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Ulcerative colitis (UC) is a chronic inflammatory bowel disease (IBD) that causes inflammation and sores, called ulcers, in the innermost lining of the large intestine (colon) and rectum. The condition typically begins in the rectum and may extend upward through part or all of the colon. It is characterized by periods of active symptoms (flare-ups) and periods of remission, where symptoms are mild or absent. UC can be painful and debilitating, occasionally leading to severe complications.
Common symptoms
Recurring diarrhea, often with blood, mucus, or pus
Abdominal pain and cramping
Rectal pain
Urgency to pass stool
Not being able to pass stool despite urgency (tenesmus)
Fatigue
Loss of appetite
Weight loss
Fever
Anemia
Painful and swollen joints (arthritis)
Mouth ulcers
Swollen fat under the skin causing bumps and patches (erythema nodosum)
Irritated and red eyes
Problems with bones, such as osteoporosis
Delayed growth and development in children
Possible causes
The exact cause of ulcerative colitis is unknown.
It is believed to be caused by an abnormal response of the immune system, which mistakenly attacks the lining of the colon, leading to chronic inflammation and ulcers.
Genetic predisposition plays a role, as it tends to run in families.
Environmental factors, such as reactions to bacteria or chemicals in the gut, may trigger uncontrolled inflammation.
Diet and stress do not cause ulcerative colitis, but they can worsen symptoms during a flare-up.
Medical treatment
Medication is the primary treatment, aiming to reduce inflammation and induce/maintain remission.
Anti-inflammatory drugs: Aminosalicylates (5-ASAs) like sulfasalazine and mesalamine are often first-line for mild to moderate UC.
Corticosteroids (e.g., prednisone, prednisolone, budesonide) are used for short-term management of flare-ups to curb serious inflammation, but not for long-term use due to side effects.
Immune suppressors (immunomodulators) like thiopurines (e.g., azathioprine) help stop the immune system from attacking healthy tissue.
Biologic agents (e.g., infliximab, adalimumab, golimumab, vedolizumab, ustekinumab, mirikizumab, risankizumab, guselkumab) target specific proteins made by the immune system and are used for moderate to severe UC or when other treatments are ineffective.
Small molecule medicines are newer therapies for moderate to severe UC.
Diet modification: While no specific diet causes UC, some people find certain foods worsen symptoms during flare-ups; a low-fiber diet or food supplements may be recommended temporarily.
Lifestyle changes: Stress management, adequate sleep, and regular exercise can help manage symptoms and reduce flare-ups.
Surgery: Colectomy (removal of the colon and rectum) is the only true cure and may be necessary for severe cases, complications, or when medications are ineffective.
Ayurvedic perspective
In Ayurveda, Ulcerative Colitis is primarily understood as an imbalance of the Pitta and Vata doshas, often correlated with conditions like Pittaja Grahani, Raktatisara, and Pravahika. Pitta, associated with fire and digestion, when aggravated, leads to inflammation, heat, and ulceration in the colon. Vata, governing movement, can cause irregular bowel movements and pain when imbalanced. A weakened digestive fire (Agni) is considered a core issue, leading to improper digestion and the accumulation of toxins (Ama) in the body. This accumulation can obstruct the Purishavaha Srotas, the channels responsible for waste elimination. Emotional factors like chronic stress, suppressed emotions, and mental unrest are also recognized as significant contributors to Pitta aggravation and weakened immunity.
Ayurvedic dietary guidelines
Avoid spicy, greasy, fried, processed, and packaged foods.
Favor easily digestible foods such as cooked vegetables (carrots, zucchini, spinach, pumpkin, bottle gourd, ash gourd, asparagus, mushrooms), white rice, moong dal khichdi, and well-cooked lentils.
Incorporate anti-inflammatory spices like turmeric, ginger, cumin, coriander, and fennel into meals.
Include healthy fats such as ghee (clarified butter), olive oil, and flaxseed oil.
Opt for ripe, sweet fruits like bananas, melons, pears, papaya, pomegranate, cooked apples, peaches, and seedless grapes. Avoid acidic or sour fruits.
Consume plain curd (if tolerated) and diluted buttermilk spiced with cumin.
Limit or avoid red meat and excessive dairy products, especially milk, cheese, and butter, as they can worsen symptoms for some individuals.
Avoid raw fruits and vegetables, high-fiber foods (especially during flares), nuts, seeds, and popcorn.
Refrain from caffeine, alcohol, and carbonated drinks, as they can irritate and dehydrate the digestive tract.
Avoid sugary foods and artificial sweeteners.
During active flare-ups, avoid onions, garlic, and cruciferous vegetables.
Consider a gluten-free diet if it triggers symptoms.
Ayurvedic medicinal herbs
Kutaj (Holarrhena antidysenterica): Known for anti-diarrheal, anti-inflammatory, and ulcer-healing properties; helps stop bleeding and controls diarrhea. — Classical Ayurvedic medicinal herb
Coriander: A cooling herb that helps pacify Pitta and reduce inflammation. — Classical Ayurvedic medicinal herb
Boswellia serrata: Shown to lower abdominal pain, improve stool properties, and reduce inflammation and ulcerations. — Classical Ayurvedic medicinal herb
Practice stress management techniques such as meditation, yoga (e.g., Setu Bandhasana, Pawanmuktasana), and breathing exercises (pranayama) to calm the mind and reduce anxiety.
Maintain a regular sleep schedule to support overall health and well-being.
Engage in light exercises like walking regularly, but avoid overexertion, which can exacerbate inflammation.
Eat slowly and mindfully, avoiding meals when anxious or angry.
Maintain a gap of 3-4 hours between meals and end the day with light soup or rice porridge.
Drink plenty of lukewarm water throughout the day to prevent dehydration and aid digestion.
Seek consultation with a qualified Ayurvedic practitioner for a personalized treatment plan based on individual constitution (Prakriti) and imbalances (Vikriti).
Ensure regular follow-up with your Ayurvedic practitioner to adjust the treatment plan as needed.
