Ulcerative Colitis and C. Diff: What You Need to Know
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Why Ulcerative Colitis Puts You at Risk for C. Diff and What to Do About It

Why Ulcerative Colitis Puts You at Risk for C. Diff and What to Do About It
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Updated on July 7, 2025
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Fever, nausea, cramping, and diarrhea — if you have ulcerative colitis (UC), you probably know that those symptoms signal a flare. The same symptoms can also be a Clostridioides difficile (C. diff) infection.

C. diff is a highly contagious bacterium that infects the large intestine and causes inflammation in the colon. People with inflammatory bowel disease (IBD) are particularly susceptible to the infection.

Unlike other bacterial infections that affect the large intestine, C. diff can cause serious complications, especially for people with UC.

Here’s what to know about C. diff, how it spreads, how it’s treated, and what you can do to avoid becoming infected.

Ulcerative Colitis and C. Diff: Understanding Your Risk

“The relationship between C. diff and IBD isn’t well understood, but it’s thought that inflammation present in the gut can create a more supportive environment for C. diff to thrive,” says Megan Hilbert, RDN, with Top Nutrition Coaching in Madison, Wisconsin.

The infection often develops after taking a course of antibiotics, which kill off good bacteria and cause C. diff to spread quickly, causing inflammation and other symptoms, says Kelley Shackelford, MD, an internal medicine specialist at Orlando Health Physician Associates in Florida.

Not everyone is aware that they’re carrying C. diff, which means they can unknowingly spread the bacterium to others. In healthy people, the “good” bacteria normally present in the gut (the gut microbiome) can help keep C. diff from spreading unchecked.

C. diff can spread via the stool if, for example, someone doesn’t wash their hands after using the bathroom. If you inadvertently ingest this bacterium by mouth, the spores are released into your body, causing inflammation in the cells lining the large intestine.

Around half a million people in the United States will become infected with C. diff every year. Risk factors other than having IBD include being 65 or older, having a weakened immune system (which can occur in people who are taking immunosuppressive drugs), and having previously had a C. diff infection.

C. diff is also a major risk for people in hospitals, who may have weakened immune systems. Proper hygiene and infection control are critical in a hospital setting.

One in 9 people who’ve had C. diff will get it again in the following two to eight weeks; this is known as recurrent C. diff.

Symptoms of C. Diff

The symptoms of a C. diff infection can mimic those of a UC flare. Symptoms include:

What to Do If You Think You Have a C. Diff Infection

Anytime you’re experiencing “symptoms of watery diarrhea, abdominal pain, or nausea, consult your doctor immediately,” says Dr. Shackelford. Often, doctors will want to take a stool sample to make sure you have C. diff rather than a UC flare.

If you test positive for C. diff, your treatment will depend on the severity of the infection. Your doctor will most likely prescribe you an antibiotic that specifically kills C. diff bacteria.

Other cases of C. diff require more serious treatment. “If you have severe symptoms, such as signs of dehydration or fever, I recommend going to the hospital to be monitored closely with antibiotics and IV fluids,” says Shackelford.

Very severe cases (known as fulminant C. diff) may require surgery such as a total abdominal colectomy, which involves removing a large part of the colon and performing an ileostomy, in which feces is rerouted and released into an ostomy bag outside of the body, says Shackelford.

People with recurrent C. diff may be candidates for fecal microbiota transplantation (FMT), in which stool from a healthy donor is introduced into the GI tract (usually via a colonoscopy or through oral pills), where it will help restore healthy bacteria to the gut. FMT is approved by the U.S. Food and Drug Administration to treat recurrent C. diff.

The Takeaway

  • C. difficile is a bacterium that can cause a serious, even life-threatening infection; people with ulcerative colitis have a higher risk of contracting the infection.
  • C. diff often occurs after taking antibiotics. It is also spread via fecal matter, so practicing good hygiene after using the bathroom is essential.
  • If you think you may have a C. diff infection, don’t hesitate to contact your doctor, even if you’re unsure what’s causing your symptoms. A simple stool test can be used to make a diagnosis and point you toward the right treatment.

Resources We Trust

    EDITORIAL SOURCES
    Everyday Health follows strict sourcing guidelines to ensure the accuracy of its content, outlined in our editorial policy. We use only trustworthy sources, including peer-reviewed studies, board-certified medical experts, patients with lived experience, and information from top institutions.
    Resources
    1. C. diff (Clostridioides difficile) Infection. Cleveland Clinic. November 19, 2024.
    2. Dalal RS et al. Diagnosis and Management of Clostridioides difficile Infection in Patients with Inflammatory Bowel Disease. Current Opinion in Gastroenterology. July 1, 2021.
    3. About C. diff. Centers for Disease Control and Prevention. December 18, 2024.
    4. Turner NA et al. Hospital Infection Control: Clostridioides difficile. Clinics in Colon and Rectal Surgery. February 25, 2020.
    5. After C. diff: Caring for Yourself and Others. Centers for Disease Control and Prevention. December 13, 2024.
    6. C. difficile Infection: Diagnosis and Treatment. Mayo Clinic. September 1, 2023.
    7. McKechnie T et al. Total Abdominal Colectomy Versus Diverting Loop Ileostomy and Antegrade Colonic Lavage for Fulminant Clostridioides Colitis: Analysis of the National Inpatient Sample 2016–2019. Journal of Gastrointestinal Surgery. July 2023.
    8. Fecal Transplant. Johns Hopkins Medicine.
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    Yuying Luo, MD

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    Yuying Luo, MD, is an assistant professor of medicine at Mount Sinai West and Morningside in New York City. She aims to deliver evidence-based, patient-centered, and holistic care for her patients.

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