Systemic Steroids for Ulcerative Colitis

Medically Reviewed by Sabrina Felson, MD on June 09, 2024
4 min read

The symptoms of ulcerative colitis happen because of inflammation in your digestive tract. Systemic steroids (corticosteroids) are powerful anti-inflammatory drugs doctors have turned to for decades as a first-line treatment for UC and Crohn’s disease, another inflammatory bowel disease. Because of serious side effects and newer medical treatments, doctors don’t use systemic steroids for UC as much as they used to.

Your body makes steroids, which are a type of chemical or hormone, naturally. Systemic steroids that treat UC are a lab-made version of the same hormone. The drug comes in a much higher dose than your body makes on its own. This leads to side effects. These drugs are different from anabolic steroids, which people sometimes use illegally to increase their muscle mass.

Steroids aren’t a cure for ulcerative colitis. But they are highly effective at reducing inflammation and getting you into remission, meaning you don’t have signs of the disease. They aren’t a long-term solution for UC symptoms, because of their serious side effects. Also, symptoms can come back while you’re on them.

Steroids are very good at healing an inflamed bowel. But they aren’t as good at preventing further flare-ups. Once your serious ulcerative colitis reaches remission on steroids, your doctor will switch you to different medications for longer-term use.

There are many types of steroids your doctor can prescribe for your UC, and different ways to take them. The most common is orally, or by mouth.

Options you take by mouth:

  • Prednisone (Deltasone) is one of the most common corticosteroid choices. You take it as a pill.
  • Budesonide (Entocort EC) is a modified steroid your body absorbs through the small intestine and colon. Your liver processes it much faster than prednisone. That means your risk of side effects is lower. This drug is a capsule.
  • Budesonide-MMX (Uceris) is the same as budesonide, but it has a special coating on it. The coating keeps the medication inside the capsule until it gets to your colon. This helps more of the medication go straight to the colon. This option is best for treating inflammation in the colon only, which is what happens in ulcerative colitis.

Doctors usually recommend you take oral steroids in the morning so they’re less likely to affect your sleep. Oral options typically improve your symptoms within 1-4 weeks. They’re not recommended for use longer than 8 weeks.

Your doctor may give you steroids you can take rectally. These are not systemic steroids, but they go to work right in the areas where the inflammation is for mild to moderate UC:

  • Suppositories of hydrocortisone help treat inflammation in your anus and rectum. You take them by inserting the small, round suppository into your anus, where it dissolves to deliver the drug.
  • Enemas (cortisol, hydrocortisone, methylprednisolone) work best for inflammation higher up in your colon past your rectum where suppositories can’t reach. These choices also deliver medication straight to the affected area. That reduces your risk of side effects.
  • Rectal foams (budesonide, hydrocortisone acetate, hydrocortisone/pramoxine) can deliver steroids to the rectum and colon. Foams stay in the area longer so the drug has a better chance to absorb.

Most people see their symptoms start to improve after 1 or 2 weeks.

For severe flares of UC, you may need hydrocortisone delivered into a vein through an IV in the hospital. This usually relieves symptoms within 4-10 days. Your doctor will then switch you to oral steroids.

Because systemic steroids slow down your immune system to reduce inflammation, your defenses against germs are much lower while you’re taking them. This means you’re at a higher risk for infection. People on steroids commonly deal with:

The side effects you get from a systemic steroid will depend on how strong a dose you’re on and how long you take it. But many different side effects are possible and common, including:

  • Acne
  • Cataracts (cloudy patches in the eye)
  • Growth issues in kids
  • High blood pressure (hypertension)
  • High blood sugar
  • Increased facial hair
  • Bigger appetite
  • Trouble sleeping
  • Mood swings
  • “Moon face” (a rounder, fuller face shape)
  • Osteoporosis (weakening of bones)
  • Psychosis
  • Stretch marks
  • Weight gain

Some side effects go away once you stop taking the steroid. That’s not the case for cataracts and osteoporosis, though. Your doctor may recommend you take extra calcium and vitamin D to help counteract the effects of osteoporosis (but it won’t prevent osteoporosis). Cataracts also require extra treatment, even after stopping the steroid.

Because of the serious side effects that come with steroids, doctors typically recommend you take them for only a short time, usually about 8 weeks.

About 1 in 5 people don’t respond to steroids. This is called "being steroid refractory." If they don’t seem to be helping your symptoms after 3 months, your doctor may add an immunosuppressant such as azathioprine (Azasan, Imuran), mercaptopurine ( Purinethol, Purixan), or methotrexate (Rheumatrex, Trexall) along with the steroid. If your UC is severe and these treatments don’t work, your doctor may move to biologic treatments like infliximab (Remicade) or adalimumab (Humira).

When you’re taking a steroid, your adrenal glands slow down or stop making cortisol, the natural steroid. Because of this, you shouldn’t stop taking steroids all at once. Your body needs time to crank its production of cortisol back up before that. Your doctor will guide you through a tapering-off process to completely wean you off your steroid over time.