Let's Talk About Treatment for Ulcerative Colitis
You have some seriously effective options for managing symptoms—and a darn good chance at reaching remission, too.by Lara DeSanto Health Writer
While there’s no total cure for ulcerative colitis (UC), treatment has come a long way in recent years. Nowadays, there are more options available than ever before to help you get your UC under control and even achieve remission. But navigating the choices can also be overwhelming and confusing. 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.
Our Pro Panel
We went to some of the nation's top UC experts to bring you the most scientific and up-to-date information possible.
Aline Charabaty Pishvaian, M.D.
Director of the Inflammatory Bowel Disease Center
Sibley Memorial Hospital
Neilanjan Nandi, M.D.
Director of the Inflammatory Bowel Disease Center
Drexel University School of Medicine
Megan Elizabeth Riehl, Psy.D.
Clinical Health Psychologist
University of Michigan
Ann Arbor, Michigan
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.
What Is Ulcerative Colitis Again and How Do You Treat It?
As the body mistakenly targets the healthy tissue lining the large intestine, painful ulcers can form, leading to super-frequent diarrhea and bloody stools (which can be scary to see).
And because it’s actually a systemic disease, patients often experience symptoms far beyond the belly, including exhaustion, joint pain, and even skin problems.
There is one common denominator driving this huge constellation of symptoms—inflammation.
Snuff that out with smart treatment (you’ve got lots of options!), and most of those uncomfortable effects can be greatly reduced—sometimes even eliminated.
With the right plan, you can stop further damage to your large intestine and allow the raw tissue to heal. And that will trigger a ripple effect from head to toe, helping you feel healthier overall.
Some people will need to take medications only when symptoms flare up, while others will do best with continuous therapy. Your doctor will guide you based on your symptom severity and how you respond to treatment. Remember to keep those lines of communication open so your doc knows exactly how you’re doing symptom- and side-effect-wise.
Treatments for UC include medication, healthy lifestyle habits, and if needed, surgery. Some people with UC also find some relief in making dietary changes, doing UC-friendly exercises, and more. Let’s take a look:
Medications for UC
There are several types of medications that treat UC. Some are pills, some are shots, some require an IV.
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.
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.
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.
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 psychiatry, nutrition, and more. Other health-related professionals may also be part of your team to assist you with the following:
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.
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.
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.
Living with a chronic disease like UC is no fun, so don’t hesitate to name any feelings of stress, frustration, sadness, or anxiety that you’re experiencing. In fact, having IBD significantly increases your risk of depression and anxiety—and many people go undiagnosed and untreated for these conditions, compounding the problem.
We know it can be difficult to talk about your UC symptoms (because poop), but having even one person in your circle you can rely on to listen can help you feel less alone. Connecting with other people who have IBD can be a lifeline, too. Check out the Crohn’s and Colitis Foundation’s website to find in-person and online support groups. Talking to someone who just gets it can remove some of the burden you’re carrying.
And if you need a pro therapist to help get you through, so what? This is called Taking Care of Yourself. Working with a mental-health professional—especially one who has had experience working with clients who have chronic illness—can be a highly beneficial way to deal with the stress of living with UC and help you get depression or anxiety under control. They can even teach you skills using cognitive-behavioral therapy (CBT) to help you change your outlook on certain aspects of living with UC.
In some cases, your health care team may also recommend antidepressant or anti-anxiety medications to get those psych symptoms under control. Again: No shame. These drugs can alleviate the big feelings so you have the mental space to learn those new coping strategies.
Bottom line? The more people you have in your corner—from professionals to friends and family—the more supported you’ll feel.
Other Ways to Ease UC Discomfort
UC can be downright uncomfortable (hello, abdominal cramps and constipation). In addition to your prescribed drugs and doctor-recommended OTC medications, there are some things you can do at home to help ease those pains.
For example, if you’re feeling crampy, try a heating pad on the belly to soothe the pain, or settle into a hot bath. Or if you’re experiencing butt irritation, make sure to have some quality wet wipes and a skin-protecting ointment (Calmoseptine is popular) stocked in your bathroom.
Some people with UC like to try complementary remedies to ease their symptoms. There’s not much research available to back the effectiveness and safety of these, so always, always talk to your doctor to get the go-ahead before you give them a shot. Some commonly used alternative therapies include:
Turmeric. There’s some evidence that this spice has anti-inflammatory qualities that can help UC symptoms.
Prebiotics and probiotics. Studies are mixed on the effectiveness of these supplements for UC symptoms.
Aloe vera. Some people with UC ingest aloe vera gel for its potential anti-inflammatory effect, but it may also cause diarrhea. (Before you go noshing on a leaf from your aloe plant, make sure you get the all-clear from your doctor to try this!)
Fish oil. This is another anti-inflammatory option that may help people with UC. Again, there’s no evidence that it actually works.
Acupuncture. Acupuncture involves the insertion of needles into the skin as a way to activate painkilling mechanisms in your body—but little research has been done on its effectiveness for UC, specifically.
- UC Treatment Basics (1): Mayo Clinic. (2017).“Inflammatory Bowel Disease.” mayoclinic.org/diseases-conditions/inflammatory-bowel-disease/diagnosis-treatment/drc-20353320
- UC Treatment Basics (2): American Journal of Gastroenterology. (2019). American College of Gastroenterology Clinical Guidelines: Ulcerative Colitis in Adults. journals.lww.com/ajg/Fulltext/2019/03000/ACG_Clinical_Guideline__Ulcerative_Colitis_in.10.aspx
- UC Treatment Basics (3): UptoDate. (2019). “Patient Education: Ulcerative Colitis (Beyond the Basics).” uptodate.com/contents/ulcerative-colitis-beyond-the-basics
- Anti-TNF Biologics for Ulcerative Colitis: Expert Review of Clinical Immunology. (2017). “Anti TNF-α Therapy for Ulcerative Colitis: Current Status and Prospects for the Future.” ncbi.nlm.nih.gov/pubmed/27687496
- Surgery for Ulcerative Colitis: Best Practice & Research in Clinical Gastroenterology. (2018). “Surgery in Ulcerative Colitis: When? How?” ncbi.nlm.nih.gov/pubmed/30060941
- Probiotics in Ulcerative Colitis Management: Journal of Clinical Gastroenterology. (2015). “Probiotics in the Management of Ulcerative Colitis.” ncbi.nlm.nih.gov/pubmed/26447965