Treatment Options for Ulcerative Colitis
Ulcerative colitis (UC) is an aggravatingly persistent disease. Its symptoms—such as abdominal cramps and diarrhea with blood or pus in it—may go away for a while, only to come back later. There's no medicine that will cure UC permanently. But there are treatments that can help you manage the symptoms and take back control of your life.
UC affects everyone differently, so a treatment that works well for someone else might not be effective for you. That means treatment must be tailored to your needs. Fortunately, there are several options for you and your doctor to choose from.
The hallmark of UC is inflammation in the inner lining of the large intestine, which is composed of the colon and rectum. Medication can decrease this inflammation and give tissues a chance to heal. This may bring on remission—a period when symptoms go away. Once your illness is in remission, medication may reduce future flare-ups.
Four main types of medication are used to treat UC:
1. Aminosalicylates: balsalazide (Colazal), mesalamine (Apriso, Asacol, Canasa, Lialda, Pentasa, Rowasa), olsalazine (Dipentum), sulfasalazine (Azulfidine)
Taken orally or rectally. These medications, which reduce inflammation, can help get mild to moderate symptoms under control. They can also help maintain remission.
2. Corticosteroids: methylprednisolone (Medrol), prednisolone (Pediapred Oral Liquid), prednisone (Deltasone)
Taken orally, rectally, or through an IV. These powerful medications, which decrease inflammation, can help control more severe flare-ups. To minimize side effects, they're usually prescribed only for limited-term use.
3. Immunomodulators: azathioprine (Azasan, Imuran), cyclosporine (Gengraf, Neoral, Sandimmune), 6-mercaptopurine (Purinethol)
Taken orally or through an IV. These medications, which suppress the immune system, can help some people who don't respond to aminosalicylates and corticosteroids. They're slow-acting, taking three to six months to be fully effective.
4. Biologics: infliximab (Remicade), adalimumab (Humira)
Taken through an IV once every six to eight weeks: golimumab (Simponi), infliximab (Remicade), vedolizumab (Entyvio); or by injection at home, in the case of adalimumab. This newer type of medication targets an inflammation-promoting protein called TNF. Because of its different mode of action, it works for some people who don't respond to other therapies. It may be helpful for maintaining remission or weaning off corticosteroids.
Changes in diet are often part of the treatment plan for UC. Such changes don't eliminate the underlying disease, but they may ease symptoms and promote healing. The exact diet recommended by your health care team will depend on your symptoms and reactions to foods.
For example, some people find that eating a low-fiber diet reduces symptoms, and low-fat diets can be especially useful during flares. Others experience less discomfort after eating if they have several small meals throughout the day rather than three large ones.
When you have a chronic disease such as UC, good nutrition is vital for your health. Yet abdominal cramps can zap your appetite, and diarrhea can rob your body of minerals and fluids. So along with eating a balanced diet and drinking plenty of water, your health care team might suggest that you take certain supplements.
Most people with UC are able to control their symptoms effectively with medications and diet. However, some 10 to 40% eventually need a proctocolectomy—surgery to remove the rectum and part or all of the colon. Individuals who experience severe UC (pancolitis) early in the disease are more likely to need surgery. Although surgery is never anyone's first choice, it does have a silver lining: Once the large intestine is gone, so is the illness.
Surgery may be recommended if other treatments aren't working well. In addition, surgery may be needed to treat serious complications, such as massive bleeding, severe illness, rupture of the colon, or precancerous changes in the colon.
Many people can still have bowel movements after surgery for UC, thanks to an operation called ileoanal pouch anastomosis ("pouch surgery"). In this operation, the anus and the muscles around it are left in place. The lower end of the small intestine is then fashioned into a pouch and pulled down to attach to the anus. Once everything heals, waste is stored in the pouch and passed through the anus in the usual way.
Managing UC isn't a one-size-fits-all proposition. But based on the nature and severity of your symptoms, your doctor can help you find a treatment plan that fits you.
- Ulcerative colitis affects everyone differently, so a treatment that works well for someone else might not for you.
- Four main types of medication are used to treat UC: aminosalicylates, corticosteroids, immunomodulators, and biologics.
- Certain diet changes also may ease symptoms and promote healing.
- Surgery may be needed if other treatments aren't working or if serious complications arise.