What Is the Prognosis for People With Ulcerative Colitis?

With no cure, it is a lifelong condition

Doctor talking to patient in hospital bed
People with IBD will often have colonoscopies on a regular basis. Expect to form a relationship with your physician and see them frequently to manage the IBD. Caiaimage/Paul Bradbury/Getty Images

Ulcerative colitis is a form of inflammatory bowel disease (IBD) for which there is currently no known cure. The primary sign of ulcerative colitis is inflammation in the colon and rectum. However, the disease is associated with complications that affect other parts of the body, including the joints, skin, and eyes. For the first 10 years after diagnosis, the prognosis for most people with ulcerative colitis is good – the rate of colectomy is low, and most patients achieve remission.

The good news is that there are more treatments available now than ever before, and more are on the way. In decades past patients got very sick and may have needed a permanent ileostomy because the disease got too advanced, or the risk of colon cancer was too high. That still does happen in some cases, but newer surgeries, such as the ileal pouch-anal anastomosis (IPAA), or j-pouch, are now commonly done.

Flare-Ups And Remission

Ulcerative colitis is a chronic illness, which means that it never goes away. The course of ulcerative colitis tends to go between periods of active disease (flare-ups) and periods of remission (where there are few or no symptoms, or where there is little inflammation in the colon). Some people with ulcerative colitis will not experience remission but instead will have continuous, active disease. About 10% of people have serious complications, such as perforation (a hole in the colon) or massive bleeding, after their first flare-up.

Approximately 10% of people never have another flare-up after their first one, which is potentially because the diagnosis of ulcerative colitis was incorrect.

Ulcerative colitis tends to begin in the rectum or the last section of the colon (the sigmoid colon) and may spread up through the rest of the colon.

For those who are diagnosed with ulcerative proctitis, where the disease is located only in the rectum, the chance of disease spreading up through the colon is 10% to 30%.

When Is A Colectomy Needed?

Anywhere from 10% to 40% of patients with ulcerative colitis will require surgery to treat their disease. Surgery always involves the complete removal of the colon; partial removals are not done because the ulcerative colitis will recur in the portion of the colon that remains. A popular choice of surgery after colectomy is the j-pouch surgery, where the last part of the small intestine (the ileum) is used to make a pouch to hold stool. The j-pouch acts like a rectum and is sewn back to the anus so that a person can move their bowels out of their bottom.

In other cases, an ileostomy might need to be done. An ileostomy is when a portion of the intestine is brought through the abdomen (a stoma), an external pouch is used to collect waste. This is done in especially complicated cases or when the j-pouch surgery fails. In this situation, the ileostomy might be permanent

The Risk Of Colon Cancer

Colon cancer develops in about 5% of people with ulcerative colitis. The risk of colon cancer is increased after 8 to 10 years of active disease and having more extensive disease (which is called pan colitis).

The reasons for the increased risk of colon cancer risk is thought to be from having continual inflammation that affects the lining of the colon. This is why it is important for people with ulcerative colitis to have regular care from a gastroenterologist, to get the disease into remission, and to have a regular colonoscopy to check for any problems.

The Bottom Line

People with ulcerative colitis do face challenges as a result of their disease. Seeing a gastroenterologist on a regular basis and receiving maintenance therapy, even when feeling well, is going to be very important in preventing flare-ups.

The ups and downs of flare-ups and remission can be stressful, which is why keeping the inflammation under control and dealing with other health concerns as they crop up is going to be the key to having a good quality of life.


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National Institute of Diabetes and Digestive and Kidney Diseases. "Ulcerative Colitis." The National Digestive Diseases Information Clearinghouse Sept 2014.

Sachar DB, Walfish AE. "Ulcerative Colitis." The Merck Manual Aug 2006. 

Solberg IC, Lygren I, Jahnsen J, Aadland E, et al. "Clinical Course During the First 10 Years of Ulcerative Colitis: Results From a Population-Based Inception Cohort (IBSEN Study)." Scand J Gastroenterol 2009;44:431-440.