Ulcerative Colitis Treatment

Key points 

  • There are many ways to manage ulcerative colitis and what works for someone else may not work for you. Learning how to maximise your own wellbeing can be a long process but it’s worth it. 
  • The main goal of ulcerative colitis treatment is to reduce inflammation and symptoms. 
  • Lifestyle changes around diet, exercise and stress management are also ways to manage ulcerative colitis. 
  • In some cases ulcerative colitis complications may be treated with surgery. 

What kind of treatments are there for ulcerative colitis?

Ulcerative colitis cannot currently be cured but for most people it can be well managed through medication, lifestyle choices and sometimes surgery. 

The aim of treatment is to reduce symptoms, control inflammation and heal the bowel. Since ulcerative colitis affects everyone differently, each person will need to work with their healthcare team to discover what works best for them. Treatment may also need to change over time if they become less effective.

Even while in remission you may still experience some symptoms. Tiredness and fatigue are common, and some people can still have increased bowel discomfort even when the inflammation is well controlled. Make sure to discuss any symptoms you may have with your doctor and let them know what medication you are taking. Some over-the-counter drugs such as anti-inflammatory drugs (e.g. ibuprofen) can affect ulcerative colitis or interfere with the medication you are on. Always speak with your doctor or healthcare team before making changes to your treatment or if you have any worries about your current treatment.

Medications

Medications for ulcerative colitis are mainly used to reduce inflammation. The main types include: 

Aminosalicylates (5-ASAs): Used to reduce inflammation in the lining of the gut and maintain remission. They are most effective for reducing inflammation in the large intestine and can be taken orally as tablets or rectally as enemas or suppositories.  

Examples include mesalazine, olsalazine, sulphalazine and balsalazide. 

Corticosteroids (steroids): Usually used to treat moderate-to-severe ulcerative colitis they block the body’s inflammatory response. They are effective for short-term control of the disease during flare-ups and are not suggested for long-term use because of side effects.  

Examples include prednisolone, prednisone, methylprednisolone, budesonide, hydrocortisone and beclometasone dipropionate. 

Immunosuppressants: Used to suppress the body’s immune response which decreases inflammation. Usually used for people who aren’t responding to aminosalicylates or are having difficulty coming off steroids without the inflammation coming back.  

Examples include azathioprine, mercaptopurine, methotrexate, mycophenolate mofetil, ciclosporin, and tacrolimus. 

Biologics: These are a newer class of drugs for ulcerative colitis that are specially made antibodies, which selectively bind to inflammatory signaling proteins to reduce inflammation. 

Biologics are currently given through an injection under the skin (subcutaneous) or by an intravenous (IV) infusion that delivers the medication into your veins over time, usually in a clinic. 

Janus kinase inhibitors (JAK Inhibitors, tofacitinib): Used in ulcerative colitis to reduce inflammation and maintain remission. They are available as tablets and after being swallowed the chemicals are absorbed into the bloodstream and are taken twice a day.  

Thalidomide: Occasionally used to treat ulcerative colitis but should never be used if pregnancy is being considered. 

For more detailed information on medication see Medication and IBD

Diet

Diet has an important role to play in of many aspects of ulcerative colitis, including symptom management, ensuring nutritional adequacy and potentially treating active disease or supporting remission.

Diet is important to treat many different aspects of ulcerative colitis. There are dietary treatments that may be used to treat malnutrition, symptoms related to active inflammation, symptoms related to bowel sensitivity rather than inflammation and for certain complications of ulcerative colitis.  

It is important that you discuss with your medical treating team, including dietitian, diets that may be appropriate for your circumstance to ensure you are not over-treating with diet. Often, objective markers, such as blood tests, stool tests and/or imaging may be applied to work out whether symptoms are from active inflammation or bowel sensitivity to guide advice on diet. Always seek advice from a gastrointestinal dietitian before trying a new diet.  

Examples of dietary treatments include:

High energy and protein diet: used to treat malnutrition or to optimise nutritional stores before planned surgery for improved recovery.

Oral vitamin and mineral supplementation: often used to treat deficiencies.

Low or moderate FODMAP diet: used to treat symptoms from bowel sensitivity, but not active inflammation.

Supplementary treatment: used sometimes to treat active inflammation, such as probiotics for pouchitis or curcumin. 

For more detailed information on diet see Nutrition. 

Surgery

Surgery for ulcerative colitis is a treatment not everyone will need. Sometimes parts of the bowel are too damaged to be healed by medications and the best way to return you to health is with an operation. Many operations are done laparoscopically now (keyhole) with quick recovery. The goal of surgery is to keep as much of the bowel as possible while restoring quality of life.

There are two main reasons why surgery may be an option for you. One, when current therapies are no longer effective and two, when complications occur. The two most common types of surgery for ulcerative colitis are ileostomies and pouch surgery, often called a j-pouch. 

An ileostomy or stoma is when the end of the small intestine is connected to an opening in the abdomen. An ostomy bag is then attached to the end of the stoma to collect waste from the digestive system. 

Depending on what you decide, the stoma can be there for the rest of your life or you can try pouch surgery to connect the small intestine to the anus which will remove the need for a stoma.  

Pouch surgery is when the large intestine including the rectum is removed. The end of the small intestine is made into a pouch that is connected to the anus. While this part of the body is healing you will have an ileostomy. After the pouch has healed, the j-pouch will be attached to the rest of the digestive system and the stoma will be closed up. 

It can be confronting to go through such large surgical procedures, so it is important to find the support you need. Ask all the questions you need so you can feel confident with your decision.  

CCA has many support services like Connect with a peer where you can ask questions of people who have already gone through surgery. 

For more detailed information see Surgery

Complementary and alternative medicine

Complementary and alternative medicine (CAM) for ulcerative colitis can be used alongside conventional treatment to reduce symptoms and improve wellbeing.  

Research is still ongoing in many areas of CAM so it is important to always talk about your options with your doctor. Some areas in which research are exploring include: 

Mind and body wellbeing: Studies have shown a connection between gut health and mental health. Improving your psychological health through certain lifestyle changes can positively affect your gut health and may reduce disease symptoms. 

Learn more about Psychological health & IBD

Supplements: It is common for people with ulcerative colitis to have lower levels of certain vitamins and minerals. If this happens your doctor may recommend taking nutritional supplements like vitamin D or iron tablets. There are many different brands of supplements so always follow what your doctor prescribes. 

Microbiome: The microbiome is a hot topic for researchers of gut health and is important for finding new ways of treating ulcerative colitis. Currently, there have not been treatments consistently shown to benefit ulcerative colitis but there are several areas of interest. This is still for research studies only and not ready for the clinic.    

  • Probiotics: Research suggests there may be a benefit to taking probiotics at inducing and maintaining remission in ulcerative colitis. Probiotics can improve the environment of your microbiome by encouraging healthy diversity of good bacteria in your gut. 
  • Faecal Microbiota Transplant (FMT): Some studies suggest that FMT has the potential to induce remission in mild-to-moderate ulcerative colitis but more research in this area is needed. This is currently only recommended to be done in expert centres or as part of a clinical trial.

Medical Cannabis: More research is needed before using medical cannabis to treat UC is recommended. Small studies have shown that cannabis can reduce symptoms like nausea and pain but there are also possible side effects like impaired judgment and anxiety. 

For more detailed information see Complementary and alternative therapies.