How Is Ulcerative Colitis Treated?
Treatment for ulcerative colitis can include medicines, changes in diet, or surgery. These UC treatments won't cure ulcerative colitis unless you have surgery that removes the colon and rectum, which is considered curative, but they can help ease your symptoms.
Medications for Ulcerative Colitis
Your doctor may suggest several types of colitis medications to curb inflammation in your bowel, including sulfa drugs, corticosteroids, immunosuppressive agents, and antibiotics.
5-aminosalicylic acid (5-ASA)
Balsalazide, mesalamine, olsalazine, and sulfasalazine are the main medications you take to treat ulcerative colitis. They come in both pill and suppository forms. Let your doctor know if you are allergic to sulfa before taking one of these drugs. They can prescribe a sulfa-free 5-ASA.
Corticosteroids
You can use these anti-inflammatory drugs if 5-ASA drugs don't work or if you have a more severe disease. These colitis medications sometimes have side effects and long-term complications, so doctors often suggest them for short periods to help you get in remission. Your doctor may then prescribe you a 5-ASA medication to keep your symptoms away for a longer period.
Immunosuppressants
If corticosteroids or 5-ASA drugs don't help, your doctor may prescribe other drugs such as 6-mercaptopurine (6-MP), azathioprine (Azasan, Imuran), cyclosporine, and tacrolimus (Astagraf XL, Envarsus XR, Prograf).
Biologics
This group of drugs includes adalimumab (Humira), plus adalimumab-atto (Amjevita) and adalimumab-adbm (Cyltezo), which are biosimilars to Humira; certolizumab pegol (Cimzia), golimumab (Simponi, Simponi Aria), infliximab (Remicade), infliximab-abda (Renflexis), infliximab-axxq (Avsola), infliximab-dyyb (Inflectra) — a biosimilar to Remicade, infliximab-qbtx (IXIFI), ustekinumab (Stelara), and vedolizumab (Entyvio).
Janus kinase inhibitors (JAK inhibitors)
These are oral medicines that can quickly work to get and maintain a remission in ulcerative colitis. Tofacitinib (Xeljanz) is the first JAK inhibitor that is FDA-approved for the treatment of ulcerative colitis. The FDA has warned that early studies show a higher risk of serious heart-related problems and cancer in people taking this drug. Talk about the risks with your doctor, but don't stop taking it without talking to them.
Sphingosine 1-phosphate (S1P) receptor modulators
Ozanimod (Zeposia), an oral medication, is the first sphingosine 1-phosphate (S1P) receptor modulator approved for patients with moderately to severely active UC.
Researchers are studying newer colitis medications, including S1P receptor receptor modulators, which you can take by mouth. They think these drugs may avoid the anti-drug antibodies that sometimes form with medications given as a shot. Antibodies are proteins that cancel out viruses, bacteria, and other things your body doesn’t recognize.
Ulcerative Colitis Diet
While food doesn't appear to play a role in causing ulcerative colitis, certain foods may cause more symptoms when your disease is active. Your doctor may suggest the following diet changes depending on your symptoms:
Avoid dairy. Dairy products such as milk, yogurt, cheese, and ice cream could make diarrhea, stomach pain, and gas worse. Try avoiding them to see if it helps.
Avoid fiber. High-fiber foods, such as raw fruits and vegetables and whole grains, are rich in nutrition but can worsen ulcerative colitis symptoms. Avoid nuts, seeds, corn, and popcorn. Instead, cook fruits and vegetables by steaming, baking, or grilling to see if it makes a difference.
Eat smaller meals. Instead of three large meals, try eating five or six small meals a day. Make sure these meals are healthy and balanced rather than just snacking throughout the day.
Choose drinks carefully. Drink lots of water every day. Avoid alcohol, caffeine, and carbonated drinks because they can add to your diarrhea and produce gas.
Add vitamins and minerals. Certain vitamins and minerals can help to supplement nutrients lost due to UC or medicines you take to treat the condition. Your doctor may suggest adding foods or supplements with:
- Calcium
- Folic acid
- Iron
- Vitamins B12, D, A, E, and K
Ulcerative Colitis Surgery
Colectomy
Some people get surgery to remove part or all of the colon. Your doctor may suggest this if your medicine isn't working, your symptoms get worse, or your ulcerative colitis leads to further serious health problems.
When you have an operation to remove your entire colon, a surgeon can either do it through a large incision or use a minimally invasive approach with small cuts and cameras — which typically offer quicker recovery. The surgeon most often creates an opening, or stoma, in your belly wall. They attach a bag there and bring the tip of your lower small intestine through the opening. Waste passes through it and collects in a pouch attached to the stoma. You'd need to wear the pouch all the time.
Before surgery, you’ll undergo health screenings, follow a special diet, and receive counseling about the procedure, risks, and life with a possible colostomy. Post-surgery, you’ll stay in the hospital for a few days. Full recovery can take up to 6 weeks, and while complications are uncommon, it’s important to contact your doctor if you notice signs of infection or other concerning symptoms.
In the long term, you may have changes to your bowel health, such as diarrhea, dehydration, gas, and constipation.
Ileal pouch-anal anastomosis
A newer surgery, known as a pelvic pouch or ileal pouch-anal anastomosis (IPAA), doesn't create a permanent opening. Instead, a surgeon removes your colon and rectum and uses your small intestine to form an internal pouch or reservoir that serves as a new rectum. This pouch is connected to the anus.
There are three types of pouches: the J-pouch (the most common), the S-pouch, and the less common Kock pouch. Recovery involves a hospital stay of about a week, and you may need a temporary external pouch until healing occurs. While J-pouches and S-pouches enable normal waste storage and passage, K-pouches allow for controlled bowel emptying.
Risks include pouchitis (inflammation), leakage, and other health problems. You should fully heal in about 4 to 8 weeks and will need to watch for changes.
Continent ileostomy
Doctors perform a procedure called a continent ileostomy (Kock pouch) if you want your external pouch converted to an internal one or if you can't get the IPAA operation.
In this procedure, there is a stoma but no bag. Your surgeon removes your colon and rectum and creates an internal reservoir from your small intestine. They make an opening in your belly wall and join the reservoir to your skin with a nipple valve. To drain the pouch, you insert a catheter through the valve into the internal reservoir.
Recovery takes several weeks, and you'll need a catheter to empty the pouch. Long-term, you may have other health problems such as valve issues, pouchitis, or fistulas (abnormal passageways that form from inside your anus to the skin outside). However, many people have a better quality of life compared to those who use traditional ileostomy methods.
Other techniques are also available. All surgeries carry some risks and further health problems. If your doctor has told you that you need surgery to treat ulcerative colitis, you may want to get a second opinion to make sure you get the best option for you.
Alternative Treatments for Ulcerative Colitis
You may consider these approaches in addition to what your doctor prescribes. But it’s important to talk to your medical team about any or all of them because some, such as supplements, can interfere with treatments from your doctor. Let’s take a look at a few:
Mind-body therapies
Stress and anxiety are well-known triggers for many people with ulcerative colitis, so it is not surprising that mind-body relaxation techniques could help. These techniques help nurture a healthy connection between your mind and body as well as between you and the outside world. In some cases, they encourage behavior changes in your everyday life. They may be worthwhile if only to lessen anxiety and depression linked to UC and improve quality of life. In addition, there is some evidence that yoga, meditation, and gut-centered hypnotherapy could help with some physical symptoms or UC flare-ups. Some of the techniques, such as cognitive behavioral therapy (a type of psychotherapy) and patient support groups, have been so successful that they have slowly become a part of mainstream treatment for IBD.
Vitamins and supplements
Many people with ulcerative colitis may not absorb enough of some vitamins or minerals from food because of their disease. In these cases, your doctor may suggest taking certain supplements. Still, it’s important to speak with your doctor before you decide to take any on your own. Many of these substances can be unsafe, particularly if you have UC and you’re taking other medicines. Some people also take certain supplements in the belief that they help control UC symptoms. These might include:
Fish oil. The omega-3 fatty acids found in fish, walnuts, flaxseed, and vegetable oils are good for your health. They lessen inflammation and help protect the heart, among other benefits. Some people with UC take omega-3 supplements in the form of fish oil capsules to lessen gut inflammation. Research has so far been unclear on whether this works. Too much fish oil may be bad for you and could be dangerous if you take it with blood thinners such as warfarin (Coumadin).
Turmeric. This spice, commonly used in Indian and South Asian cooking, has a chemical called curcumin that may help lessen inflammation in some people. Some small studies show that it could help with UC flare-ups in capsule form, but scientists need to do more research to confirm these results. Also, many of the studies used very pure curcumin compounds that may not be available in retail brands. Curcumin can also have side effects such as bloating, nausea, and diarrhea. Also, it thins the blood and has not been tested for safety in pregnant women.
Probiotics. These are “good” bacteria found in many foods that add to the healthy balance of bacteria in your gut. In supplement form, some studies suggest they could help bring a UC flare-up to an end and keep it there, especially if you have a pouch (from J-pouch surgery) that is inflamed. Still, it’s important to take care. There is a wide variety of probiotic products on the market, and much more study is needed.
Keep in mind that the FDA doesn't regulate supplements, so claims on packaging may not be accurate. That’s yet another reason why it’s important to talk to your doctor before you start taking any supplements for your UC.
When Should I Call My Doctor About Ulcerative Colitis?
Call your doctor right away if you have:
- Heavy, persistent diarrhea
- Rectal bleeding with clots of blood in your stool
- Constant pain and a high fever
Takeaways
Doctors treat ulcerative colitis with a combination of medicines, diet changes, and sometimes surgery. While medicines, such as 5-aminosalicylic acids, corticosteroids, immunosuppressants, and newer biologics, can help manage symptoms and lower inflammation, they don’t cure the disease unless doctors surgically remove your colon and rectum.
You and your doctor may consider surgery for severe UC cases or when medications fail. Diet changes may help ease symptoms during flare-ups, and complementary therapies, such as mind-body techniques and certain supplements, could offer relief. But, it’s essential to talk to your doctor before trying new treatments or supplements to avoid possible further health problems.
