Steroids for Ulcerative Colitis: What You Need to Know

Table of Contents
View All
Table of Contents

Ulcerative colitis (UC) is a chronic inflammatory disease that affects the colon, causing symptoms such as bloody diarrhea and fatigue. If you live with UC, your healthcare provider may prescribe steroids, also called corticosteroids, to treat inflammation in the digestive tract. The goal of treatment is to resolve symptoms and maintain remission, or a period of no symptoms.

Steroids typically treat short-term flare-ups of UC effectively. However, long-term use of steroids can have negative side effects. This article discusses how to use steroids for UC, and lifestyle changes that can help relieve symptoms.

Abdominal pain patient woman having medical exam with doctor

Phynart Studio / Getty Images

Why Take Steroids for Ulcerative Colitis? 

Taking steroids for ulcerative colitis is an effective way to reduce symptoms in the short term. They are 80% effective at achieving a reduction in symptoms and 50% effective at putting the disease into remission.

However, due to the risks of long-term steroid use, they’re most effective for short-term flare-ups when symptoms are at their worst.

Steroids for Ulcerative Colitis Treatment 

Steroid use is often one part of the treatment plan for ulcerative colitis.

Most healthcare providers will prescribe steroids to treat a flare-up of symptoms, then work to lower the dose as early as possible. This helps avoid negative side effects such as dependence, weight gain, and effects on blood sugar regulation.

How Do Steroids Work?

Steroids work by stopping the production of certain chemicals in the body that produce inflammation.

The body naturally produces steroid hormones in the adrenal cortex. The adrenal cortex produces certain hormones to regulate a variety of bodily functions, such as the fight-or-flight response and the inflammation response.

Corticosteroids mimic these natural hormones to produce anti-inflammatory effects.

Corticosteroids vs. Anabolic Steroids

Though corticosteroids are referred to as steroids, they are not the same as the steroids some athletes use for performance enhancement. These steroids, known as anabolic steroids, are human-made versions of testosterone. Taking corticosteroids for UC does not have any testosterone-producing effects on the body.

Taking Steroids for Ulcerative Colitis

The two most common ways to take steroids for ulcerative colitis are orally and rectally. For some hospitalized patients, intravenous (IV) steroids might be prescribed.

The most commonly used oral steroids are prednisone and budesonide.

Prednisone

Prednisone works by changing the way the immune system functions and by reducing inflammation.

The main side effects of prednisone include, but aren’t limited to:

  • Weight gain
  • Increased appetite
  • Mood swings
  • Depression
  • Fatigue
  • A puffy face caused by more fat, known as “moon face
  • Difficulty sleeping

Though these side effects can be experienced by both men and women, women tend to feel these negative effects more often than men.

Budesonide

Budesonide is another oral corticosteroid that is used for mild to moderate UC. Budesonide has less widespread effects on the body and is more focused on the GI tract.

Both prednisone and budesonide are effective in treating UC, but since there are fewer side effects associated with budesonide, it may be preferred.

Side effects of budesonide include, but aren’t limited to:

  • Headache
  • Dizziness
  • Runny nose, sneezing, coughing
  • Nausea
  • Indigestion
  • Back pain
  • Fatigue

These side effects can be experienced by both men and women.

Rectal Steroids

Rectal steroids are used when the affected part of the colon is closer to the anus. In this case, the steroids can be administered rectally so that they can work on the affected areas directly. This topical approach reduces the risk of full-body side effects that are common with oral steroids.

Rectal steroids come in suppository, enema, and rectal foam preparations.

Common rectal steroids include, but aren’t limited to:

  • Hydrocortisone in suppository, enema, and rectal foam form
  • Cortenema and methylprednisolone in enema form only
  • Uceris (budesonide foam) and Proctofoam-HC in rectal foam form

Managing Ulcerative Colitis Long Term

While corticosteroid use is a common treatment for UC, it is best used for controlling acute flare-ups and bringing UC into remission. Long-term use of prednisone can be dangerous and may not help to control UC over time.

To manage UC long term, there are other options.

What Is Considered Long-Term Prednisone Use?

Long-term prednisone use is the use of the medication for more than a month.

Using prednisone long term can have adverse effects. The longer the treatment time, the more negative side effects can be expected.

Long-term use of corticosteroids can cause other conditions, such as diabetes, cataracts, high blood pressure, and osteoporosis.

To manage UC long term, talk to your healthcare provider about other options for controlling your disease.

Alternatives to Prednisone

Though corticosteroids are an effective treatment option in the short term, it’s important to know alternative options.

Several medications can be used to treat UC long term. These include, but are not limited to:

  • 5-aminosalicylates (5-ASA) such as sulfasalazine, mesalamine, and olsalazine
  • Immune system suppressors or immunomodulators such as azathioprine, cyclosporine, and tacrolimus
  • Biologics such as adalimumab, golimumab, and infliximab

In some cases, surgery to treat UC may be necessary. Approximately 20% of people with UC will need surgery to treat the disease at some point.

Surgery main be needed for those who have stopped responding to treatment, have developed cancer, or have an emergency situation such as severe bleeding or toxic megacolon.

The most common type of surgery is a restorative proctocolectomy with ileal pouch-anal anastomosis (IPAA), which involves removing all or part of the colon and restoring bodily function.

Lifestyle Changes for Ulcerative Colitis 

While medical treatment can help control UC and keep it in remission, changing certain lifestyle factors can also help you live well with the disease.

These changes can help lessen the severity of UC. If your UC does worsen, being continuously monitored by your healthcare team can boost chances of early detection and improve colon cancer survival rates.

Lifestyle changes you can consider making include:

  • Having regular cancer screening via colonoscopy
  • Seeing your gastroenterologist annually, or more often as needed
  • Eating a diet that is high in vegetables, fruits, and whole grains
  • Limiting dairy product intake
  • Reducing your intake of red meat and processed meats, which are connected to risk of colorectal cancer
  • Limiting alcohol intake or avoiding it altogether
  • Drinking a lot of liquids, all day long
  • Eating smaller meals throughout the day
  • Exercising regularly
  • Reducing stress

Summary

Corticosteroids are a common type of medication used to treat ulcerative colitis. However, they can have negative side effects when used on a long-term basis. There are alternative treatment options for UC, including other types of medications, surgery, and lifestyle modifications.

A Word From Verywell

Living with UC requires work to manage the disease. While steroids can be an important part of your treatment plan to help you reach and maintain remission, it’s important to talk to your healthcare provider about other treatment options and lifestyle changes you can make. These can improve your quality of life while living with the disease, as the negative effects of long-term steroid use can be consequential.

Frequently Asked Questions

  • Is prednisone a corticosteroid?

    Prednisone is a corticosteroid that lowers inflammation in the body.

  • How long can you take steroids for ulcerative colitis?

    Though steroids can be used long term, it’s not advisable as negative side effects become more common. Most healthcare providers will work to keep steroid treatment to the minimum time necessary to achieve results.

  • What is the most effective medication for ulcerative colitis?

    Each person with UC has a different course of disease, and it’s important to talk to your healthcare provider to find the most effective medication for you.

  • Are there any new treatments for ulcerative colitis?

    Although treatment for UC used to be limited to steroids, over the last two decades more medications have been developed to treat the disease.

Was this page helpful?
15 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.
  1. Ungaro R, Mehandru S, Allen PB, Peyrin-Biroulet L, Colombel JF. Ulcerative colitisLancet. 2017;389(10080):1756-1770. doi:10.1016/S0140-6736(16)32126-2

  2. Okayasu M, Ogata H, Yoshiyama Y. Use of corticosteroids for remission induction therapy in patients with new-onset ulcerative colitis in real-world settingsJ Mark Access Health Policy. 2019;7(1):1565889. doi:10.1080/20016689.2019.1565889

  3. Ericson-Neilsen W, Kaye AD. Steroids: pharmacology, complications, and practice delivery issuesOchsner J. 2014;14(2):203-207.

  4. Medline Plus. Prednisone. Updated September 29, 2021.

  5. Lee I, Kaminski HJ, McPherson T, Feese M, Cutter G. Gender differences in prednisone adverse effects: survey result from the MG registryNeurol Neuroimmunol Neuroinflamm. 2018;5(6):e507. doi:10.1212/NXI.0000000000000507

  6. Abdalla MI, Herfarth H. Budesonide for the treatment of ulcerative colitisExpert Opin Pharmacother. 2016;17(11):1549-1559. doi:10.1080/14656566.2016.1183648

  7. Medline Plus. Budesonide. Updated September 29, 2021.

  8. Christophi GP, Rengarajan A, Ciorba MA. Rectal budesonide and mesalamine formulations in active ulcerative proctosigmoiditis: efficacy, tolerance, and treatment approachClin Exp Gastroenterol. 2016;9:125-130. doi:10.2147/CEG.S80237

  9. Mundell L, Lindemann R, Douglas J. Monitoring long-term oral corticosteroidsBMJ Open Qual. 2017;6(2):e000209. doi:10.1136/bmjoq-2017-000209

  10. Crohn’s and Colitis Foundation. Medication options for ulcerative colitis.

  11. Kühn F, Klar E. Surgical principles in the treatment of ulcerative colitis. Viszeralmedizin. 2015;31(4):246-250. doi:10.1159/000438894

  12. Clarke WT, Feuerstein JD. Colorectal cancer surveillance in inflammatory bowel disease: practice guidelines and recent developmentsWorld J Gastroenterol. 2019;25(30):4148-4157. doi:10.3748/wjg.v25.i30.4148

  13. Keshteli AH, Madsen KL, Dieleman LA. Diet in the pathogenesis and management of ulcerative colitis; a review of randomized controlled dietary interventionsNutrients. 2019;11(7):1498. doi:10.3390/nu11071498

  14. Langhorst J, Schöls M, Cinar Z, et al. Comprehensive lifestyle-modification in patients with ulcerative colitis-a randomized controlled trialJ Clin Med. 2020;9(10):3087. doi:10.3390/jcm9103087

  15. Kayal M, Shah S. Ulcerative colitis: current and emerging treatment strategiesJ Clin Med. 2019;9(1):94. doi:10.3390/jcm9010094