The Pros and Cons of Taking Steroids for Ulcerative Colitis

Steroids can help reduce UC symptoms, but your long-term treatment strategy should rely on other medications. Here's why.

Medically Reviewed
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Steroids can help relieve inflammation, but long-term use can lead to complications.Canva; Everyday Health

Since the 1950s, corticosteroids (steroids) have been helping those with ulcerative colitis (UC) put the disease in remission. These powerful anti-inflammatories are highly effective at treating acute flare-ups, but they also come with problems.

They’re best for short-term use, and while they can relieve symptoms, they don’t slow disease progression, notes the Crohn’s and Colitis Foundation. They also increase your risk for infections, osteoporosis, and high blood pressure. And, according to a study published in August 2020 in the journal Gastroenterology, corticosteroid use is associated with severe COVID-19 symptoms in IBD patients.

“Steroids provide patients with vast relief quickly, but they’re not a long-term solution and they have a lot of side effects,” says Laura Raffals, MD, a gastroenterologist at the Mayo Clinic in Rochester, Minnesota. In the short term, steroids frequently cause:

  • Weight gain
  • Moon face
  • Acne
  • Irritability
  • Insomnia

Consistent use — even at low doses — can affect bone strength, increasing the risk of osteoporosis. And typically, the higher the dose, the higher the risk. There are many side effects from continued use of steroids, notes the Mayo Clinic, including:

“Steroids can reduce inflammation, but they don’t heal the inside,” says David Hudesman, MD, medical director of the inflammatory bowel disease center at NYU Langone Health in New York City. “They’re like a Band-Aid.”

Short-Term Steroids Can Help Relieve Symptom Flares

If your UC flare is severe and you’re in significant pain, with bloody stools and diarrhea, your doctor may prescribe an intravenous high dose of prednisone for immediate relief. “We try to minimize it to the shortest period possible and allow it to serve as a bridge to a better long-term treatment strategy,” says Dr. Raffals.

If your UC flare is mild to moderate, your doctor may prescribe a gentler steroid, such as Entocort (budesonide) to reduce inflammation. It isn’t as strong as prednisone and has fewer side effects. It’s designed to attack mild to moderate intestinal inflammation and keep inflammation at bay for three months or so. The drug is FDA-approved for use for eight weeks, although it can be prescribed for longer in certain cases, according to Massachusetts General Hospital in Boston.

At the same time, you’ll likely also be prescribed a long-term maintenance medication that’s not a steroid, such as Lialda (mesalamine), which can take time to kick in. Since steroids are not designed for long-term use, you’ll need to wind down their use as the maintenance medication begins to work. Your doctor will likely taper off your steroid dosage until you’re off it completely.

Other Medication Options for Ulcerative Colitis

But what if symptoms recur just months after you’ve stopped steroids?

“The response shouldn’t be to go back on prednisone,” Dr. Hudesman says. “You shouldn’t be on multiple courses of steroids, even two courses, within a year.”

Instead, talk to your doctor about using an immunosuppressant or biologic agent, both of which have fewer side effects. The immunosuppressant drugs will reduce inflammation by calming your body’s immune system. Biologics, on the other hand, will attach to and then interrupt a molecule in the body responsible for inflammation.

“Whatever is a reasonable time for maintenance medication, we try to give it,” Hudesman says. “If you’re not getting there, then we consider moving medications or make sure something else isn’t complicating your disease.”

RELATED: Medications for Ulcerative Colitis

Stick to Your Colitis Treatment Plan to Avoid Overusing Steroids

Some people may worry about side effects that can be caused by their maintenance medication — and they ditch their treatment while they’re in remission. According to a study published in March 2019 in the journal PLoS One, nearly half of inflammatory bowel disease patients stop taking their medication for a variety of reasons. But doing so increases the risk of relapse.

Although steroids can have dangerous side effects, you should take them as directed if you need them. The same goes for your maintenance medication.

“The most important thing to know with UC is that how you feel doesn’t correlate with what’s happening on the inside,” Hudesman says. “Even if you feel great most of the time without medication, if I did a colonoscopy, it might show severe disease. A lot of patients tolerate little flares until they can’t. Then all of a sudden, you’re talking about surgery or a very complicated disease.”

RELATED: Thinking of Stopping Your Ulcerative Colitis Medication? Think Again

The bottom line? Every patient is different. But if you’re experiencing severe UC flares, you may need a steroid initially until your maintenance medication can control your condition. The various side effects associated with prolonged steroid use give many doctors pause.

“Steroids are fast and cheap and well-known, but we prefer to get a flare under control without them if we can,” Raffals says.

You may also need to experiment with maintenance medication until you find one that works, or switch to immunosuppressant or biologic therapy.

“Ideally, the goal is to find a maintenance medication that you feel well with and that heals you from the inside,” Hudesman says.