The onset may be sudden or insidious. In the ACUTE form there is severe diarrhoea and the patient may pass up to 20 stools a day containing blood, pus and mucus. There is always fever, which runs an irregular course. With more insidious onset the patient first notices some irregularity of the movement of the bowels, with the passage of blood. This becomes gradually more marked. There may be pain but usually a varying amount of abdominal discomfort. The constant diarrhoea can lead to emaciation, weakness and ANAEMIA. As a rule the acute phase passes into a chronic stage with most patients suffering relapses for many years. Associated with the disease may be inflammation of the joints, eyes and skin. COLONOSCOPY, BIOPSY and abdominal imaging are essential diagnostic procedures.

Patients who are undernourished may need expert dietary assessment and appropriate calorie, protein, vitamin and mineral supplements, in the most severe cases with the help of PARENTERAL NUTRITION for a time. Nutritional treatment alone does not provoke REMISSION in ulcerative colitis. CORTICOSTEROIDS, given by mouth or by ENEMA, help control diarrhoea. MESALAZINE and SULFASALAZINE are helpful in the prevention of recurrences as is the immunosuppressant AZATHIOPRINE. The anaemia is treated with iron supplements, and with blood transfusions if necessary. If SEPTICAEMIA is suspected, broad-spectrum antibiotics are given. Surgery to remove part of the affected colon may be necessary and an ILEOSTOMY is sometimes required.