Diagnosis of ulcerative colitis: tests, treatments and stories

Ulcerative colitis is a long-term disease that affects the large intestine. It swells the lining of the colon, which leads to open sores and ulcers. Ulcerative colitis is a type of inflammatory bowel disease (IBD).

Ulcerative colitis diagnostic tests may include blood tests, stool tests, and colonoscopies. Doctors may start by asking the person questions about their family history and symptoms.

This article explains how doctors diagnose ulcerative colitis and what a person can expect during this process. It also includes firsthand stories from Daisy Warner, who was diagnosed with ulcerative colitis in 2012 and is now in remission.

To diagnose ulcerative colitis, doctors ask several questions and perform a series of tests. The sections below look at some of these tests in more detail.

Family and medical history

Doctor can ask one person on the following topics.

Some typical symptoms ulcerative colitis may include:

Learn more about the symptoms of ulcerative colitis here.

Physical examination

A physical exam may involve:

  • check the person’s blood pressure, temperature, and heart rate
  • listening to the person’s stomach with a stethoscope
  • check for tenderness or lumps by pressing on the person’s stomach

Sometimes the doctor may also do a digital rectal exam. This means gently inserting a lubricated finger into the rectum to check for signs of ulcerative colitis.

Blood tests

During a blood test, a healthcare professional uses a needle to draw a small amount of blood from a person’s arm. They then send this sample to a lab, where a scientist looks for signs of ulcerative colitis. including signs of infection, anemia or inflammation.

Stool tests

To perform a stool test, a doctor or nurse gives the person a container and asks them to put a small amount of stool in it. A scientist then analyzes the stool for signs of ulcerative colitis.

Endoscopy and colonoscopy

An endoscope is a long, flexible tube with a small camera and a light at the end. When a doctor uses this tool to examine the inside of the large intestine, the procedure is known as a colonoscopy.

A healthcare professional usually asks the person to prepare their bowels for this procedure. For example, they may recommend following a clear liquid diet for 1-3 days previously. Alternatively, they can prescribe a combination of laxatives. This will cause diarrhea to make sure the bowel is clear before the procedure.

The colonoscopy takes 30 to 60 minutes. The healthcare professional will usually administer sedatives or pain relievers and ask the person to lie on their side. They then insert the tube through the anus, into the rectum, and then into the colon.

Learn how to prepare for a colonoscopy here.


Doctors can also use the endoscope to perform a biopsy during this procedure. This means removing parts of the lining of the colon and checking them under a microscope for signs of ulcerative colitis.

There is currently no cure for ulcerative colitis. Doctors generally recommend a combination of treatments to help reduce inflammation and relieve symptoms. It is important to remember that treatment can vary from person to person.

The sections below look at some treatment options in more detail.


Certain drugs that can help treat ulcerative colitis include:

Lifestyle changes

According to National Institute of Diabetes and Digestive and Kidney Diseases, people with ulcerative colitis should try to eat a healthy, balanced diet. Some foods can make ulcerative colitis worse, but these foods can vary from person to person.

Many people with ulcerative colitis find it helpful to keep a food diary so they can identify foods that affect their symptoms and then avoid them.

Learn more about foods to eat and avoid with ulcerative colitis here.


If medications and lifestyle changes don’t work, doctors may suggest surgery. The two main types ulcerative colitis surgery are:

  • Surgery of the ileo-anal reservoir: Surgeons remove the colon and rectum, then use the end of the small intestine to make a pocket. They then attach the pouch to the anus. After the operation, stool collects in the pouch and passes through the anus.
  • Ileostomy: Surgeons remove the colon and rectum, then attach the end of the small intestine to an opening in the abdomen. Doctors call this opening a stoma. After the operation, stool passes through the stoma into an ostomy pouch, which is a bag that the person wears on the outside of the body.

Learn more about ulcerative colitis treatment options here.

The specific carbohydrate diet involves cutting out foods that contain disaccharides and most polysaccharides, such as grains, dairy products, and most sugars. A person can include foods that contain monosaccharides, such as fruits, nuts, non-starchy vegetables, meat, and fish.

Step therapy

Health insurance companies sometimes use a protocol called step therapy for people who have been diagnosed with ulcerative colitis. This is aimed at providing people with cheaper alternatives to drugs that a doctor recommended before trying more expensive options if those more affordable drugs don’t work.

In a 2016 survey of 2,600 people with IBD, 40% of them had undergone step therapy. Of those, 59% said they couldn’t start their recommended treatment plan within 3 months because of it.

Knowing about step therapy is crucial to understanding how to reform it. The Crohn’s and Colitis Foundation suggests that people work closely with their healthcare team and their insurance company to navigate the calls for this process.

A person can also join the Crohn’s and Colitis Foundation Advocacy Network to support transparent appeals and clear timelines.

Clinical tests

A doctor may mention clinical trials when discussing treatment options for ulcerative colitis. Clinical trials may involve participating in a study that examines the effect of certain treatment options that might not be widely available.

One such option for ulcerative colitis is a fecal transplant. Learn more about fecal transplants for ulcerative colitis here.

A doctor should inform the person of the risks involved to help them decide whether or not to participate.

Learn more about clinical trials for ulcerative colitis here.

Ulcerative colitis is a long-term disease that affects the large intestine. A failure of the immune system is the cause.

Doctors perform several tests to diagnose ulcerative colitis. These can include blood and stool tests, physical exams, and endoscopies.

There is currently no cure for ulcerative colitis, but people can try dietary changes, lifestyle changes, and certain medications to manage their symptoms. That said, some people may need an operation to remove their colon and rectum.

The process of finding and receiving a diagnosis of ulcerative colitis can be difficult. It can be helpful to listen to how other people have overcome the challenges of living with the disease.

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About Catherine Sherrill

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