How Inflammatory Bowel Disease (IBD) Is Treated

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Inflammatory bowel disease (IBD) is a chronic condition that must be consistently managed for symptom control. There currently is no cure for any form of the disease, but there are effective IBD treatment options that might provide you with relief—these include medications, lifestyle management, and, rarely, surgery.

Treatments approved for IBD fall into two categories: those for Crohn's disease and those for ulcerative colitis. If you have indeterminate colitis, the third type of IBD, you will typically take the treatments that are approved for ulcerative colitis.

There isn't one standard of treatment that's used for every person with IBD. There are evidence-based guidelines offered by medical societies, but your treatment ultimately needs to be customized to fit your individual needs.

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Prescriptions

There are several classes of drugs that may be used to treat IBD. Pharmaceutical treatments have a two-fold goal: to get a flare-up under control and into remission and to keep you in remission by preventing more flare-ups.

Some drugs can help with one of these goals, while others are used for both.

Class Drug Approved for Crohn's Approved for Ulcerative Colitis
Aminosalicylates (5-ASA) Azulfidine (sulfasalazine)   X
  Asacol, Pentasa, Lialda, Apriso, Delzicol (mesalamine)   X
  Canasa (mesalamine suppositories)   X
  Colazal (balsalazide)   X
  Dipentum (olsazine)   X
  Rowasa (mesalamine enemas)   X
Antibiotics Cipro (ciprofloxacin) X  
  Flagyl (metronidazole) X  
Biologics* Cimzia (certolizumab pegol) X  
  Entyvio (vedolizumab) X X
  Humira (adalimumab) X X
  Inflectra (infliximab-dyyb) X X
  Remicade (infliximab) X X
  Simponi (golimumab)   X
  Stelara (ustekinumab) X X
  Tysabri (natalizumab) X  
       
       
Corticosteroids Cortenema (hydrocortisone) X X
  Deltasone (prednisone) X X
  Entocort (budesonide) X X
  Medrol (methylprednisolone) X X
  Proctofoam-HC (hydrocortisone acetate, rectal foam) X X
  Uceris (budesonide)   X
Immunomodulators Imuran, Azasan  (azathioprine) X X
  Folex, Rheumatrex (methotrexate) X  
  Prograf (tacrolimus) X X
  Purinethol, 6-MP (6-mercaptopurine) X X
  Sandimmune, Neoral (cyclosporine A) X X
Small molecules Xeljanz (tofacitinib)   X

*According to 2020 guidelines, a biologic drug should be used as first-line for treatment of moderate to severe ulcerative colitis.

Over-the-Counter (OTC) Therapies

There are a few OTC treatments recommended for helping to manage IBD.

Your healthcare provider may suggest:

  • Fiber supplements: Chronic mild-to-moderate diarrhea is often treated with a fiber supplement, such as Metamucil (psyllium powder) or Citrucel (methylcellulose). Fiber helps add bulk to stool, making it firmer. 
  • Anti-diarrheal medications: Your healthcare provider may recommend an OTC anti-diarrheal medicine, such as Imodium A-D (loperamide).
  • Acetaminophen: OTC pain relievers, such as Tylenol (acetaminophen), may be helpful for mild pain. Other pain relievers, such as non-steroidal anti-inflammatories (NSAIDs), may irritate the stomach and worsen symptoms. 
  • Iron: Chronic intestinal bleeding may cause iron-deficient anemia. Your healthcare provider may recommend supplementing with iron, though it's important to know that constipation is a common side effect. Talk to your practitioner about brands you should try. All-natural liquid iron supplements, such as Floradix Floravital, are non-binding and may be more gentle on your gastrointestinal system. 
  • Calcium and vitamin D: If your IBD is treated with steroids, you may need to supplement with calcium and vitamin D. Both corticosteroid use and Crohn’s disease itself can increase your risk of osteoporosis, and these supplements may help to improve your bone density.

Always speak to your healthcare provider before taking non-prescription medications to treat your IBD.

Lifestyle

Since a number of foods can cause a flare-up of your symptoms when you have IBD, getting appropriate nutrition can be challenging. There is no standard list of foods to avoid because each person may have different triggers. 

Low-Residue Diet

Your healthcare provider may recommend that you switch to a low-residue diet, especially if you have stenosis or stricture in the bowel. This type of diet can reduce the likelihood that undigested food will get stuck in the narrowed part of the bowel and lead to a blockage. 

A low-residue diet restricts high-fiber foods, like whole grains, nuts, seeds, fruits, and vegetables.

Enteral or Parenteral Nutrition

Some people who have severe IBD can't get enough nutrition through diet and may need to get nutrition through a feeding tube (enteral nutrition) or a vein (parenteral nutrition).

  • A feeding tube can be placed through your nose for short-term nutrition (days or weeks), or surgically placed through your abdomen into your stomach for a longer duration of time (months or longer). After your tube is placed, you can have your tube feeding at home. 
  • Parenteral nutrition, sometimes called total parenteral nutrition (TPN), is a sterile liquid chemical formula that you can receive through an intravenous catheter (IV). This bypasses your gastrointestinal tract so your nutrients will go directly into your bloodstream. The catheter is placed into a large vein leading to the heart, typically under sedation. TPN can be delivered in an outpatient hospital setting or at home.

Surgeries

Sometimes people who have IBD may need surgical treatment if medication isn't helping the condition or for management of complications. Crohn's disease and ulcerative colitis are treated with different types of surgeries because these diseases affect the digestive system differently.

The surgical procedure you may need depends on the location of the inflammation and how far it has spread.

Surgery is not a cure. In fact, for some people, inflammation may return in another location, even after surgery.

Procedures for Crohn's Disease

Surgery for Crohn's disease is often done with minimally invasive techniques (such as laparoscopic surgery), which reduces the time you will spend in the hospital and shortens your recovery period.

A few of the more common types of surgery for Crohn's disease include:

  • Resection: This is the most common surgical option to treat Crohn's disease. A resection is when a portion of an inflamed or diseased intestine is removed, and the two ends of healthy tissue are stitched back together again (also called an anastomosis). This can be done in the small intestine or the large intestine.
  • Strictureplasty: Crohn's disease can cause scar tissue to build up and cause a narrowing in the intestine. When a portion of the intestine becomes too narrow, it might be opened up again during strictureplasty surgery.
  • Proctocolectomy (ileoanal anastomosis, straight pull-through): Some people with Crohn's disease don't have disease in the rectum, and a restorative proctocolectomy might be done. The large intestine is removed and the end of the small intestine is connected directly to the anus. This means that a stoma isn't needed and stool can be passed out the rectum.
  • Ostomy surgery: Some people with Crohn's disease that affects the colon will have surgery to create an ileostomy. This is when the colon is removed and a stoma is created on the abdomen. Stool passes out of the body through the stoma, and an ostomy appliance is worn on the abdomen to catch it. Most people with Crohn's disease will not need ostomy surgery.

Procedures for Ulcerative Colitis

The Crohn's and Colitis Foundation of America estimates that between 23 and 45% of ulcerative colitis patients have surgery. The surgical options for ulcerative colitis involve removal of the large intestine (colectomy) with the creation of either a stoma or an internal pouch to collect stool.

The surgical options for ulcerative colitis include:

  • Protocolectomy with the creation of pelvic pouch (ileal pouch-anal anastomosis, IPAA): After the colon is removed to treat ulcerative colitis, an internal pouch is created out of the last section of the small intestine (the ileum). With this pouch, there is no external ostomy bag or a stoma because the pouch acts like a rectum. Pelvic pouches can be made in a few different shapes, but the one that's most often used is the j-pouch.
  • Protocolectomy with creation of ileostomy: After the colectomy, some patients with ulcerative colitis have an end ileostomy created. A stoma is created on the abdomen for the passage of stool and an ostomy appliance is worn over the stoma.

The idea of having a stoma may seem intimidating, but most patients with ulcerative colitis have a higher quality of life after having ileostomy surgery and do very well with their stoma.

A Word From Verywell

There are more options available today to treat Crohn's disease and ulcerative colitis than ever before. The IBD treatments that have become available in recent years are effective for reducing symptoms, and there are more being studied.

The most important part of treating your IBD successfully and getting it into remission is seeing a gastroenterologist regularly and taking your medication on time. With the variety of medications available, many patients can bring down inflammation, prevent complications, and improve the quality of their lives.

Frequently Asked Questions

  • How is IBD diagnosed?

    IBD is diagnosed based on symptoms, lab tests, imaging, colonoscopy, and mucosal biopsy of the intestines. Lab tests can include a complete blood count, fecal occult blood test, electrolyte panel, and liver function tests, while imaging tests will look for any abnormal growths, such as tumors or polyps in the GI tract.

  • How common is IBD?

    IBD is very common. Approximately 3 million Americans have some form of IBD, including Crohn's disease, ulcerative colitis, and microscopic or indeterminate colitis.

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9 Sources
Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read our editorial process to learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.
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