Living with Ulcerative Colitis

Ulcerative colitis diet and lifestyle choices

/ Author:  / Reviewed by: Joseph V. Madia, MD

Ulcerative colitis is a condition that falls under the category of IBD – inflammatory bowel disease. The disorder involves the presence of long-term inflammation and ulcers in parts of the digestive tract, usually the rectum and the innermost layers of the large intestine (the colon).

According to the Mayo Clinic, “There's no known cure for ulcerative colitis, but therapies are available that may dramatically reduce the signs and symptoms of ulcerative colitis and even bring about a long-term remission.”

Some of these options (along with prescription drugs and surgery) include lifestyle and diet choices that can be made at home which, for some, can help greatly to ease the pain and frustration of ulcerative colitis.

Causes of Colitis

Ulcerative colitis involves symptoms like frequent diarrhea, feeling an urgent need to defecate, and bloody stools, abdominal cramps, and anemia, all stemming from the inflammation in the digestive tract.

The exact causes for ulcerative colitis are not known, but researchers have been able to pinpoint possible contributing causes.

Stress was once thought to be the main cause behind the disorder. While this is no longer the case, it is thought that stress can contribute to ulcerative colitis and worsen symptoms.

Now the causes are thought to be more likely related to both the immune system and genetics. It is possible that a bacteria or an autoimmune reaction (even if no bacteria is actually present) may spark the beginnings of ulcerative colitis.

It is also possible that genetics are a contributing factor, and those with a parent or sibling with ulcerative colitis are more likely to develop it themselves.

According to the University of Maryland Medical Center (UMMC), it is also now thought that a diet high in sugar, cholesterol, saturated fat and processed foods may play a role in the development of the disease, as ulcerative colitis is more prevalent in developed countries with diets high in these substances.

Traditional treatments for ulcerative colitis usually involve medication to help ease the inflammation in the digestive tract, and in severe cases, surgery may be required.

Eating to Ease the Pain

While there is no clear evidence that diet does cause ulcerative colitis or related IBDs, some foods do seem to aggravate or worsen symptoms.

There are several dietary steps ulcerative colitis patients can take that may help ease symptoms, one of which is to limit dairy products, as the digestion of lactose is difficult for many and may worsen ulcerative colitis symptoms, particularly diarrhea.

For some with IBD, fiber, normally a recipe for health, can actually aggravate symptoms. If raw fruits and veggies don’t seem to be digested easily, cooking them lightly, by steaming or baking them, for example, may help.

UMMC suggests that during a flare-up of symptoms, “a bland, low fiber diet may be best.”

It is also recommended that foods known to produce gas – like beans, cabbage, spicy foods, carbonated drinks and caffeine – should be avoided. Eating more small meals in a day, as opposed to two or three big ones, may help symptoms as well.

Drinking lots of liquids, especially water, to help ease ulcerative colitis. The Mayo Clinic reports “...beverages that contain caffeine stimulate your intestines and can make diarrhea worse, while carbonated drinks frequently produce gas.”  

Furthermore, the diarrhea that is often present in ulcerative colitis may increase the risk of dehydration, making water even more important.

Dieticians and doctors can help advise patients with ulcerative colitis to ensure they are getting the right mix of vitamins and nutrients. Multivitamins may help some patients supplement their diet and absorb sufficient amounts of nutrients.

In an interview with dailyRx News, Gastroenterologist Maxwell M. Chait, MD, FACP (Fellow of the American College of Physicians), highlighted the fact that the relationship between food and ulcerative colitis is different for every patient.

"It is important to eat a well-balanced diet and talk to your doctor or dietitian before dropping any food," said Dr. Chait.

Calming the Mind

As mentioned earlier, while stress may not in and of itself cause ulcerative colitis, it can contribute to the disease and make symptoms worse.

According to the Mayo Clinic, “When you're stressed, your normal digestive process can change, causing your stomach to empty more slowly and secrete more acids. Stress can also speed or slow the passage of intestinal contents. It may also cause changes in intestinal tissue itself.”

Managing stress can help ease symptoms and prevent flare-ups of the disease.

Exercising regularly is a good step to take, as it not only can help ease stress, but it can also help regulate bowel function. However, UMMC does warn that “ is especially important for people with ulcerative colitis to drink water before and during exercising to prevent dehydration.”

Relaxation techniques and breathing exercises help some slow down and manage stress. Participating in a yoga, tai chi or meditation class can be a good way to get introduced to methods and exercises.

According to UMMC, breathing deeply from the diaphragm creates a relaxation response in your body, that “may also help relax your abdominal muscles, which can help with normal intestinal health.”

Avoiding stress can be a very personal and varied task. The Mayo Clinic recommends settings aside some time every day to enjoy activities that relax you. Maybe this is taking a bath, listening to music, writing in a journal, spending time with loved ones or playing a computer game. Whatever the activity, make sure to take time to relax and unwind daily.

Some use the method of biofeedback, which uses a machine that helps teach the patient how to slow down the heart rate and reduce muscle tension on their own. This relaxed state can help the patient deal with stress. Doctors can help patients find locations with feedback machines.

Progressive muscle relaxation is another technique to reduce stress. In this method, the patient tightens and relaxes a specific muscle group, then moves on to a different group.

"For most people, ulcerative colitis is controllable. The key to helping the stress that comes along with a chronic illness is by having the disease under control," said Dr. Chait.

According to Dr. Chait, an important step in this is "...seeing a gastroenterologist with whom you are comfortable talking on a regular basis and who knows all the latest and medicines available."

Mental Wellness Beyond Stress

For some with ulcerative colitis, the disease can prove to be emotionally and mentally challenging, beyond just the physical pain.

Some may feel they need to constantly remain near a toilet, which may prevent them from participating in many activities. Some suffer from great anxiety worrying about their disorder in general or about having an accident.

Additionally, some cope with a good deal of embarrassment about their symptoms and these concerns. All of these factors can lead to depression, anxiety and feelings of isolation.

Support groups are one way to help manage these emotional effects of the disease. Not only do support groups help patients learn more about their disease, they provide access to a community of people, all coping with the same issues.

For others, one-on-one counseling is a good option for maintaining emotional and mental health while dealing with ulcerative colitis. According to the Mayo Clinic, therapists who are familiar with IBDs are available, and may be of particular help to ulcerative colitis patients.

Dr. Chait also recommended taking practical, preventative steps to help ease this anxiety.

"Prepare an emergency kit with items such as wipes, toilet tissue, change of underwear and pants and panty liners. Carrying it with you may ease your anxiety about accidents. Plan ahead by knowing where the restrooms are," Dr. Chait told dailyRx News.

By taking care to manage stress, diet and emotional health, patients with ulcerative colitis can help to create comfortable and happy lives for themselves.

Working closely with a doctor they trust can help a patient along this path. 

"I tell my patients to let me know at the first evidence of any flare of the disease, because the earlier you treat it, the more likely you are able to avoid having to go to aggressive therapy," said Dr. Chait.

Doctors can help patients find the right balance between lifestyle changes and medical treatments (like drugs or surgery) in order to help each individual patient heal and find longer periods of remission from ulcerative colitis.

For information regarding the different types of UC and the available medical treatments, please read our companion feature article "Digesting Ulcerative Colitis".

Review Date: 
November 2, 2012