Treating Ulcerative Colitis

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What to Expect After an Ulcerative Colitis Diagnosis

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Ulcerative colitis is a chronic inflammatory bowel disease that can cause diarrhea, abdominal pain, and nutritional challenges. An ulcerative colitis diagnosis can be alarming, but having an accurate diagnosis is the first step to appropriate treatment and symptom relief. Here's what to expect and questions to ask your doctor about ulcerative colitis medications, diet and potential complications.

Ulcerative Colitis Medications

Most people with ulcerative colitis take prescription medication to control symptoms. Because ulcerative colitis is a progressive, chronic disease, your healthcare provider may need to occasionally change your medication regimen. It may take some time and experimentation to find the right medication or combination of medications to effectively control your symptoms.

Common medications for ulcerative colitis include:

  • Aminosalicylates, including mesalamine, balsalazide and olsalazine. These drugs contain 5-aminosalicylic acid (5-ASA), an ingredient that decreases inflammation. Aminosalicylates are used in people with mild to moderate ulcerative colitis. These medications can be taken by mouth or rectally.

  • Corticosteroids, including prednisone, methylprednisolone, hydrocortisone and budesonide. Oral steroid medications can decrease inflammation, but they also cause unwanted side effects, including insomnia, weight gain, and high blood sugar levels. Healthcare providers usually use corticosteroids to control symptoms during an ulcerative colitis flare or to treat symptoms that haven’t responded to aminosalicylates.

  • Immunomodulators, including azathioprine and 6-MP. These medications suppress the immune system, which leads to decreased colon inflammation. Immunomodulators can damage the liver and increase the likelihood of infections and some cancers (including skin cancer), so these medications are usually reserved for people who do not respond to aminosalicylates.

  • Biologics, including adalimumab, golimumab and infliximab, can rapidly decrease inflammation and bring about remission. These powerful drugs are administered by IV or injection.

Approximately 20% of people with ulcerative colitis will eventually need surgery. Your healthcare provider may recommend surgical removal of your colon (or part of your colon) if medication cannot control your symptoms or you develop health-threatening complications.

Ulcerative Colitis Diet and Nutrition

There is no one-size-fits-all ulcerative colitis diet, but nutrition plays an important role in managing this condition. You may find that certain foods trigger increased abdominal pain, gas and diarrhea. Identifying and avoiding these foods may help you feel better.

Because ulcerative colitis affects your body’s ability to effectively absorb nutrients, your healthcare provider may recommend over-the-counter vitamins and dietary supplements.

Ulcerative Colitis Tests

Your healthcare provider will monitor your colitis and overall well-being with a variety of tests, including:

  • Colonoscopy/flexible sigmoidoscopy. These tests allow your healthcare provider to see the inside of your colon. They are used to monitor the progression of your disease and to screen for colon cancer.

  • Blood tests. Simple blood tests help your medical team identify and treat nutritional deficiencies.

  • Bone scans. Some ulcerative colitis medications can cause gradual bone loss. Healthcare providers use bone scans to evaluate the health of your bones. If needed, they can prescribe medication to support bone health.

Ulcerative Colitis Complications

Ulcerative colitis and the medications used to treat it can cause:

  • Intestinal bleeding. If you notice bloody or black bowel movements, notify your healthcare provider, as these symptoms can signify internal bleeding.

  • Dehydration or malnutrition. During symptom flare-ups, some people with ulcerative colitis need IV fluids to stay hydrated.

  • Bone loss. Nutritional supplements and prescription medication can prevent and slow bone loss.

  • Megacolon, a rare life-threatening complication in which the large intestine stops working all together.

  • Colon cancer. People who have ulcerative colitis are at increased risk of developing colon cancer. Regular colonoscopies may allow healthcare providers to detect colon cancer in its earliest stages, when it’s most treatable.

Most people with ulcerative colitis live satisfying lives. Communicate your symptoms to your healthcare provider. Together, you can develop a treatment plan that fits your needs.

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Medical Reviewer: William C. Lloyd III, MD, FACS
Last Review Date: 2021 May 11
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