Treating Ulcerative Colitis: Understanding Your Options

The goal of treatment is to control inflammation and achieve and maintain remission.

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Ulcerative colitis (UC) is a chronic inflammatory bowel disease that causes irritation, swelling, and sores (ulcers) on the inner lining of the colon. Each year, 38,000 Americans are diagnosed with ulcerative colitis, according to the Crohn’s and Colitis Foundation of America.

Ulcerative colitis symptoms vary greatly among different individuals. “Some patients may have just mild symptoms … and go on for years,” says Sergey Khaitov, MD, surgeon at Mount Sinai Beth Israel. “Some patients may have such severe disease they may require emergency surgery within days after the disease started.” These symptoms may include:

  • Loose and bloody stool
  • Frequent diarrhea
  • Ulcers (open sores in the colon and rectal lining)
  • Abdominal pain
  • Weight loss
  • Loss of appetite
  • Fatigue
  • Delayed growth

There’s no cure for UC, but a proper treatment plan can help patients manage symptoms and even achieve remission—which is a period of no symptoms—for years. “Primarily the goal of treatment these days is not just to deal with the symptoms, but to really try to get the underlying inflammation under control so that the patients don't have symptoms that need to be treated anymore,” says Todd Linden, MD, a gastroenterologist in New York City.

How Ulcerative Colitis Is Treated

The goal of treatment for UC is to control inflammation, and achieve and maintain remission. Medications to treat UC include: aminosalicylates (5-ASAs), corticosteroids, immune modifiers (immunomodulators), biologics, antibiotics, and OTC medications, such as antidiarrheals and pain relievers.

Aminosalicylates (5-ASAs) decrease inflammation in the intestinal lining and are good for mild to moderate UC symptoms. They are available in oral or rectal form.

Corticosteroids. Steroids suppress the immune system to help reduce inflammation. They are helpful for moderate to severe UC, but are not recommended as a long-term treatment because they can cause a dependence or resistance to steroids. They are available orally, as an injection, rectally, or intravenously.

Immune modifiers (immunomodulators) also suppress the immune system to help reduce inflammation. These medications are available orally or by injection.

Biologics suppress the immune system and reduce inflammation, and are a good option for people who haven’t responded to other medications. Biologic therapies are available orally or by injection.

Antibiotics may be used to help treat infections and complications of UC.

Over-the-counter medications, such as pain killers or antidiarrheals, may be helpful for symptom management, but not so much for treating the disease itself. “The only things that the over-the-counter [medications] help us with is symptomatic treatment for some of the symptoms of colitis, but really in terms of treating the underlying disease process, none of the over-the-counter stuff have really been shown to do very much,” says Dr. Linden.

“For people who are in active disease, if they are not responding to the medicines that we are using for maintenance, then we will probably intensify the regimen,” says Dr. Linden. “We will leave people on whatever agents it took to get them into remission. 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.”

Lifestyle Changes That May Help Ulcerative Colitis

While there are no recommended lifestyle changes to help a patient reduce inflammation or achieve remission with UC, there are a few tweaks that may help with flare management.

Some of these include eating a well-balanced diet and keeping a journal to track foods that may aggravate UC symptoms during flare-ups. “We need people to have good nutrition to be able to heal well,” says Dr. Linden.

Other habits, like not managing stress or following your UC treatment regimen can also affect ulcerative colitis flares.

Skipping or taking the wrong dose of your UC medication can cause inflammation and symptoms to return. During remission, you should continue taking medications at the correct dose and at the scheduled time.

“We really try to encourage people to understand that the treatments have come so far that they will likely have a completely normal life. They will get the illness under control, which is what happens the vast majority of the time,” says Dr. Linden. “The vast majority of people will be totally in remission and happy and healthy and unbothered by this for the rest of their life.”