Treatment Options for Ulcerative Colitis

Medically Reviewed By Youssef (Joe) Soliman, MD
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No medication that will permanently cure ulcerative colitis (UC). However, treatments can help you manage the symptoms and regain control of your life. Symptoms of UC, such as abdominal cramps and diarrhea with blood or pus, may go away for a while, only to come back later.

Treatment for UC must be tailored to your needs. However, there are several options you and your doctor can choose.

This article will explain the main treatment options for ulcerative colitis. You can discuss with your doctor which might be right for you.

Key takeaways

  • Ulcerative colitis affects everyone differently, so a treatment that works well for someone else might not for you.
  • Four main types of medication are used to treat UC: aminosalicylates, corticosteroids, immunomodulators, and biologics.
  • Certain diet changes also may ease symptoms and promote healing.
  • Surgery may be needed if other treatments aren’t working or if serious complications arise.

Medication

a person with ulcerative colitis is taking pills
Maskot/Getty Images

The hallmark of UC is inflammation in the inner lining of the large intestine, which is composed of the colon and rectum. Medication can decrease this inflammation, allowing tissues to heal. This may bring on remission — a period when symptoms go away. Once your illness is in remission, medication may reduce future flare-ups.

Doctors use four main types of medication to treat UC. These are:

Drug typeExamplesAdministrationDetails
Aminosalicylatesbalsalazide (Colazal), mesalamine (Apriso, Asacol, Canasa, Lialda, Pentasa, Rowasa), olsalazine (Dipentum), sulfasalazine (Azulfidine)Take them orally or rectally.

These medications, which reduce inflammation, can help get mild to moderate symptoms under control.

They can also help maintain remission.

Corticosteroidsmethylprednisolone (Medrol), prednisolone (Pediapred Oral Liquid), prednisone (Deltasone)Take them orally, rectally, or through an IV.

These powerful medications, which decrease inflammation, can help control more severe flare-ups.

To minimize side effects, they are usually recommended only for limited-term use.

Immunomodulatorsazathioprine (Azasan, Imuran), cyclosporine (Gengraf, Neoral, Sandimmune), 6-mercaptopurine (Purinethol)Take them orally or through an IV.

These medications, which suppress the immune system, can help some people who do not respond to aminosalicylates and corticosteroids.

They are slow-acting, taking 3–6 months to be fully effective.

Biologicsinfliximab (Remicade), adalimumab (Humira)Take them through an IV once every 6–8 weeks for golimumab (Simponi), infliximab (Remicade), vedolizumab (Entyvio), or by injection at home, in the case of adalimumab.

This newer type of medication targets an inflammation-promoting protein called TNF.

Because of its different mode of action, it works for some people who do not respond to other therapies.

It may be helpful for maintaining remission or weaning off corticosteroids.

Combination therapy

Sometimes, doctors will give you more than one medication to try. This is called combination therapy. Work with your doctor to find the right dosage and combination for you.

Diet and nutrition

The word “diet” can have many meanings. This article uses the term “diet” to refer to an eating lifestyle rather than a temporary change in how you eat.

Changes in diet are often part of the treatment plan for UC. Such changes do not eliminate the underlying disease, but they may ease symptoms and promote healing. The exact diet recommended by your healthcare team will depend on your symptoms and reactions to foods.

For example, some people find that a low fiber diet reduces symptoms, and low fat diets can be especially useful during flares. Others experience less discomfort after eating if they have several small meals throughout the day rather than three large ones.

Learn more about meal planning with UC.

When you have a chronic disease such as UC, good nutrition is vital for your health. Yet abdominal cramps can reduce your appetite, and diarrhea can reduce minerals and fluids. So along with eating a balanced diet and drinking plenty of water, your healthcare team might suggest that you take certain supplements.

Learn more about dehydration.

Other diet tips that may help with UC symptoms include:

  • including probiotics
  • curcumin, from the herb turmeric
  • calcium supplements

There are also ways you can change your diet to allow periods of rest for your bowel. This can promote healing. Methods of doing this can include:

  • specialized diets
  • easy-to-digest meal substitutes, such as elemental formulations
  • fasting with intravenous feeding (total parenteral nutrition)

Learn the best and worst foods for UC.

Surgery

Most people with UC can control their symptoms effectively with medications and diet. However, surgical options for UC can include the removal of the rectum and part or all of the colon, called a colectomy or proctocolectomy, depending on what surgeons remove.

Doctors may recommend surgery if other treatments are not working well. In addition, surgery may be necessary to treat serious complications, such as massive bleeding, severe illness, rupture of the colon, or precancerous changes in the colon.

Pouch surgery

An operation called ileoanal pouch anastomosis (“pouch surgery”) allows many people to still have bowel movements after UC surgery.

In this operation, the anus and its muscles are left in place. Surgeons modify the lower end of the small intestine into a pouch and pull it down to attach to the anus. Once all parts heal, your body stores waste in the pouch and passes it through the anus in the usual way.

Learn more about living with an ostomy.

Frequently asked questions

The following are some frequently asked questions about treatment for ulcerative colitis.

How long does it take for ulcerative colitis to heal?

Ulcerative colitis never heals fully unless you undergo surgery to remove your colon. However, symptoms of the condition come and go in flares. Periods of remission can last months or even years.

Are bananas good for colitis?

Bananas are low in fiber, easily digested, and highly nutritious fruit.

Many people with ulcerative colitis find they can tolerate eating bananas even if their symptoms are flaring up.

Can colitis be caused by stress?

Stress can cause symptoms of ulcerative colitis to flare, according to a 2019 paper. Mindfulness techniques, such as meditation, may help relieve stress.

However, researchers are not yet sure what causes UC.

Summary

Treatment options for ulcerative colitis include medications, diet and lifestyle changes, and surgery. Medications are usually the first-line treatment and can include aminosalicylates, corticosteroids, immunomodulators, and biologics. Your doctor may recommend a combination of different treatments.

Ulcerative colitis affects every person differently. Work with your doctor to find the dosage and combination of treatments that work best for you.

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Medical Reviewer: Youssef (Joe) Soliman, MD
Last Review Date: 2022 Aug 24
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