Finding the Right Treatment for Ulcerative Colitis
There are more and better treatments for ulcerative colitis (UC) available today than ever before. No two people experience the disease exactly the same way, but everybody with UC can eventually find a treatment plan that minimizes their symptoms and makes a full life possible.
All your UC problems won't necessarily be solved overnight. As you may have already discovered, the challenge often lies in finding the specific treatment approach that works best for you. Even when you've found a treatment plan that's effective for you today, your therapeutic needs might change tomorrow.
UC is a long-lasting disease that causes inflammation and sores in the inner lining of the large intestine, which is composed of the colon and rectum. The most common symptoms are abdominal cramping and diarrhea with blood or pus in it. But there also can be other symptoms, such as tiredness, fever, nausea, lack of appetite, weight loss, and rectal bleeding. Plus, UC sometimes leads to problems in other parts of the body, such as skin disorders, joint pain, eye irritation, kidney stones, liver disease, and bone loss.
Treatment can help get symptoms under control and often bring on remission—a period when symptoms go away for weeks, months, or even years. Once the disease is in remission, treatment can help keep symptoms away for longer. Eventually, however, they're likely to crop up again—and it's hard to predict when the next flare-up will be.
In short, staying ahead of UC can be tricky. Fortunately, several types of medication are available to help. If medications don't work well for you or if serious side effects are a concern, surgery is another possibility.
To plan your treatment, your doctor may consider a number of factors:
Severity of your symptoms. Mild symptoms mean you have fewer than four stools per day, which may be bloody. Moderate symptoms mean you have four to six bloody stools per day. Severe symptoms mean you have more than six bloody stools per day along with symptoms such as a faster-than-normal heartbeat, fever, or anemia.
Why it matters: Aminosalicylates—a group of medications that help reduce inflammation—are often the first choice for treating mild to moderate symptoms. But they may not be strong enough to control more severe symptoms. You may require other UC drugs to deliver the relief you need.
Location in the large intestine. Once UC is diagnosed, your doctor may assess how much of your large intestine is inflamed by using a flexible viewing tube that's inserted into the anus. In distal colitis, inflammation starts at the rectum and may go higher, but reaches no farther than a bend in the colon near the spleen, in the upper left abdomen. In extensive colitis, inflammation affects the rectum and entire colon.
Why it matters: Distal colitis is sometimes treated with medicated suppositories, rectal foam, or enemas. This may lead to faster results and fewer side effects than taking a pill. But medication taken rectally doesn't get far enough into the colon to treat more extensive colitis.
Activity of your disease. When UC is active, you're currently having symptoms. When UC is in remission, you're between flare-ups and currently symptom-free.
Why it matters: You may need to keep taking medication during remission, but the type of drug might change. For example, corticosteroids—a group of medications that fight inflammation quickly and powerfully—are a mainstay of treatment for more severe, active UC. But corticosteroids generally aren't taken while in remission, because they don't help prevent future flare-ups and long-term use only increases the risk for serious side effects.
Response to other treatments. Another key factor is how effective a previous treatment was for you and whether it had troublesome side effects.
Why it matters: If aminosalicylates and corticosteroids haven't worked well for you, there are other drug options. Golimumab (Simponi), infliximab (Remicade), adalimumab (Humira), and vedolizumab (Entyvio)are biologic medications that target an inflammation-promoting protein called TNF. Immunomodulators are medications that suppress the immune system. If you've tried various medications but haven't found one that's safe and effective for you, your doctor might advise surgery to remove the rectum and part or all of the colon.
Emergency symptoms. If you develop severe bleeding or serious dehydration due to diarrhea, you might need to be hospitalized. Immediate surgery may be required for massive bleeding, severe illness, or rupture of the colon.
Other complications. Antibiotics may be prescribed if an infection develops. Surgery may be considered for precancerous changes in the colon. Additional treatments might be needed for complications outside the large intestine.
Your doctor will also look at how your disease has progressed with time—how often it comes and goes and whether it's getting worse. Plus, your doctor will consider your age, overall health, lifestyle, and personal preferences.
Considering all possible combinations of so many factors, the authors of one journal article calculated that there are more than 1,000 different scenarios calling for different treatment regimens. As a patient, however, you only need to worry about one scenario—the one that describes your life right now.
It may take time to find the specific treatment for ulcerative colitis that works best for you.
Your doctor will consider the severity of your symptoms, the location of the disease, and how active your UC is.
- Another key factor is how previous treatments worked for you and whether they had troublesome side effects.