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Patient Instructions

You were in the hospital because you have ulcerative colitis, swelling of the inner lining of your colon and rectum. It damages the lining in spots (leaving ulcers) and causes it to bleed or ooze cloudy 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 drugs to help stop diarrhea. Your doctor may have prescribed drugs to reduce swelling, prevent or fight infection, or help your immune system.

Surgery may have been needed (rarely). If so you, you may have had either ileostomy or small bowel resection repair surgery

See also:

• Ileostomy - discharge
• Small bowel resection repair - discharge

Most people will have long breaks between flare-ups of their ulcerative colitis.

When you first go home, your doctor may ask you to drink only liquids or eat different foods from what you normally eat. Ask your doctor 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 essential 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. Try to avoid foods that make your signs and symptoms worse.

If your body does not digest dairy foods well, limit dairy products. Try low-lactose cheeses, such as Swiss and cheddar, and an enzyme product, such as Lactaid, to help break down lactose. If you must stop eating dairy products, talk with a dietitian about getting enough calcium.

Eat low-fat foods. Avoid high-fat foods, such as butter, nuts, peanut butter, mayonnaise, ice cream, fried foods, chocolate, and red meat.

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 fruits -- 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 doctor about extra vitamins and minerals you may need:

• Iron supplements (if you are anemic)
• Nutrition 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.

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.

Ask your doctor or nurse about these tips to help you manage your ulcerative colitis:

• Join a support group. Ask your doctor, nurse, or dietitian about groups in your area.
• Exercise -- talk with your doctor about an exercise plan that’s right for you.
• Try biofeedback to reduce muscle tension and slow your heart rate, deep breathing exercises, hypnosis, or other ways to relax -- such as yoga, listening to music, reading, or soaking in a warm bath.
• See a mental health care provider for help.

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

• Anti-diarrhea drugs can help when you have very bad diarrhea. You can buy loperamide (Imodium) without a prescription. Always talk to your doctor or nurse before using these drugs.
• Fiber supplements may help your symptoms. You can buy psyllium powder (Metamucil) or methylcellulose (Citrucel) without a prescription.
• Always talk to your doctor before using any laxative medicines.
• You may use acetaminophen (Tylenol) for mild pain. Drugs such as aspirin, ibuprofen (Advil, Motrin), or naproxen (Aleve, Naprosyn) may make your symptoms worse. Talk to your doctor first. Your doctor may also give you a prescription for stronger pain medicines.

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

Your ongoing care will be based on your unique needs. The doctor will tell you when to return for an exam where the inside of your rectum and colon is checked through a flexible tube (colonoscopy).

Call your doctor or nurse 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 or drainage or sores
• Fever that lasts more than 2 or 3 days, or a fever higher than 100.4 °F 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 drugs prescribed for your condition

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

Baumgart DC and Sandborn WJ. Inflammatory bowel disease: clinical aspects and established and evolving therapies. Lancet. 2007;369(9573):1641-57.

Clark M, Colombel JF, Feagan BC, Fedorak RN, Hanauer SB, Kamm MA, et al. American gastroenterological association consensus development conference on the use of biologics in the treatment of inflammatory bowel disease, June 21-23, 2006. Gastroenterology. 2007 Jul;133(1):312-39.

Langan RC, Gotsch PB, Krafczyk MA and Skillinge DD. Ulcerative colitis: diagnosis and treatment. Am Fam Physician. 2007; 76(9):1323-30.

Updated by: George F Longstreth, MD, Department of Gastroenterology, Kaiser Permanente Medical Care Program San Diego, California. Also reviewed by David Zieve, MD, MHA, Medical Director, A.D.A.M., Inc.