Can ulcerative colitis affect pregnancy at 26?

Question

Hi doctor,

My 26-year-old daughter has been struggling with ulcerative colitis for four years, and it is affecting every aspect of her life. She has bloody diarrhea eight to 12 times daily and has to know where every bathroom is located before going anywhere. She was on Mesalamine for two years, but stopped working, so the gastroenterologist started Adalimumab injections. The biologic helped for about eight months, but now symptoms are coming back, and her inflammatory markers are rising again. Her hemoglobin dropped to 8.9 from chronic bleeding, and she needs iron infusions monthly.

The worst part is that she just started dating someone seriously, but feels embarrassed about her condition and avoids eating out or traveling. Also worried about having children someday because she read that ulcerative colitis can affect pregnancy, and some medications are not safe. Her colonoscopy last month showed active inflammation from the rectum to the descending colon. Can this disease ever go into permanent remission?

Thanks.

Answer 1

Hi,

Welcome to icliniq.com.

I can understand your concern.

Ulcerative colitis can be an exhausting and life-altering disease, especially when symptoms remain active despite multiple treatments, and, understandably, your daughter feels overwhelmed and limited in both her health and personal life.

While the condition is chronic and currently has no known cure, many patients can achieve long-term remission with the right treatment plan. Some respond well to switching biologics (for example, from Adalimumab to Infliximab, Vedolizumab, Ustekinumab, or newer small molecule therapies like Janus kinase inhibitors), and others may eventually require combination therapy or, in cases where medical treatments fail, surgical removal of the colon, which can be curative for ulcerative colitis, though it comes with its own considerations.

The fact that her disease extends from the rectum to the descending colon shows a moderate extent, and persistent inflammation increases risks such as anemia, poor quality of life, and long-term colon cancer risk, making tighter disease control very important.

Regarding pregnancy, most women with ulcerative colitis can have healthy pregnancies, especially if conception happens during a period of remission; some medications (like Mesalamine and certain biologics) are considered safe in pregnancy, but others are not, so planning with her gastroenterologist and a maternal-fetal medicine specialist is key.

It may help her to know that remission is possible, sometimes lasting years, with the right therapy, and that she is not alone in navigating the emotional and social challenges of living with IBD (irritable bowel disease). Support groups, counseling, and open communication with her partner can make a big difference while medical therapy is being optimized.

I hope this information is helpful to you.

Thanks.