How Is Ulcerative Colitis Treated?
Treatment for ulcerative colitis can include medicine, changes in your diet, or surgery. These treatments won't cure your ulcerative colitis, unless you have surgery that removes the colon and rectum, which is considered curative, but they can help ease your symptoms.
It's important to get treated for ulcerative colitis as soon as you start having symptoms. If you have severe diarrhea and bleeding, you might need to go the hospital to prevent or treat dehydration, reduce your symptoms, and make sure you're getting the right nutrition.
Medications for Ulcerative Colitis
- 5-aminosalicylic acid (5-ASA). Balsalazide, mesalamine, olsalazine, and sulfasalazine are the main medications used to treat ulcerative colitis. They come in pills and suppositories. Let your doctor know if you are allergic to sulfa before taking one of these drugs. They can prescribe a sulfa-free 5-ASA.
- Corticosteroids. These anti-inflammatory drugs can be used if 5-ASA drugs don't work for you or if you have a more severe disease. These medicines sometimes have side effects and long-term complications, so doctors often suggest them for short periods of time to help you get in remission. Your doctor may then prescribe you a 5-ASA medication to keep your symptoms away for a longer period.
- Immunosuppressants. If corticosteroids or 5-ASA drugs don't help, your doctor may prescribe these kinds of drugs, such as 6-mercaptopurine (6-MP), azathioprine (Azasan, Imuran), cyclosporine, and tacrolimus (Astagraf XL, Envarsus XR, Prograf).
- Biologics. This group of drugs includes adalimumab (Humira), plus adalimumab-atto (Amjevita) and adalimumab-adbm (Cyltezo), which are biosimilars to Humira; certolizumab pegol (Cimzia), golimumab (Simponi, Simponi Aria), infliximab (Remicade), infliximab-abda (Renflexis), infliximab-axxq (Avsola), infliximab-dyyb (Inflectra), a biosimilar to Remicade, infliximab-qbtx (IXIFI), ustekinumab (Stelara), and vedolizumab (Entyvio).
- Janus kinase inhibitors (JAK inhibitors). These are oral medicines that can work quickly to get and maintain a remission in ulcerative colitis. Tofacitinib (Xeljanz) is the first JAK inhibitor that is FDA-approved for the treatment of ulcerative colitis.
- Sphingosine 1-phosphate (S1P) receptor modulators. Ozanimod (Zeposia) is an oral medication and is the first sphingosine 1-phosphate (S1P) receptor modulator approved for patients with moderately to severely active UC.
Newer medications being studied include a group called sphingosine 1-phosphate receptor modulators. These can be taken by mouth. Researchers think they may get around the anti-drug antibodies that sometimes form with medications given as a shot. Antibodies are proteins that cancel out viruses, bacteria, and other things your body doesn’t recognize.
Diet Changes for Ulcerative Colitis
While food doesn't appear to play a role in causing ulcerative colitis, certain foods may cause more symptoms when your disease is active. Your doctor may suggest diet changes, depending on your symptoms. They may also recommend vitamins or nutritional supplements.
Surgery for Ulcerative Colitis
Some people get surgery to remove part or all of the colon. Your doctor may suggest this if your medicine isn't working, your symptoms get worse, or your ulcerative colitis leads to serious complications.
When you have an operation to remove your entire colon, the surgeon most often creates an opening, or stoma, in your belly wall. They attach a bag there and bring the tip of your lower small intestine through the opening. Waste passes through it and collects in a pouch, which gets attached to the stoma. You'd need to wear the pouch all the time.
A newer surgery, called a pelvic pouch or ileal pouch anal anastomosis (IPAA), doesn't create a permanent opening. Instead, a surgeon removes your colon and rectum, and your small intestine is used to form an internal pouch or reservoir that serves as a new rectum. This pouch is connected to the anus.
A procedure called a continent ileostomy (Kock pouch) is done if you want your external pouch converted to an internal one, or if you can't get the IPAA operation.
In this procedure, there is a stoma but no bag. Your surgeon removes your colon and rectum and creates an internal reservoir from your small intestine. They make an opening in your belly wall and join the reservoir to your skin with a nipple valve. To drain the pouch, you insert a catheter through the valve into the internal reservoir.
Other techniques are also available. All surgeries carry some risk and complications. If you have been told you need surgery to treat ulcerative colitis, you may want to get a second opinion to make sure you get the best option for you.
When Should I Call My Doctor About Ulcerative Colitis?
Call your doctor right away if you have:
- Heavy, persistent diarrhea
- Rectal bleeding with clots of blood in your stool
- Constant pain and a high fever
Complementary Treatments and Therapies
You may consider these approaches in addition to what your doctor prescribes. But it’s important to talk to your medical team about any and all of them because some, like supplements, can interfere with treatments from your doctor. Let’s take a look at a few:
Mind-body therapies: Stress and anxiety are well-known triggers for many people with ulcerative colitis, so it is not surprising that mind-body relaxation techniques could help. These techniques help nurture a healthy connection between your mind and body as well as between you and the outside world. In some cases, they encourage behavior changes in your everyday life. They may be worthwhile if only to lessen anxiety and depression linked to UC and improve quality of life. In addition, there is some evidence that yoga, meditation, and gut-centered hypnotherapy could help with some physical symptoms or flare-ups of UC. Some of the techniques, like cognitive behavioral therapy (a type of psychotherapy) and patient support groups, have been so successful that they have slowly become a part of mainstream treatment for IBD.
Vitamins and supplements: Many people with ulcerative colitis may not absorb enough of some vitamins or minerals from food because of their disease. In these cases, your doctor may suggest taking certain supplements. Still, it’s important to speak with your doctor before you decide to take any on your own. Many of these substances can be unsafe, particularly if you have UC and you’re taking other medicines. Some people also take certain supplements in the belief that they help control UC symptoms. These might include:
- Fish oil: In foods, the omega-3 fatty acids found in fish, walnuts, flaxseed, and vegetable oils are good for your health. They lessen inflammation and help protect the heart, among other benefits. Some people with UC take omega-3 supplements in the form of fish oil capsules to lessen gut inflammation. Research has so far been unclear on whether this works. Too much fish oil may be bad for you and could be dangerous if you take it with blood thinners like warfarin (Coumadin).
- Turmeric: This spice, commonly used in Indian and South Asian cooking, has a chemical called curcumin that may help lessen inflammation in some people. Some small studies show that it could help with UC flare-ups in capsule form, but scientists need to do more research to be sure of these results. Also, many of the studies used very pure curcumin compounds that may not be available in retail brands. Curcumin can also have side effects that include bloating, nausea, and diarrhea. It also thins the blood and has not been tested for safety in pregnant women.
- Probiotics: These are “good” bacteria found in many foods that add to the healthy balance of bacteria in your gut. In supplement form, some studies suggest they could help bring a UC flare-up to an end and keep it there, especially if you have a pouch (from J-pouch surgery) that is inflamed. Still, it’s important to take care. There are a wide variety of probiotic products on the market, and much more study is needed.
Keep in mind that the FDA doesn't regulate supplements, so claims on packaging may not be accurate. That’s yet another reason why it’s important to talk to your doctor before you start taking any supplements for your UC.