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Ulcerative colitis is a chronic inflammatory bowel disease that mainly affects the large intestine and rectum. It can cause bloody diarrhea, abdominal pain, mucus in the stool, weakness, and weight loss. A medical diagnosis is important because its symptoms can resemble hemorrhoids, an intestinal infection, or Crohn's disease.

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Bloody stools, recurring diarrhea, abdominal pain, or mucus in the stool often leave people wondering: is this hemorrhoids, an intestinal infection, or a sign of a more serious illness? One condition that can cause these complaints is ulcerative colitis, known in Indonesian as kolitis ulseratif.

Ulcerative colitis is a chronic inflammatory bowel disease that mainly affects the large intestine and rectum. The condition can flare up and subside. Understanding its symptoms and tests therefore helps you make decisions more calmly: when to monitor, when it is advisable to consult a doctor, and when complaints should not be put off. Ulcerative colitis is a chronic inflammatory bowel disease associated with an abnormal immune reaction that causes inflammation of the inner lining of the large intestine.

Although ulcerative colitis is not a primary heart disease, the body works as one system. Chronic inflammation, anemia, dehydration, or the risk of blood clots in some cases can affect a person’s general condition. That is why clear education is important, so that patients do not panic but also do not delay seeking medical help.

What Is Ulcerative Colitis

Ulcerative colitis is a chronic inflammatory bowel disease that causes inflammation of the inner lining of the large intestine and rectum. Symptoms can include bloody diarrhea, abdominal pain, mucus in the stool, frequent urges to have a bowel movement, weakness, fever, or weight loss. The condition can flare up and subside, so diagnosis and medical monitoring are important.

The terms ulcerative colitis and kolitis ulseratif refer to the same condition. In everyday Indonesian, this condition is often associated with radang usus besar (“inflammation of the large intestine”). However, inflammation of the large intestine is a broader term, so not every case of colon inflammation automatically means ulcerative colitis. An educational article from the Indonesian Ministry of Health through Dr. Soeradji Tirtonegoro Central General Hospital (RSUP dr. Soeradji Tirtonegoro) lists ulcerative colitis as one of the major types of inflammatory bowel disease.

Ulcerative colitis needs attention because its symptoms can come and go. When symptoms subside, the patient may enter a phase of remission. However, the symptoms can later return or flare up again. The NIDDK states that periods of remission can last for weeks to years, after which symptoms can return.

Symptoms of Ulcerative Colitis

The symptoms of ulcerative colitis can differ from person to person. Some patients have mild complaints, while others have more severe and more frequent symptoms. The symptoms that most often prompt people to look for information are bloody stools, bloody diarrhea, abdominal pain, and mucus in the stool.

Symptoms to recognize include:

Diarrhea, especially if it keeps coming back.
Blood in the stool or bleeding from the rectum.
Mucus or pus in the stool.
Abdominal pain or cramps.
A sudden urge to have a bowel movement.
A constant feeling of needing to have a bowel movement even though the bowel feels empty.
Weakness or tiring easily.
Fever.
Nausea or vomiting in certain conditions.
Weight loss.

Diarrhea, blood in the stool, abdominal pain or cramps, mucus or pus in the stool, tenesmus, and a sudden urge to have a bowel movement are common symptoms of ulcerative colitis. In addition, symptoms such as fatigue, fever, nausea, vomiting, and weight loss are more likely to appear when the inflammation is more severe or affects a larger part of the large intestine.

Bloody Stools Are Not Always Hemorrhoids

It is true that hemorrhoids can cause blood during bowel movements. However, bloody stools can also occur because of digestive tract infections, sores in the digestive tract, inflammatory bowel disease, or other conditions that need to be examined.

So pay attention to the pattern of your symptoms. If bloody stools keep recurring, or come with diarrhea, mucus in the stool, abdominal pain, fever, weakness, or weight loss, it is advisable not to simply wait. A medical examination can help determine the cause.

Heartology recommends seeking a medical evaluation if you experience a long-lasting change in bowel habits, blood in the stool, diarrhea that does not improve with over-the-counter medication, diarrhea that wakes you from sleep, or an unexplained fever that lasts more than one to two days.

Differences From Other Conditions

Ulcerative colitis can resemble several other conditions. Symptoms alone are therefore not enough to confirm a diagnosis. The following table gives an initial overview, but it does not replace an examination by a doctor.

Condition	General description	Complaints that may look similar	Important notes
Ulcerative colitis	Chronic inflammation of the large intestine and rectum	Bloody diarrhea, mucus in the stool, abdominal pain, frequent urges to have a bowel movement	Requires a medical evaluation, including blood tests, stool tests, endoscopy/colonoscopy, or a biopsy if needed.
Crohn’s disease	A chronic inflammatory bowel disease that can affect a wider area of the digestive tract	Diarrhea, abdominal pain, weight loss, weakness	Differs from ulcerative colitis because it can involve other parts of the digestive tract and deeper layers of the intestinal wall.
Hemorrhoids	Swollen blood vessels in the anal or rectal area	Blood during bowel movements, pain or itching around the anus	Usually do not cause chronic bloody diarrhea, fever, or weight loss.
Intestinal infection	Inflammation caused by bacteria, viruses, parasites, or contaminated food/drinks	Diarrhea, abdominal pain, fever, sometimes blood/mucus	Often acute, but should be checked if it is severe, bloody, or not improving.

Crohn’s disease can affect a wider part of the digestive tract and often involves the small intestine, while ulcerative colitis is limited to the large intestine and rectum.

Ulcerative Colitis vs. Crohn’s Disease

Ulcerative colitis and Crohn’s disease are both forms of inflammatory bowel disease, a group of chronic inflammatory conditions of the intestines. The difference lies in the location and pattern of the inflammation. Ulcerative colitis mainly affects the large intestine and rectum, while Crohn’s disease can affect a wider part of the digestive tract.

For readers, the key point is simple: do not try to tell the two apart based on symptoms alone. Both conditions can cause diarrhea, abdominal pain, weakness, and weight loss. An examination by a doctor is still needed.

Ulcerative Colitis vs. Hemorrhoids

Hemorrhoids are usually related to swollen blood vessels around the anus or rectum. Complaints can include fresh blood during bowel movements, pain, itching, or a lump in the anal area.

On the other hand, ulcerative colitis is related to chronic inflammation of the large intestine and rectum. Both can cause blood during bowel movements, but ulcerative colitis is more often accompanied by recurring diarrhea, mucus, abdominal pain, or systemic symptoms such as weakness and weight loss.

Ulcerative Colitis vs. Intestinal Infection

Intestinal infections often appear more suddenly, for example after consuming contaminated food or drinks. Complaints can include diarrhea, abdominal pain, nausea, vomiting, or fever.

Meanwhile, ulcerative colitis tends to be chronic and can flare up. Stool tests can help the doctor rule out infection or look for signs of inflammation in the intestines. Stool tests can be used to check for conditions other than ulcerative colitis, including infections that may cause similar symptoms.

Causes and Risk Factors

The exact cause of ulcerative colitis is not yet fully known. However, experts believe the condition likely involves a combination of the immune system, genetic factors, the gut microbiome, and environmental factors.

In other words, ulcerative colitis is not simply the result of “eating the wrong things” or “not taking care of yourself”. This explanation is important so that patients do not feel blamed.

Factors that may play a role include:

An abnormal immune response. The immune system, which should protect the body, can trigger excessive inflammation in the digestive tract.
Genetic factors. A family history of inflammatory bowel disease can increase a person’s likelihood of developing a similar condition.
The gut microbiome. Differences in the balance of bacteria, viruses, and fungi in the digestive tract are thought to play a role in inflammatory bowel disease.
Environmental factors. Lifestyle, environmental exposures, and other external factors are still being studied.

The National Institute of Diabetes and Digestive and Kidney Diseases states that genes, abnormal immune reactions, the microbiome, and the environment may play a role in ulcerative colitis, although the exact cause has not yet been determined.

Does Stress Cause Ulcerative Colitis?

Stress is not the sole cause of ulcerative colitis. However, stress can affect bowel function and worsen digestive complaints in some people.

Diet and stress were once thought to be causes, but current medical understanding considers them factors that can worsen symptoms, not direct causes.

Does Food Cause Ulcerative Colitis?

No single type of food has been shown to directly cause ulcerative colitis in everyone. However, certain foods can trigger complaints in some patients, especially when the disease is active.

Researchers have not found specific foods that cause or worsen ulcerative colitis symptoms in all patients. Even so, your doctor may suggest keeping a food diary to help identify foods that seem to be linked to your symptoms.

Diagnosing Ulcerative Colitis

Ulcerative colitis cannot be diagnosed from symptoms alone. Bloody stools and diarrhea can occur in many conditions, so the doctor needs to determine the cause step by step. In addition, tests help assess how severe the inflammation is and which parts of the large intestine are involved.

In general, the diagnostic process may include:

A medical interview about your symptoms, how long the complaints have lasted, bowel patterns, medication history, and family history.
A physical examination, including vital signs and an abdominal examination.
Blood tests to look for anemia, signs of inflammation, or signs of infection.
Stool tests to rule out infection and assess signs of inflammation.
Endoscopy of the large intestine, such as a colonoscopy or flexible sigmoidoscopy.
A biopsy of intestinal tissue if needed.

Doctors diagnose ulcerative colitis by reviewing medical and family history, performing a physical examination, and using medical tests such as blood tests, stool tests, and endoscopy of the large intestine. The tests also aim to rule out infection, irritable bowel syndrome, or Crohn’s disease, which can cause similar symptoms.

Why Might a Colonoscopy Be Needed?

A colonoscopy helps the doctor see the inner lining of the large intestine directly. This examination can show the location, extent, and degree of inflammation.

If needed, the doctor can take a small tissue sample, or biopsy, to be examined in the laboratory. Endoscopy of the large intestine with a biopsy is used to diagnose ulcerative colitis, assess the severity of the disease, and rule out other digestive conditions.

Notes Before Your Consultation

To make your consultation more efficient, prepare some simple notes. This helps the doctor understand the pattern of your complaints, not just a single episode of symptoms.

Write down the following:

When the diarrhea or bloody stools started.
How many bowel movements you have per day.
Whether there is blood, mucus, or pus.
Whether the abdominal pain appears before, during, or after a bowel movement.
Whether there is fever, nausea, vomiting, weakness, or weight loss.
Over-the-counter medications, antibiotics, supplements, or herbal products you have taken.
Any family history of inflammatory bowel disease.
Foods or situations that seem to worsen your complaints.
Whether diarrhea wakes you from sleep.

Treating Ulcerative Colitis

The treatment of ulcerative colitis aims to reduce inflammation, relieve symptoms, maintain remission, and prevent complications. Because the severity and location of the inflammation can differ from patient to patient, therapy must be tailored to each person’s condition.

Treatment options may include:

Anti-inflammatory medications to help reduce inflammation.
Corticosteroids for certain conditions, generally not for long-term use.
Medications that affect the immune response in moderate to severe cases.
Biologic therapy or targeted therapy for certain patients.
Additional medications to help with symptoms or complications, as the doctor considers appropriate.
Surgery for severe cases, complications, or conditions that do not improve with medication.

Doctors prescribe medications to reduce inflammation in the large intestine and help patients achieve and maintain remission. The type of medication used depends on the severity of the ulcerative colitis, and surgery may be considered in certain situations, such as severe complications or symptoms that do not improve with medication.

Can Ulcerative Colitis Be Cured Completely?

Ulcerative colitis is a chronic condition. This means treatment usually focuses on controlling the inflammation and keeping the symptoms under control.

Many patients can still lead productive lives if their condition is monitored and treated appropriately. Medication does not yet cure ulcerative colitis permanently, but it can reduce symptoms, help the intestinal lining heal, and support long-term remission.

Why Is Self-Medication Not Advisable?

Self-medication risks delaying a diagnosis. For example, antidiarrheal medication can make complaints feel better temporarily, while the cause of the bleeding remains unknown.

In addition, not all over-the-counter medications are safe for every condition. Heartology advises patients to talk to a doctor before using over-the-counter medications; in patients with ulcerative colitis, certain nonsteroidal anti-inflammatory drugs can worsen symptoms.

Complications to Watch For

Not all patients with ulcerative colitis develop complications. However, understanding the risks helps patients know when symptoms need to be taken more seriously.

Possible complications include:

Anemia due to bleeding.
Dehydration due to severe diarrhea.
Weight loss or nutritional problems.
Inflammation outside the intestine, for example in the joints, skin, or eyes.
Osteoporosis in certain conditions.
A risk of colon cancer, especially with extensive and long-standing disease.
Severe bleeding.
Toxic megacolon.
Blood clots in the blood vessels.

Mayo Clinic lists potential complications of ulcerative colitis such as severe bleeding, severe dehydration, anemia, osteoporosis, inflammation of the skin/joints/eyes, an increased risk of colon cancer, toxic megacolon, and an increased risk of blood clots in the veins and arteries.

Warning Signs That Should Not Be Put Off

Seek medical help immediately if you experience:

Heavy rectal bleeding or passing blood clots.
Severe or very frequent diarrhea.
Severe or persistent abdominal pain.
High fever.
Continuous vomiting.
Signs of dehydration, such as extreme thirst, dizziness, very little urine, or severe weakness.
Shortness of breath.
Chest pain.
Severe palpitations.
Nearly fainting or fainting.
Swelling and pain in the leg, especially on one side.

Patients are advised to contact a healthcare provider promptly if they experience persistent severe diarrhea, bleeding from the anus with clots in the stool, ongoing pain, or a high fever.

The Link With the Heart

Ulcerative colitis is not a primary heart disease. However, as a chronic inflammatory disease, it can affect the body as a whole. This is where the discussion of ulcerative colitis becomes relevant to holistic health education.

There are several pathways to understand:

Anemia can occur if bleeding happens repeatedly. When red blood cells are low, the body may feel weak, palpitate easily, feel dizzy, or become short of breath during activity.
Dehydration due to severe diarrhea can affect blood pressure, heart rate, and the body’s fluid balance.
Systemic inflammation can be linked with complaints outside the digestive tract, such as in the joints, skin, eyes, or the body’s general condition.
Blood clots can be a serious complication in some patients, especially when the disease is active, severe, or accompanied by other risk factors.

Ulcerative colitis can increase the risk of blood clots and anemia, and Mayo Clinic also lists an increased risk of blood clots as one of the possible complications.

When Is a Cardiovascular Evaluation Needed?

Not all patients with ulcerative colitis need a heart examination. However, a cardiovascular evaluation may be considered if digestive complaints are accompanied by:

Shortness of breath.
Severe palpitations.
Chest pain.
Unusual, severe weakness.
Severe dizziness, nearly fainting, or fainting.
Swelling, pain, or a heavy feeling in the legs.
A history of heart or blood vessel disease.
Risk factors such as hypertension, diabetes, high cholesterol, smoking, or a family history of heart disease.

The key point: this link needs to be understood in proportion. Ulcerative colitis does not automatically mean a person has heart disease. However, if there are systemic or cardiovascular complaints, a medical examination helps determine the cause and the appropriate next steps.

Living With Ulcerative Colitis

Living with ulcerative colitis is not only about managing diarrhea. A chronic condition can affect energy, eating patterns, work, social activities, and self-confidence.

That is why a good approach is usually a comprehensive one: medical treatment, regular monitoring, adequate nutrition, stress management, and family support.

Some steps that may help:

Take your medication as directed by your doctor, including when your symptoms improve.
Learn your pattern of relapses and the early symptoms of a flare.
Record your bowel movement frequency, blood/mucus, pain, and suspected triggers.
Stay hydrated, especially when you have diarrhea.
Eat a balanced diet according to what your body tolerates.
Avoid extreme diets without guidance from a doctor or dietitian.
Manage stress, get enough sleep, and stay active within your abilities.
Discuss the psychological impact if the disease starts to interfere with your activities or makes you anxious.

Heartology emphasizes the importance of working together with your healthcare team, using medication as prescribed, and understanding how the risk of complications affects your care plan.

A Food Diary to Identify Triggers

A food diary is not meant to find “the food that causes ulcerative colitis”. Instead, these notes help you find your personal patterns.

Record the following:

The food and drinks you consume.
Mealtimes.
Bowel movement frequency.
Whether there is blood or mucus.
Abdominal pain, bloating, or nausea.
Sleep quality.
Stress level.
Medications you are currently taking.

Your doctor may suggest a food diary to help identify foods that seem to worsen your symptoms.

Psychosocial Support and Quality of Life

Ulcerative colitis can feel exhausting both physically and emotionally. Worrying about finding a toilet, fearing that bloody stools will return, or feeling anxious when traveling can make a person limit their activities.

Family support and open communication with your doctor are important. If anxiety, stress, or feelings of isolation start to interfere with daily life, psychological support can be part of your care.

When to See a Doctor

Consider consulting a doctor promptly if you experience:

Recurring bloody stools.
Diarrhea that lasts several days or often comes back.
Abdominal pain that does not improve.
Stool with mucus or pus.
Fever.
Unexplained weight loss.
Weakness, paleness, or palpitations that come on easily.
Diarrhea that wakes you from sleep.
Complaints that interfere with work, sleep, or daily activities.

An initial evaluation can start with a general practitioner or an internal medicine specialist. If chronic inflammatory bowel disease is suspected, the patient may be referred to a gastroenterohepatology consultant (an internal medicine subspecialist in digestive and liver diseases). Meanwhile, if there are complaints such as chest pain, shortness of breath, severe palpitations, fainting, or concerns about the blood vessels, a cardiovascular evaluation may be considered depending on the condition.

The symptoms of ulcerative colitis often first lead patients to primary care, after which the doctor may refer them to a gastroenterologist, a specialist who treats diseases of the digestive tract.

Conclusion

Ulcerative colitis is a chronic inflammatory bowel disease that can cause bloody diarrhea, mucus in the stool, abdominal pain, frequent urges to have a bowel movement, weakness, and weight loss. Its symptoms can flare up and subside, so a diagnosis should not be based on personal guesswork alone.

Bloody stools do not always mean ulcerative colitis. However, if the complaints keep recurring or come with other symptoms, a medical examination can help determine the cause. With the right diagnosis, appropriate treatment, and long-term monitoring, many patients can control their symptoms and maintain their quality of life.

Understanding ulcerative colitis early helps you make health decisions more calmly. Heartology is here as a caring and holistic source of health education, especially when digestive complaints come with concerns about your overall condition, your heart, or your blood vessels.

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The information on this page is for educational purposes and does not replace medical consultation, diagnosis, or treatment. For any health concerns, please consult a doctor directly.

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Reviewer

Translated from the Indonesian edition medically reviewed by dr. Debby C. Soemitha, Sp.PD, Internal Medicine on July 6, 2026.

Sources as cited in the Indonesian edition.