into periods of remission.

Ulcerative Colitis | Symptoms & Causes

What are the symptoms of ulcerative colitis?

Ulcerative colitis affects all patients differently, but the most common symptom is frequent, bloody diarrhea.

Other common ulcerative colitis symptoms include:

  • abdominal pain
  • fatigue
  • weight loss
  • loss of appetite
  • rectal bleeding
  • loss of body fluids and nutrients
  • anemia caused by severe bleeding

Some patients may also experience:

  • skin lesions
  • joint pain
  • eye inflammation
  • liver disorders
  • osteoporosis
  • rashes
  • kidney stones

What causes ulcerative colitis in children?

Experts do not yet know the cause of ulcerative colitis, but it’s an area of active research. We believe that both genes and environment play a role. We also know that the immune system is involved, which is why ulcerative colitis treatment often involves medication to reduce its activity.

Ulcerative Colitis | Diagnosis & Treatments

How is ulcerative colitis diagnosed in children?

Diagnosing ulcerative colitis begins with an examination and a detailed medical history. Your child’s clinician will rule out other possible causes and may recommend one or more of the following tests:

  • blood tests
  • stool sample tests
  • endoscopy
  • colonoscopy
  • video capsule endoscopy
  • MR enterography
  • biopsy
  • imaging studies

Once you have an accurate diagnosis, the goal is to get your child on the road to proper care and management of pediatric ulcerative colitis — and, most importantly, to start feeling better as soon as possible.

How is ulcerative colitis treated?

With consistent ulcerative colitis treatment and a good understanding of the condition, the vast majority of children with the condition go on to live full and active lives. Depending on the severity of symptoms, treating ulcerative colitis often requires a combination of approaches:


Drug therapy can reduce inflammation and control symptoms. Ulcerative colitis medications may include:

  • anti-inflammatory drugs, such as steroids, to bring the disease under control
  • immune system suppressants that can reduce swelling
  • antibiotics to treat related complications, such as abscesses or fistulas
  • antiulcer/H2 blockers (acid-reducing medications) to treat related ulcers and irritation

Nutrition support

All of our patients have the option to meet a registered dietitian who will develop an ulcerative colitis diet to help control your child’s symptoms and improve health.


A percentage of children, adolescents, and young adults with ulcerative colitis, who do not respond to or have significant side effects to medications, may need surgery. Surgical treatment includes removal of the colon, also called the large bowel (colectomy), and the creation of an internal “J” shaped reservoir (J-pouch) in either two or three surgical procedures called “stages,” which based upon the particular situation may include:

  • Ileostomy: A surgically created temporary opening on the abdomen. The end of the small intestine is brought through this opening to form a stoma. A pouch (or ostomy bag) is worn over the stoma to collect stool and is emptied multiple times a day.
  • Ileoanal J-Pouch: This procedure is the creation of an internal J-pouch from the small bowel, which then is connected to the anus. It allows elimination of stool through the anus after removal of the colon. After all the surgeries, the stoma is gone and it is possible to go to the bathroom the “normal way.”

How we care for ulcerative colitis

At the Boston Children’s Inflammatory Bowel Disease Center, our team believes that, with proper management, all children and teens with ulcerative colitis can live comfortably. We partner with you and your child to effectively manage IBD and provide support through all life stages, from school and relationships to work.

Ulcerative Colitis | Programs & Services