Ulcerative colitis - discharge

You were in the hospital because you have ulcerative colitis. This is a swelling of the inner lining of your colon and rectum (also called your large intestine). It damages the lining, causing it to bleed or ooze mucus or pus.

You probably received fluids through an intravenous (IV) tube in your vein. You may have received a blood transfusion, nutrition through a feeding tube or IV, and medicines to help stop diarrhea. You may have been given medicines to reduce swelling, prevent or fight infection, or help your immune system. Treatment usually involves long-term medicines that block the immune system from causing inflammation. This may be by pill, infusion, or injection. These medicines will be continued at home.

You probably had blood tests, stool tests, and imaging tests such as CT or MRI. These help look for problems from your ulcerative colitis.

You may have undergone a colonoscopy. A colonoscopy is a lighted flexible tube placed through the rectum to look at the whole colon in high definition, on a video screen. The colonoscopy tells the extent of your disease (all of the colon vs part of the colon) and the severity of your inflammation.

You also may have had surgery. If so, you may have had either an ileostomy or colon resection (colectomy). Sometimes a special pouch is created near the old rectum (called a J-pouch). Depending on your type of surgery and details about your disease, you may be sent home to have a second surgery months later.

Most people will have long breaks between flare-ups of their ulcerative colitis if they take their prescribed medicines. The goal of treatment is to induce remission (cause the disease to get better) and maintain remission (keep flares away).

When you first go home, you will need to drink only liquids or eat different foods from what you normally eat. Ask your health care provider when you can start your regular diet. You should eat a well-balanced, healthy diet. It is important that you get enough calories, protein, and nutrients from a variety of food groups.

Certain foods and drinks can make your symptoms worse. These foods may cause problems for you all the time or only during a flare-up. Avoid foods that make your symptoms worse.

• Too much fiber may make your symptoms worse. Try baking or stewing fruits and vegetables if eating them raw bothers you.
• Avoid foods that are known to cause gas, such as beans, spicy food, cabbage, broccoli, cauliflower, raw fruit juices, and fruit (especially citrus fruits). Avoid or limit alcohol and caffeine. They may make your diarrhea worse.

Eat smaller meals, and eat more often. Drink plenty of liquids.

Ask your provider about extra vitamins and minerals you may need, including:

• Iron supplements (if you are anemic). Sometimes iron is given intravenously.
• Nutrition supplements especially if you haven't been eating well. You may have developed some vitamin deficiencies. Speak with your provider before taking any supplements.
• Calcium and vitamin D supplements to help keep your bones strong.

Talk with a dietitian, especially if you lose weight or your diet becomes very limited.

Immunosuppressive medicines for IBD can make you stay at higher risk of getting other infections. Make sure to speak with your provider about getting the appropriate vaccinations to decrease your risk. Live vaccinations are not given while on those medicines, so follow your provider's guidance.

If you are planning to get pregnant in the near future, discuss this with your provider. It is best to have your ulcerative colitis under control (be in remission) before pregnancy.

You may feel worried about having a bowel accident, embarrassed, or even feel sad or depressed. Other stressful events in your life, such as moving, job loss, or the loss of a loved one, can cause problems with your digestion.

These tips may help you manage your ulcerative colitis:

• Join a support group. Ask your provider about groups in your area.
• Exercise. Talk with your provider about an exercise plan that is right for you.
• Try biofeedback to reduce muscle tension and slow your heart rate, deep breathing exercises, hypnosis, or other ways to relax. Examples include doing yoga, listening to music, mindfulness, reading, or soaking in a warm bath.
• See a mental provider for help. Having a chronic disease is difficult. There is no shame in wanting to speak with a professional.
• The Crohn's and Colitis Foundation of America provides education and supportive services to help manage the disease.

Your provider may give you some medicines to help relieve your symptoms. Based on how severe your ulcerative colitis is and how you respond to treatment, you may need to take one or more of these medicines:

• Anti-diarrhea medicines can help when you have very bad diarrhea. You can buy loperamide (Imodium) without a prescription. Always talk to your provider before using these medicines. Do not use them if you have a fever or bloody diarrhea.
• Fiber supplements may help your symptoms. You can buy psyllium powder (Metamucil) or methylcellulose (Citrucel) without a prescription.
• Always talk to your provider before using any laxative medicines.
• You may use acetaminophen (Tylenol) for mild pain. Medicines such as aspirin, ibuprofen (Advil, Motrin), or naproxen (Aleve, Naprosyn) may make your symptoms worse. Talk to your provider before taking these medicines. You may also need a prescription for stronger pain medicines.

There are many types of medicines your provider may use to prevent or treat attacks of your ulcerative colitis.

Your ongoing care will be based on your needs. Your provider will tell you when to return for an exam of the inside of your rectum and colon through a flexible tube (sigmoidoscopy or colonoscopy). IBD can increase your risk of colon cancer so at some point, your provider will put you in a colonoscopy screening program. Follow-up bloodwork and stool tests are usually done.

Contact your provider if you have:

• Cramps or pain in your lower stomach area
• Bloody diarrhea, often with mucus or pus
• Diarrhea that cannot be controlled with diet changes and drugs
• Rectal bleeding, drainage, or sores
• Fever that lasts more than 2 or 3 days, or a fever higher than 100.4°F (38°C) without an explanation
• Nausea and vomiting that lasts more than a day
• Skin sores or lesions that do not heal
• Joint pain that keeps you from doing your everyday activities
• A feeling of having little warning before you need to have a bowel movement
• A need to wake up from sleeping to have a bowel movement
• Failure to gain weight, a concern for a growing infant or child
• Side effects from any medicines prescribed for your condition

Inflammatory bowel disease - discharge; Ulcerative proctitis - discharge; Colitis - discharge

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Crohn's & Colitis Foundation website. What is ulcerative colitis? www.crohnscolitisfoundation.org/patientsandcaregivers/what-is-ulcerative-colitis. Accessed January 29, 2025.

Fergus KB, Kattah MG, Wick EC. Management of chronic ulcerative colitis. In: Cameron J, ed. Current Surgical Therapy. 14th ed. Philadelphia, PA: Elsevier; 2023:186-190.

Feuerstein JD, Isaacs KL, Schneider Y, Siddique SM, Falck-Ytter Y, Singh S; AGA Institute Clinical Guidelines Committee. AGA Clinical Practice Guidelines on the management of moderate to severe ulcerative colitis. Gastroenterology. 2020;158(5):1450-1461. PMID: 31945371 pubmed.ncbi.nlm.nih.gov/31945371/.

Lichtenstein GR. Inflammatory bowel disease. In: Goldman L, Cooney KA, eds. Goldman-Cecil Medicine. 27th ed. Philadelphia, PA: Elsevier; 2024:chap 127.

Updated by: Jenifer K. Lehrer, MD, Gastroenterologist, Philadelphia, PA. Review provided by VeriMed Healthcare Network. Also reviewed by David C. Dugdale, MD, Medical Director, Brenda Conaway, Editorial Director, and the A.D.A.M. Editorial team.