When Ulcerative Colitis Symptoms Get Worse

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If you've been battling ulcerative colitis (UC) for some time, you understand the need to break free from symptoms. Perhaps past treatments haven't worked. Or maybe you've achieved remission, only to have your condition flare again. If you're facing increasing symptoms of UC, take heart. There are innovative therapy options that can help you gain control.

If your UC symptoms progress beyond the mild stage, your doctor will change your treatment plan. People with moderate UC usually have four to six stools a day with rectal bleeding. Those with severe colitis usually have more than six stools a day with bleeding. They also experience other symptoms like fever, anemia, and increased heart rate.

Many people are successfully treated with 5-aminosalicyclic acids (5-ASAs). However, it's common to require more aggressive therapy at moderate and severe stages of the disease, when higher dosages of these medications fail to provide relief. Although every treatment plan is different, your doctor may consider the following options for treatment when 5-ASAs no longer work.


Corticosteroids, such as prednisone, are often used for people with moderate to severe UC. They've been shown to successfully control symptoms in people with moderate and severe forms of the disease. Your doctor may prescribe corticosteroids in oral form. If you have more severe ulcerative colitis, you may need to go to the hospital to be given the drug intravenously.

If corticosteroids are successful in controlling your symptoms, you can stay on them for up to two or three months and then be transitioned to maintenance medication. Corticosteroids shouldn't be taken as maintenance therapy because they can cause harsh side effects such as high blood pressure, diabetes, loss of bone mass, cataracts, facial hair, weight gain, and an increased risk for infection. Maintenance medication may include immunomodulator drugs, such as azathioprine (Imuran) or 6-mercaptopurine (6-MP, Purinethol), which help control inflammation in the gastrointestinal tract by suppressing the immune system.

A New Class of Drugs

When other medications fail to work, newer medications called biologics may be prescribed. Biologic drugs are naturally occurring compounds made from living organisms. They are designed to target certain proteins that can cause inflammation. The therapy, which is self-injected or provided intravenously, can effectively control symptoms in people with severe ulcerative colitis. Examples of FDA-approved biologics to treat UC include infliximab (Remicade), golimumab (Simponi), vedolizumab (Entyvio), and adalimumab (Humira).

Seeking Hospitalization

During your journey to achieving control of your UC, symptoms of the disease may take a toll on your body. If bleeding and diarrhea are so severe that you become dehydrated, you may need to be hospitalized. To help, health care providers will provide intravenous fluids to treat your diarrhea and loss of blood and fluids.

Considering Surgery

It's estimated that about 10 to 40% of people with UC will eventually need surgery to remove the rectum and part or all of the colon. You may need surgery if other therapies don't work or the side effects of medications are too severe. It could be essential if complications of the disease become life-threatening.

Some people are candidates for an ileoanal pouch anastomosis, or "pouch surgery." This type of surgery makes it possible for people with UC to have normal bowel movements after surgery. During the procedure, the surgeon preserves the outer muscles of the rectum. The lower end of the small intestine, or ileum, is then pulled through the remaining rectum and joined to the anus, creating a pouch. Waste is stored in the pouch and passes through the anus as usual. The surgery isn't without complications, however. If the pouch becomes inflamed, it can lead to increased diarrhea and reduced control of bowel function.

Based on the severity of your disease, another form of the surgery, called an ileostomy, may be performed. This operation requires the ileum—the end of the small intestine—to be connected to an opening made in the abdomen. An ostomy pouch then collects stool on the outside of the body. Although this type of surgery is the last resort, it does provide complete relief of colitis symptoms.

Wherever you are in the treatment process, it's important to work closely with your doctor. Ask questions about your medication. Find ways to help improve your quality of life. And prepare yourself for next steps. As treatment options grow, more and more people are finding relief.

Key Takeaways

  • If your ulcerative colitis symptoms worsen and 5-ASAs no longer work, your doctor will change your treatment plan.

  • Your doctor may recommend corticosteroids, which often control symptoms in people with moderate and severe forms of the disease.

  • When other medications fail, newer drugs called biologics may be prescribed.

  • You may need surgery if other therapies don't work or if medication side effects are too severe.
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Medical Reviewer: William C. Lloyd III, MD, FACS
Last Review Date: 2019 Apr 14

  1. Jakobovits SL and Travis SPL. Management of acute severe colitis. 

    British Medical Bulletin 2006; 75 and 76: 131–144. 

  2. Ulcerative Colitis.  National Institutes of Health. National Institute of Diabetes and Digestive Kidney Diseases. https://www.niddk.nih.gov/health-information/digestive-diseases/ulcerative-colitis

  3. Adams SM and Bornemann PH.  Ulcerative Colitis. Am Fam Physician. 2013 May 15;87(10):699-705.

  4. Humira. AbbVie Inc. https://www.humira.com/ulcerative-colitis/treatment

  5. Biologic Therapy. Crohn’s & Colitis Foundation of America. http://www.crohnscolitisfoundation.org/resources/biologic-therapies.html

  6. Immunomodulators. Crohn’s & Colitis Foundation of America. http://www.crohnscolitisfoundation.org/resources/immunomodulators.html

  7. Living with Chrohn's & Colitis. Crohn’s & Colitis Foundation of America. http://www.crohnscolitisfoundation.org/living-with-crohns-colitis/

  8.  Meier J and Sturm A. Current Treatment of Ulcerative Colitis. World J Gastroenterol. 2011 Jul 21; 17(27): 3204–3212.

  9. Danese S and Fiocchi C. Ulcerative Colitis. N Engl J Med. 2011 Nov 3;365(18):1713-25. 

  10. Lark SC and Jeen YT. Current and Emerging Biologics for Ulcerative Colitis. Gut. January 15, 2015, vol 9, no. 1, pp. 18-27.

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