Ulcerative Colitis Treatments: How to Find the Right One for You

Ulcerative colitis (UC) is a chronic autoimmune condition where the body's own immune system causes inflammation and damage in the colon, or large intestine.

Experts aren't exactly sure what causes ulcerative colitis. It runs in families, which means genetics have a role. Other factors, such as where you live and what you eat, may also contribute.

But there are lots of ulcerative colitis treatment options available. Let's take a closer look at medications and other approaches that can help you live better with ulcerative colitis.

What are the symptoms of ulcerative colitis?

Sometimes, ulcerative colitis can be tricky to diagnose because its symptoms can look like ones caused by other medical conditions. Some of the most common symptoms of ulcerative colitis include:

• Frequent stools

• Leaking of stool

• Bloody stool

• Mucus in stool

• Fatigue

• Crampy abdominal pain

• Joint pain

• Skin rashes

• Eye pain

If you're having one or more of these symptoms, a good place to start is by talking with your healthcare professional. They'll likely do a series of exams and tests to find out whether you have ulcerative colitis. This will probably include getting blood work and having a colonoscopy.

Goals of treatment of ulcerative colitis

Ulcerative colitis is a chronic condition, which means it's never fully cured. It's normal for people with ulcerative colitis to have periods of active symptoms, called flare-ups, and periods during which symptoms are improved, called remissions. These are the main goals of treatment:

• Controlling flare-ups to get you in remission, and to keep you in remission once you get there

• Improving quality of life and improving your symptoms so they don't interfere with your daily activities

• Avoiding serious complications, such as serious bleeding or colon cancer

Treatment options for ulcerative colitis

The main treatment options for ulcerative colitis are medications and surgery. And sometimes, a combination of medications and surgery can be used. The treatments that are best for you will depend on your symptoms, other medical conditions you have, and what you may have tried in the past. Based on these factors, you and your healthcare professional will determine which treatment plan works best for you.

Here you'll find a summary of medications often used to treat ulcerative colitis and how they work.

Aminosalicylates

How they work

Aminosalicylates are a type of anti-inflammatory medication. It's not clear exactly how they work, but they may be similar to ibuprofen and other nonsteroidal anti-inflammatory drugs (NSAIDs). They can be taken as pills or given as enemas or suppositories for a direct effect on the colon. Examples include:

• Sulfasalazine

• Mesalamine

• Balsalazide

• Olsalazine

Who they work for

Aminosalicylates can treat mild or moderate ulcerative colitis flares. People will take a pill, an enema, or both - depending on which part of the colon is involved. People who are in remission often take them to help stay in remission.

Side effects

Common side effects include:

• Decreased appetite

• Headache

• Nausea

• Vomiting

• Abdominal pain

Corticosteroids

How they work

Corticosteroids are powerful anti-inflammatory medications. Common corticosteroids for ulcerative colitis are budesonide MMX and prednisone.

Who they work for

People take corticosteroids to treat mild flares if aminosalicylates aren't working. Corticosteroids come as pills or in topical forms, such as enemas. If your ulcerative colitis flare is more severe to begin with, you might start corticosteroids as the first treatment. Most experts consider budesonide to be a better option than prednisone because budesonide works specifically in the colon to treat ulcerative colitis.

Side effects

Long-term use of corticosteroids can cause numerous problems, such as infections, worsening diabetes, and a dependency on them. Most experts recommend against using them in the long term.

Common side effects are:

• Headache

• Nausea

• Abdominal pain

• Weight gain

• Gas

• Acne

• Urinary tract infections (UTIs)

• Joint pain

• Constipation

Biologics

How they work

Biologics are lab-made mimics of natural parts of the immune system. They interfere with the way the immune system works to prevent the inflammation that damages the colon.

• Infliximab (Remicade)

• Adalimumab (Humira)

• Golimumab (Simponi)

• Vedolizumab (Entyvio)

• Mirikizumab (Omvoh)

• Risankizumab (Skyrizi)

• Guselkumab (Tremfya)

Who they work for

Biologics can treat severe ulcerative colitis flares or moderate flares that aren't improving with other treatments. You'll often take them alongside other medications, such as immunomodulators.

Infliximab and vedolizumab require intravenous infusion once every few weeks. You need to inject adalimumab or golimumab under the skin every other week. You can also take these medications to stay in remission if you needed them to stop a flare.

Mirikizumab, risankizumab, and guselkumab are given in the form of IV infusions to start, and then switch to injections under the skin for a maintenance dose at home. This offers added convenience and in many cases an improved quality of life.

Tofacitinib (Xeljanz)

How it works

Tofacitinib interferes with the way that cells in the immune system talk to each other, which leads to a decreased immune response in the colon.

Who it works for

Tofacitinib is for people with moderate-to-severe ulcerative colitis flares. It's a pill that you take twice daily.

Side effects

Common side effects are:

• Colds and upper respiratory infections

• High cholesterol

• Headache

• Rashes

• Diarrhea

• Shingles

Immunomodulators

How they work

Immunomodulators interfere with the function of the cells in the immune system. This leads to decreased inflammation in the colon. Common examples are:

• Azathioprine

• 6-mercaptopurine

• Tacrolimus

• Cyclosporine

• Etrasimod (Velsipity)

Who they work for

Immunomodulators can help with severe ulcerative colitis flares. Sometimes, you take them alongside other medications, such as biologics. Healthcare professionals may use tacrolimus and cyclosporine only for very severe cases that don't respond to other therapies.

Side effects

Immunomodulators cause many side effects. Common side effects are:

• Nausea and vomiting

• Rashes

• Balding

• Joint pain

• Diarrhea

Are ulcerative colitis medications covered by insurance?

Many insurance plans cover medications for ulcerative colitis. All insurance plans are different, though. Talk with your insurance company to see what's covered. Often, they will ask you to try older, safer treatments, also known as "step-up therapy," before they'll cover newer treatments. They may require prior authorization or coinsurance.

Typical treatment plans for ulcerative colitis

The medications you take for ulcerative colitis depend on how severe your condition is and if you're in a flare-up or remission. If you're in a flare-up, you'll take medicines to get you into remission. If you're in remission, you'll take medications to keep you in remission.

Typical treatment for a flare-up

If your flare-up is mild:

• Usually, you'll start with an aminosalicylate, and that will normally be a topical version, such as an enema or suppository. If that isn't working, you'll move on to an oral aminosalicylate.

• If aminosalicylates aren't working, you'll move on to a corticosteroid, like budesonide MMX.

• If steroids aren't working, you'll move on to a biologic, with or without an immunomodulator.

If your flare-up is severe:

• You'll probably start with a corticosteroid.

• If that isn't working, the next step is a biologic with or without an immunomodulator.

• If this doesn't control your flare-up, you may need admission to the hospital for intravenous medications.

Typical treatment for maintaining remission of ulcerative colitis

Once in remission, treatment depends on how you got there:

• In very mild cases, you might just watch your symptoms without taking medications, but people typically take an aminosalicylate to help them stay in remission.

• If you needed a corticosteroid to get into remission, you might take an immunomodulator to keep you in remission.

• If you needed a biologic agent to get you into remission, you might need to keep taking it long term to stay in remission.

Nonmedication approaches for treating ulcerative colitis

Although medications are the most effective way to treat ulcerative colitis, there are some nonmedication options that can be helpful.

Dietary changes

Your diet might affect your ulcerative colitis. Eating a diet high in fruits and vegetables can be helpful if you have the condition. However, there are some foods that are thought to contribute to ulcerative colitis and are best avoided, especially if you're having a flare-up. These include:

• Red meat and processed meat

• High-fat diets

• Sugar

• Soft drinks

• Dairy

• Spicy foods

Avoiding NSAIDs

NSAIDs, like ibuprofen (Motrin) and naproxen (Aleve), may make ulcerative colitis flare-ups worse - so it's probably best to avoid them.

Look after your mental health

Many people with ulcerative colitis have depression, anxiety, and stress as a result of their condition. It's not clear that stress causes flare-ups, but it might make flare-ups worse.

Surgery for ulcerative colitis

Sometimes, ulcerative colitis can cause complications that need surgery to treat. This may be the case when you have:

• Severe symptoms that don't respond to medications

• Severe, life-threatening bleeding from the colon

• Colon cancer that's at risk of spreading

In most cases, surgery involves taking out most of the colon in a procedure called a subtotal colectomy. This is because of how severe the inflammation is and how likely the complications are to happen again.

Ulcerative colitis clinical trials

Medical advancement is typically made through research, including clinical trials. There are several studies going on with the goal of ulcerative colitis treatments. Some trials are researching the relationship between your genetics and ulcerative colitis. This will help researchers discover new information and treatment targets, and test new medications. If you're interested, you can find more information on participating in a research group.

Is there a cure for ulcerative colitis?

Ulcerative colitis is a chronic condition, which means it's never fully cured. It's normal for people with ulcerative colitis to have periods of active symptoms, called flare-ups, and periods during which symptoms are improved, called remissions.

Although you can get into remission with the right treatment, ulcerative colitis is never fully cured because the inflammation can come back. It's important that you work closely with your healthcare team to make sure you're on the best treatment plan for you.

Bottom line [Bottom line]

You know your body best, so you'll learn to spot your own personal triggers and what the early signs of a flare feel like to you. As time goes by, your symptoms may change, and the treatment that's best for you may change, too. Finding a healthcare professional you trust will help you keep one step ahead of your ulcerative colitis and prevent serious complications.

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