Treatment Options for Ulcerative Colitis

Medication is just one of many options to treat UC.

Medically Reviewed
Colorful Treatment Options for Ulcerative Colitis
Medications, surgery, and alternative therapies can help, and more are on the way.Getty Images; Stocksy; Shutterstock; Canva

Optimal ulcerative colitis care often requires a holistic management approach that includes medications, dietary changes, and lifestyle modifications. Your doctor will work with you to develop a treatment plan that’s right for you. This plan will likely change over time, depending on whether your disease worsens or you go into remission.

Medication, dietary changes, nutritional supplements, and surgery may all be necessary, according to the Crohn’s & Colitis Foundation.

Per MedlinePlus, the goals of treatment for ulcerative colitis are:

  • Treating acute attacks
  • Inducing remission
  • Prolonging disease remissions

Drug Therapy for Ulcerative Colitis

Most drugs prescribed to treat ulcerative colitis work by suppressing the inflammation in your colon. This allows the lining of your colon to heal and reduces the severity of symptoms such as diarrhea and abdominal pain.

Typically, your doctor will prescribe one or more of the following drugs.

Aminosalicylates These drugs are used to treat disease flares, and can help prevent future flares when taken as maintenance therapy.

Because they work directly in the digestive system, aminosalicylates have a relatively low risk of negatively affecting other areas of the body.

Corticosteroids Also known simply as steroids, corticosteroids are used to treat active disease.

Because of their high risk of side effects, steroids are used only as a “bridge” to help UC symptoms while other, safer drugs are introduced. Steroids should not be taken for long periods of time.

Immune system suppressors These drugs work directly on the immune system to reduce inflammation. They’re used to treat disease flares, as well as to prevent future ones when taken for maintenance therapy.

For many people with ulcerative colitis, immune system suppressors are combined with other classes of drugs, notes Mayo Clinic.

Biologics Biologic drugs are used to treat individuals with moderate to severe ulcerative colitis. Biologics are lab-made antibodies that target certain proteins in the body to stop them from causing inflammation.

Small molecules are chemical compounds taken orally that also work on the immune system, but act differently from biologics.

These drugs are used to treat moderate to severe ulcerative colitis.

Immunomodulators are a second-line drug for treating ulcerative colitis. These drugs limit inflammation at its source in the immune system.

Other types of drugs your doctor may prescribe include:

Antidiarrheal medication This type of drug should be used only with caution to treat severe diarrhea, since it raises the risk of toxic colitis, a dangerous complication.

Pain relievers Your doctor may recommend Tylenol (acetaminophen) for mild pain.

Avoid ibuprofen (Advil, Motrin), naproxen (Aleve), and diclofenac (Voltaren), which can worsen ulcerative colitis symptoms.

Iron supplements Taking supplemental iron may be necessary if you have chronic intestinal bleeding, since anemia is common in people with ulcerative colitis. It’s important to have your iron levels tested before taking supplements. Excess iron can be toxic to the liver, according to a study published in 2021 in BMC Gastroenterology.

Surgery for Ulcerative Colitis

Ulcerative colitis can be cured through surgery to remove the entire colon, but this course of treatment shouldn’t be taken unless it’s medically necessary.

About one-quarter to one-third of people with ulcerative colitis eventually become candidates for surgery.

Surgery may be necessary in the following situations:

  • Disease that doesn’t respond to multiple types of drug therapy
  • Severe complications, like toxic colitis, a ruptured colon, or extensive bleeding
  • Abnormal cells, or dysplasia, in the colon, which puts you at high risk for colon cancer

Surgery for ulcerative colitis usually involves removing the entire colon and rectum. Women of childbearing age should speak to their doctors to see if preserving part of their rectum would be preferable.

When your rectum is removed, continence is usually preserved. For example, a proctocolectomy — removal of your entire colon and rectum — may require an ileostomy. In this procedure, the surgeon creates a small opening in the abdominal wall and attaches the tip of the lower small intestine, the ileum, to the opening.

Waste exits the body through this opening and must be collected in a pouch or bag.

In an alternative approach — called ileoanal anastomosis, commonly called J-pouch surgery — your surgeon may create an internal pouch out of the ileum and connect it to the anus. This allows you to pass stool fairly normally.

Home Remedies for Ulcerative Colitis

A number of lifestyle measures can help control ulcerative colitis symptoms and reduce the stress of living with this chronic condition.

Check with your doctor before trying any of the following approaches to managing your disease.

Eat small, frequent meals. Compared with eating three large meals each day, this lowers the likelihood of abdominal discomfort after eating.

Stay hydrated. Drink plenty of fluids every day to keep hydrated, which is especially important during flares. Water is the best option, while alcohol and beverages with caffeine should be avoided, as they stimulate the intestines and can make diarrhea worse. Carbonated drinks should also be limited, as they produce gas.

Curcumin A component of the spice turmeric, this supplement has an anti-inflammatory effect, and some research suggests it may help when taken along with conventional medication. A review published in April 2021 in Pharmaceutics found that curcumin effectively tamped down inflammation related to ulcerative colitis.

It also noted that patients taking the anti-inflammatory drug mesalamine along with 3,000 milligrams (mg) of curcumin capsules achieved remission faster and recovered more quickly than those taking mesalamine and a placebo.
Fish oil These supplements, which contain high levels of omega-3 fatty acids, may help some people reduce symptoms or stay in remission. A review published in July 2021 in the journal Foods found that diets rich in omega-3s improved the inflammatory signals associated with ulcerative colitis, and people who ate an omega-3 rich diet were at a lower risk of ulcerative colitis.

Mind-body practices Regularly engaging in meditation, tai chi, or yoga may reduce the stress of living with ulcerative colitis, according to the Crohn’s & Colitis Foundation.

Alternative Therapies for Ulcerative Colitis

Given the lack of a cure for ulcerative colitis and the difficulty of living with the disease, researchers continue to look for more and better treatments.

Nicotine patches in combination with prescribed medicine for ulcerative colitis appear more beneficial than medicine alone, according to a review published in October 2020 in Cureus.

Why exactly it works remains unknown. A review published in October 2020 in BMC Complementary Medicine and Therapies found several studies indicating that acupuncture may help relieve symptoms of ulcerative colitis.

This ancient Chinese practice can reduce stress and pain, and may be especially helpful in combination with your regular treatment.

Additional reporting by Ashley Welch and Jordan M. Davidson.

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