Fortunately, there is a wide range of treatment options available that can help control ulcerative colitis (UC) as long as you stay on your treatment as prescribed. Getting ulcerative colitis under control and achieving remission (few or no symptoms) is a main goal of ulcerative colitis treatment.
It’s important to set treatment goals with your doctor
Often, the time with your doctor may be limited, so make it a priority to talk to your doctor about what you can expect from treatment and whether your treatment plan is working for you at every check-up. Talk to your doctor about finding a treatment that can help you reach these goals:
- Controlling inflammationImmune response to tissue injury that causes redness, swelling, and pain. that triggers your symptoms
- Achieving remission
- Maintaining remission
Remember, if you still experience a flare-up of symptoms and are taking your treatment as prescribed, you may want to talk to your doctor about whether your treatment is right for you. Your doctor may reassess your medication depending on the severity of your symptoms (whether they are mild, moderate, or severe).
Treatment options for IBD
Gastroenterologist Dr. Millie Long discusses treatment options and the importance of setting treatment goals.
Millie Long, M.D., M.P.H., is an Associate Professor at the University of North Carolina Chapel Hill School of Medicine.
Ulcerative Colitis Symptom Severity
- Up to 4 loose stools per day
- Stools may be bloody
- Mild abdominal pain
- 4-6 loose stools per day
- Stools may be bloody
- Moderate abdominal pain
- More than 6 bloody loose stools per day
- Fever, anemia, and rapid heart rate
Very Severe (Fulminant)Symptoms of disease coming on suddenly with great severity.
- More than 10 loose stools per day
- Constant blood in stools
- Abdominal tenderness/
- Blood transfusion may be a requirement
- Potentially fatal complications
Using this information, along with certain other tests and additional information, your doctor can help develop a treatment plan that works for you.
Prescription medications that treat UC
Medications that treat ulcerative colitis strive to control the inflammation that is a main cause of UC symptoms and induce remission. It’s quite possible that you may try multiple medications before finding the one that works best. So talk to your doctor if you feel like your medication isn’t meeting your treatment goals.
It’s also important to note that the medication your doctor prescribes may depend on whether you have mild, moderate, or severe UC and/or where in your large intestine your disease is active.
The following are the categories of drugs prescribed to treat UC:
Metronidazole, ciprofloxacin, and other antibiotics may be used when infections occur, or to treat complications of ulcerative colitis.
Given either orally or rectally, these drugs work to decrease inflammation in the lining of the intestines and are usually used to treat mild to moderate UC symptoms.
Given orally, as an injection, rectally, or intravenously, these medications help reduce inflammation by suppressing the immune system and are usually given to help with moderate to severe UC symptoms. Steroids are not intended for long-term use; they are best suited for short-term control of IBD symptoms and disease activity. If not used appropriately, patients can become steroid dependent or resistant.
Immune modifiers (Immunomodulators)
Given orally or injected, these medications suppress the body's immune response so that it cannot cause ongoing inflammation.
Biologic therapies (Biologics)
Given intravenously or injected, this class of drugs suppresses the immune system to reduce inflammation by targeting a specific pathway, and is usually given to people who have not responded to conventional therapy.
Other oral agents
Given orally, it suppresses the immune system to reduce inflammation by targeting a specific pathway.
Depending on your ulcerative colitis symptoms, your doctor may recommend over-the-counter (OTC) medications for you, such as:
- Pain relievers
- Nutritional supplements
Over-the-counter medications are often suggested to be taken as a supplement to your prescription—not instead of it.
You may also be familiar with “natural” medicine—alternative treatments, therapies, or medicine to supplement or use in place of prescription medications. Make sure you have an honest dialogue with your doctor before using alternative treatments, as they can impact the effects of traditional therapies.
When surgery is necessary
Treatment with medication is the first therapeutic option for people with ulcerative colitis. However, surgery may be a consideration if the disease doesn’t respond to medication—and surgery is sometimes considered to be a cure in ulcerative colitis.
Certain types of surgery for UC may result in a patient needing an ostomy. The United Ostomy Associations of America is a good place to find information.
Surgery in ulcerative colitis usually involves removal of the colon and rectum, which is called a proctocolectomySurgical procedure involving removal of the rectum and/or colon. The procedure can include all or part of the colon., of which the following variations are possible:
Total proctocolectomy with end ileostomy
A total proctocolectomy is when the anus is surgically removed in addition to the colon and rectum. An ileostomy is a surgical procedure that creates a hole in the abdomen (called a stoma) through which solid waste is emptied into a pouch.
Proctocolectomy with ileal pouch-anal anastomosis (IPAA)
In this procedure, the colon and the rectum are removed, but the anus and anal sphincter muscles are preserved. The ileum is fashioned into a J, S, or W shaped pouch. This eliminates the need to wear a permanent external bag.
It’s important to keep in mind that ulcerative colitis can still cause symptoms after surgery—so it's essential to continue to work with your doctor to keep up with the management of your disease.
Find out about a treatment option for moderate to severe ulcerative colitis. Learn more.