In Remission with Ulcerative Colitis? Why Continuing Treatment Is Vital

Ulcerative colitis, or UC, cannot be cured, but it can be managed. “When we think about treating ulcerative colitis, our goal now is to get the inflammation itself under control,” says Todd B. Linden, MD, gastroenterologist. When inflammation is lowered, many people will enter a state of remission, or a period with little to no symptoms.

But reaching the point of remission doesn’t mean treatment is over. Remission is a break from symptoms, not treatment. Remission can only occur—and be maintained—by consistent treatment, even when symptoms are mild or not present. Sustained remission means your treatment is doing its job.

It’s tempting for individuals with UC to relax their treatment efforts when they’re not dealing with painful and disruptive UC symptoms, such as frequent diarrhea and abdominal pain. Here are some reasons people cite for not maintaining UC treatment, according to a 2017 study in the journal Patient Preference and Adherence:

• Not seeing the point of taking medications if no symptoms are occurring
• Forgetting to take medications
• Inconvenient medication schedules or pill burden
• Being in denial about having an illness
• And depression. 

Treatment to Maintain Remission

Doctors may prescribe different types of medications depending on whether you are in remission or having a flare of UC symptoms. Medications for flare-ups are more potent and aggressive, and they may cause side effects.

To make treatment for UC more sustainable, your doctor will prescribe a medication specifically for remission, known as “maintenance therapies.” These medications cause fewer side effects and better tolerated by the body long-term.

Medications for remission may include:

• 5-ASAs, or aminosalicylates: These decrease intestinal inflammation and are available in oral or rectal form.

• Immune modifiers, or immunomodulators: These suppress the immune system to reduce inflammatory attacks. They are available in oral or injection form.

• Biologics: These also suppress the immune system, and are also available in oral and injection form.

In addition to maintenance therapy drugs, lifestyle habits to manage UC are also important to stay in remission.

If you ever think your medications aren’t right for you—whether they don’t seem to be working or you find them hard to stick with—talk to your doctor. Skipping or altering doses without discussing with your doctor could lead to a flare-up, and uncontrolled UC can lead to possible complications of UC.

“Often, we will leave people on whatever agents it took to get them into remission,” says Dr. Linden. “We’ll often leave them on those same agents because we think that’s what they need to keep their disease under control, and that’s probably what’s going to lead to a long-term remission.”