Ulcerative Colitis Treatment
You have some seriously effective options for managing symptoms—and a good chance at reaching remission, too.
While there’s no ulcerative colitis cure, treatment has come a long way in recent years. Nowadays, there are more options available than ever before to help you get your ulcerative colitis (UC) under control and even achieve remission. With this inflammatory bowel disease, the body mistakenly targets the healthy tissue lining the large intestine, leading to painful ulcers and super-frequent diarrhea and bloody stools (which can be scary to see).
But navigating the treatment choices can also be overwhelming and maybe even a bit scary. How do you know which treatment route is right for you and your particular case of IBD? Your doctor will recommend treatment based on your specific symptoms and other information about your health and your overall needs. From steroids to biologic drugs, we’ll break down all your treatment possibilities—along with benefits, side effects, and more.
Medications for UC
There are several types of medications that treat UC. Some are pills, some are shots, some require an IV.
Aminosalicylates (5-ASAs)
This group of drugs, which includes mesalamine, helps to reduce inflammation in your intestines. They can be taken either orally or rectally.
Typically, these drugs are recommended for people with mild to moderate UC.
Steroids
Corticosteroids, like prednisone, can help decrease inflammation throughout the body. They can be given orally, rectally, through an IV, or as an injection.
Usually steroids are only prescribed for moderate to severe UC—you’ll likely take a daily dose, but not for more than a couple of months to get a flare under control.
That’s because steroids suppress the entire body’s immune system, which can cause an array of other health problems if they’re used for too long. For example, results from a 2020 study published in the journal Gastroenterology indicated that corticosteroids (along with increasing age and comorbidities) were associated with severe COVID-19 among patients who had IBD.
Your Real-Life Guide to Living With UC
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Immunomodulators
These immune system-modifying drugs are usually given orally and work to reduce your body’s immune response, which is what creates inflammation. (Side note: When you’re actually sick or injured, that inflammation response is what helps you fight off infection; it’s only bad news when it doesn’t shut down when the job is done).
These drugs can be highly effective long-term treatment for moderate to severe UC and are often prescribed if you haven’t responded to 5-ASAs or steroids. However, it does take about three to six months of treatment before symptoms begin to improve.
Biologics
Biologic drugs are unique in that they are actually antibodies, rather than artificially prepared chemicals.
They’re pretty cool: They target key proteins in the immune system that are involved in inflammation, going straight to the source of your UC.
Right now, there are two main types of biologics approved for UC treatment: Anti-tumor necrosis factor (TNF) agents, including drugs such as Humira (adalimumab), Remicade (infliximab), and Simponi (golimumab) and the anti-integrin Entyvio (vedolixumab).
Biologics for UC are either given as an injection (you do it yourself at home) or through an IV at a doctor’s office or infusion center.
They can be a great choice for people who have moderate to severe UC or those who haven’t responded to other types of medications—plus, they’re safer than steroids and work faster than immunomodulators.
While these medications can work wonders in helping you achieve or maintain remission from UC, there are some risks to keep in mind—namely, biologics suppress your immune system, so you may be at increased risk of infection.
Your doctor also may suggest certain over the counter (OTC) drugs, depending on your symptoms, including pain relievers, anti-diarrheal medications, and nutritional supplements. They also may prescribe antibiotics, like metronidazole or ciprofloxacin, if you get an infection or a complication of UC.
Surgery for Ulcerative Colitis
The good news is that fewer and fewer surgeries are necessary these days for people with UC, thanks to the introduction of new and effective drugs, like biologics, which can help heal even severe UC. However, sometimes no medication seems to work or certain complications develop. In those cases, surgery may be required.
Typically, the surgery for severe UC is a proctocolectomy, which involves removing the colon and rectum. There are two main types of this procedure:
Proctocolectomy With Ileal Pouch-Anal Anastomosis (IPAA)
Proctocolectomy with IPAA, sometimes simply referred to as J-pouch surgery, is the most common type of UC-related surgery. It involves the removal of the colon and rectum, without the removal of the anal sphincter and anus. A part of your small intestine, called the ileum, is turned into a pouch inside the body (the IPAA, or J-pouch) to replace some of the function of the removed large intestine.
The surgery can be done all in one go or in up to three stages, depending on factors like your overall physical health, whether you’ve been on high doses of steroids, and more. Most commonly, though, the surgery is done in two stages.
After J-pouch surgery, you may have more bowel movements than normal—but usually this side effect decreases over time. Like all surgeries, J-pouch surgery comes with a risk of complications, like pouchitis (when your J-pouch gets inflamed) and small-bowel obstruction. Talk with your gastroenterologist (GI) about what to expect and how to reduce your chances of having complications.
Total Proctocolectomy With End Ileostomy
This surgery, less common than J-pouch surgery, involves the removal of the colon and rectum as well as the removal of the anus. A quarter-sized surgical hole (called a stoma) is created in the abdomen, and waste from the body is emptied through the hole into a pouch called an ostomy bag.
Usually the ostomy will sit a little to the right of your belly button, and the pouch can lie flat under your clothes where no one can see it. You’ll wear the ostomy bag at all times and need to empty it a few times a day. This can be a difficult adjustment—but know that you can live a happy, active life with an ostomy.
Other Types of Therapy for Ulcerative Colitis
Managing a chronic illness can be overwhelming with all the doctor’s appointments, medications, and more to keep track of. To make sure you feel as well as possible while living with UC, you may need a medical team consisting of specialists from a variety of fields, including fitness, nutrition, and more. Other health-related professionals may also be part of your team to assist you with the following:
Exercise
Exercise may seem like the last thing you want to do when you’re dealing with UC, but doctors say physical activity can be highly beneficial. In fact, exercise may boost your immune system, helping to reduce inflammation from UC. Some research has demonstrated that people with UC who exercise regularly are less likely to have flare-ups.
Beyond physical fitness, exercise also comes with tons of benefits for your mental health. In fact, exercise has been shown to reduce stress and even boost your mood (endorphins, baby!).
That said, depending on your UC symptoms, you may have to get creative about the types of exercise you do. For example, training for a marathon may not be your speed if your disease is severe. Instead, you may feel most comfortable working out in your own home where you can take bathroom breaks whenever you need to—YouTube pause button to the rescue!
And on days when you’re not feeling your best, gentle yoga or stretching may help you move your body in a way that feels good without going overboard. Talk with your doctor to come up with an appropriate exercise plan for you.
Sleep
Getting a quality night’s sleep is crucial for people with UC, who may already struggle with fatigue due to iron-deficiency anemia and other symptoms. Talk to your doctor if fatigue is a problem area for you—they’ll first want to make sure you’re getting enough iron to combat anemia. If your iron is low, your doc may recommend an infusion—iron supplements can be hard on the stomach, and as you can imagine, your colon is already dealing with enough from the UC.
The inflammation, pain, and emotional stress from UC can also disturb your sleep. If that’s the case, talk with your doctor to develop a plan to tackle those symptoms and get to the root of the problem. Once you’re not having to get up multiple times in the night to run to the bathroom, you’re likely to feel much more rested.
To further improve your sleep quality and quantity, focus on your sleep hygiene habits. That may mean banning your smart phone from the bedroom or simply sticking to a strict sleep/wake schedule—or both.
Diet
There’s no specific “ulcerative colitis diet.” That said, you may find that certain foods trigger your UC symptoms while others tend to be “safe.” The best way to figure out your problem foods is to work with your doctor or a registered dietitian.
But in the meantime, or if you don’t have access to a dietitian, you can also create a food and symptom diary (your R.D. and doc will likely recommend it, too!). By tracking the foods you eat and the symptoms you have, you can start to zero in on the culprits you’ll want to avoid. For example, some people find their UC symptoms flare up after eating dairy or high-fat foods.
Many health care professionals also recommend avoiding processed and refined substances in the diet. Instead, experts typically recommend you aim for a plant-based, Mediterranean diet for overall health.
Clinical Trials for UC
While participation requires careful consideration and consultation with your doctors and care team, if you choose to join a clinical trial you'll become a partner in the collective effort to transform the landscape of UC care. In short: Clinical trials are a big deal.
For UC, these trials aim to identify innovative approaches that could enhance symptom management, induce remission, or slow the progression of the disease. Here's a closer look at the different kinds of UC clinical trials enrolling participants:
Medication Trials
Many clinical trials focus on testing new drugs or variations of existing medications. This could include investigating formulations, exploring different delivery methods, or looking at the efficacy of medications not yet approved for UC.
Diet and Lifestyle Trials
Some trials explore the impact of dietary changes, probiotics, or lifestyle modifications on UC symptoms. Understanding how factors like diet and stress affect the disease can provide valuable insights into holistic management strategies.
Biologics and Immunotherapy Trials
With advancements in immunotherapy, researchers are investigating the potential of biologics and other immunomodulatory agents in treating UC. These therapies aim to target specific components of the immune system to reduce inflammation and promote healing.
Surgery and Interventional Trials
For individuals with severe UC or those who haven't responded to traditional treatments, surgical and interventional trials may explore new procedures or techniques, such as minimally invasive surgeries or novel endoscopic interventions.
Biologic drugs are antibodies that target key proteins in your immune system involved in inflammation. They’re typically recommended for people with modern to severe UC. By working to reduce inflammation at the source, biologics can greatly improve symptoms and potentially help you achieve remission.
The conversation around whether you can “cure” UC is hotly debated. Some say the only true cure is a proctocolectomy, which is surgery that removes your colon and rectum. However, some symptoms can persist even after surgery. While a total cure may not be possible, the good news is it’s possible to reach remission (meaning you have few or no symptoms) with the right treatment.
Surgery for UC has become less common in recent years due to the introduction of newer treatment options, like biologics. However, in cases when your UC is not responding to medications or you’re experiencing UC complications, surgery may be necessary.
Simply changing your diet likely won’t be enough to manage your UC completely, but it is one key piece of the UC puzzle. Work with a registered dietitian to figure out any potential trigger foods and to learn about how to maintain a healthy diet with UC.
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