How Ulcerative Colitis Is Treated

If you've been diagnosed with ulcerative colitis, your treatment plan will take into consideration your specific symptoms and how long you have had the disease. A variety of over-the-counter and prescription medications, from antidiarrheals to antibiotics to anti-inflammatories, may be considered along with lifestyle modifications. Probiotics may also be recommended to help restore healthy gut bacteria.

 In more severe cases, surgical procedures to remove diseased parts of the colon can provide relief and reduce the risk of developing colon cancer. 

Finding what works best for you may take some trial and error on the part of you and your doctor. Sometimes a treatment that was working stops providing relief, and your regimen may need to be changed. Since there is no way for a healthcare provider to measure a treatment's efficacy, it's important to inform yours about how you're feeling. 

Prescriptions

Many different classes of medications are used to treat symptoms of ulcerative colitis, alone or in combination. Some may be taken regularly, while other fast-acting drugs are given on a short-term basis to treat an active flare-up. Some of them can have serious side effects, so it's important to communicate with your doctor and weigh the risks and benefits of continued treatment.

Anti-Inflammatories
Anti-inflammatory drugs are often the first step in the treatment of ulcerative colitis.

 They include:

  • 5-aminosalicylates: Depending on which part of your colon is affected, you can take these orally, or as an enema or suppository. Some examples include Azulfidine (sulfasalazine), Asacol HD and Delzicol (mesalamine), Colazal (balsalazide), and Dipentum (olsalazine). 
  • Corticosteroids: Prednisone and hydrocortisone fall into this category; they are generally reserved for moderate to severe ulcerative colitis that doesn't respond to other treatments. This is due to the potential for side effects, such as weight gain, high blood pressure, mood changes, fluid retention, and osteoporosis.

    Immune System Suppressors

    These medications control inflammation by suppressing the immune system response. They are often given in combination. This class includes:

    • Azasan and Imuran (azathioprine); Purinethol and Purixan (mercaptopurine): These are the most widely used immunosuppressants for treatment of inflammatory bowel disease. They suppress the immune system by interfering with the body's production of DNA molecules. If you take these, you will have to stay in close touch with your doctor, who will check your blood regularly, as side effects can affect the liver and pancreas.
    • Gengraf, Neoral, and Sandimmune (cyclosporine): These are generally reserved for people who haven't responded well to other medications. Cyclosporine is believed to work by suppressing lymphocytes, a type of white blood cell. Because cyclosporine has the potential for serious side effects, it is not intended for long-term use.
    • Remicade (infliximab), Humira (adalimumab), and Simponi (golimumab): These drugs, called biologics or tumor necrosis factor (TNF) inhibitors, neutralize a protein produced by your immune system. They are for people with a severe disease who don't respond to or can't tolerate other treatments.
    • Entyvio (vedolizumab): This medication is used to treat ulcerative colitis in people who don't respond to or can't tolerate other treatments. It works by blocking inflammatory cells from getting to the site of inflammation.

    Antibiotics

    Antibiotics may be prescribed if an infection in the colon is suspected, but people with ulcerative colitis are sometimes counseled against the use of antibiotics when they are not clearly needed, as they can cause diarrhea.

    Some researchers think there may be a connection between antibiotic use and the development of inflammatory bowel disease (IBD), one form of which is ulcerative colitis.

    This theory is yet unproven, with only a few studies and anecdotal evidence to support it. 

    Over-the-Counter Therapies

    Certain OTC medications may be used to relieve some symptoms of ulcerative colitis, though they are used in conjunction with prescription drugs because they do not address the underlying causes of the disease.

    Always talk to your doctor before purchasing OTC medications. Here are some that may be recommended:

    • Antidiarrheal medications: Imodium (loperamide) can help with diarrhea, but use it and other brands of this drug with caution, as they can increase the risk of an enlarged colon (toxic megacolon).
    • Pain relievers: For mild pain, your doctor may recommend Tylenol (acetaminophen). Avoid Advil or Motrin (ibuprofen), Aleve (naproxen sodium), and Voltaren (diclofenac sodium), which can worsen symptoms and increase the severity of the disease.
    • Enemas and suppositories: Those containing butyrate may be effective in treating ulcerative colitis in the very last sections of the colon (which is often called distal ulcerative colitis). Butyrate has been shown to be beneficial to the cells in the intestinal tract by combating inflammation, preventing cells from becoming cancerous, and reducing the effects of oxidative stress (a process by which cells can get damaged and then be unable to function properly).
    • Iron supplements: If you have chronic intestinal bleeding, you may develop iron deficiency anemia; iron supplements may help.

    Surgeries

    About 30 percent of people with ulcerative colitis will require surgery to get relief from symptoms, dangerous medication side effects, or to reduce the risk of colon cancer. Emergency surgery is sometimes required if there is a sudden perforation of the colon or massive bleeding. The surgery, called a colectomy, involves removal of the large intestine (colon).

    There are various types of colectomy surgery, with these two being the most common in the treatment of ulcerative colitis. You and your surgeon will discuss which option is best for you, based your specific symptoms and overall health status, as well as lifestyle and personal preferences. 

    "J-Pouch" Surgery 

    In this procedure—officially known as proctocolectomy with ileal pouch-anal anastomosis (IPAA)—the large intestine and most of the rectum are removed, and a small reservoir (called a J-pouch) is created out of the small intestine and attached to the remaining portion of the rectum just above the anus.

    Because the muscles of the anus (anal sphincter) are not removed, this procedure allows people to remain in control of their bowels.

    When the J-pouch is done for ulcerative colitis, it is considered a treatment, not a cure, because certain manifestations of IBD that can occur outside of the intestines are still possible. Furthermore, because intestinal tissue remains, the procedure does not eliminate the risk of colon cancer. 

    Total Proctocolectomy

    This surgery involves complete removal of the large intestine, rectum, and anus, and permanently cures ulcerative colitis and eliminates the risk of colon cancer. However, because the rectum and anus are removed, you must have a permanent ileostomy.

    In an ileostomy, a surgeon brings the end of the lowest portion of the small intestine (ileum) out through an opening in the abdominal wall (stoma). People who have an ileostomy must always wear a plastic bag (ileostomy bag) over the opening to collect the stool that comes out. 

    Complementary Medicine (CAM)

    While some of these remedies are believed to be effective in alleviating symptoms, none have undergone extensive clinical research. Here are three that have begun to attract the attention of medical researchers:

    Probiotics
    Probiotics are believed to be beneficial in managing ulcerative colitis and other chronic digestive disorders. Probiotics contain so-called "friendly" bacteria are often able to control more harmful bacteria while reducing inflammation and improving the protective mucus lining of the gut. They are considered safe with no significant side effects and can be found in supplement form as well as in some yogurts, kombucha, and kefir.

    Aloe Vera Gel
    Pure aloe vera gel—from inside the leaf of the aloe plant—has been found to have an anti-inflammatory effect in people with ulcerative colitis. Aloe vera juice, however, may have a laxative effect and is therefore not a good choice if you have diarrhea. 

    Boswellia
    Boswellia is a medicinal herb derived from a tree native to India. The active ingredient is found in the resin of the bark and is believed to have robust anti-inflammatory effects. In it extract from, Boswellia is used to treat inflammatory conditions such as rheumatoid arthritis, and it is said to do so without the stomach irritation often seen with conventional pain relievers.

    Keep in mind that supplements and other forms of alternative therapies have not been stringently tested for safety in pregnant women, nursing mothers, children, or individuals with medical conditions. Always tell your healthcare provider about any supplements, herbs, or homeopathic remedies you are taking or that you may want to try.

    Home Remedies and Lifestyle

    Changes in your diet and lifestyle may help control your symptoms and lengthen the time between flare-ups. You may be able to find some relief from ulcerative colitis by taking some of the following measures:

    • Limit dairy products. Problems such as diarrhea, abdominal pain, and gas may improve by limiting or eliminating dairy products. You may be lactose intolerant—that is, your body can't digest the milk sugar (lactose) in dairy foods. Using an enzyme product such as Lactaid may help as well.
    • Limit fiber. High-fiber foods, such as fresh fruits and vegetables and whole grains, may make your symptoms worse. If raw fruits and vegetables bother you, try cooking them. (Foods in the cabbage family, such as broccoli and cauliflower, may be especially irritating.)
    • Try fatty fish. Omega-3 fatty acids, the healthy fats found in salmon and mackerel, may keep inflammation at bay and ease ulcerative colitis symptoms.
    • Avoid spicy foods, alcohol, and caffeine. These may make your symptoms worse.
    • Eat small meals. Five or six small meals a day rather than two or three larger ones may help you digest more easily and efficiently.

    Sources:

    Fedorak, R. Probiotics in the Management of Ulcerative Colitis J Clin Gastroenterol. 2015 Nov-Dec;49 Suppl 1. doi:10.1097/MCG.0000000000000368.

    Mayo Clinic, Ulcerative Colitis.

    Merck Manual, Consumer Version. Ulcerative Colitis.

    University of Michigan Medicine, Complementary and Alternative Therapies for IBD.