Treatment for Ulcerative Colitis

How do doctors treat ulcerative colitis?

Doctors treat ulcerative colitis with medicines and surgery. Each person experiences ulcerative colitis differently, and doctors recommend treatments based on how severe ulcerative colitis is and how much of the large intestine is affected. Doctors most often treat severe and fulminant ulcerative colitis in a hospital.

Medicines

Doctors prescribe medicines to reduce inflammation in the large intestine and to help bring on and maintain remission—a time when your symptoms disappear. People with ulcerative colitis typically need lifelong treatment with medicines unless they have surgery to remove the colon and rectum.

Which medicines your doctor prescribes will depend on how severe ulcerative colitis is. Ulcerative colitis medicines that reduce inflammation in the large intestine include

• aminosalicylates, which doctors prescribe to treat mild or moderate ulcerative colitis or to help people stay in remission.
• corticosteroids, also called steroids, which doctors prescribe to treat moderate to severe ulcerative colitis and to treat mild to moderate ulcerative colitis in people who don’t respond to aminosalicylates. Doctors typically don’t prescribe corticosteroids for long-term use or to maintain remission. Long-term use may cause serious side effects.
• immunosuppressants, which doctors may prescribe to treat people with moderate to severe ulcerative colitis and help them stay in remission. Doctors may also prescribe immunosuppressants to treat severe ulcerative colitis in people who are hospitalized and don’t respond to other medicines.
• biologics, which doctors prescribe to treat people with moderate to severe ulcerative colitis and help them stay in remission.
• a novel small molecule medicine, which doctors may prescribe for adults with moderate to severe ulcerative colitis who don’t respond to other medicines or who have severe side effects with other medicines.

Surgery

Your doctor may recommend surgery if you have

• colorectal cancer
• dysplasia, or precancerous cells that increase the risk for developing colorectal cancer
• complications that are life-threatening, such as severe rectal bleeding, toxic megacolon, or perforation of the large intestine
• symptoms that don’t improve or stop after treatment with medicines
• symptoms that only improve with continuous treatment with corticosteroids, which may cause serious side effects when used for a long time

To treat ulcerative colitis, surgeons typically remove the colon and rectum and change how your body stores and passes stool. The most common types of surgery for ulcerative colitis are

• ileoanal reservoir surgery. Surgeons create an internal reservoir, or pouch, from the end part of the small intestine, called the ileum. Surgeons attach the pouch to the anus. Ileoanal reservoir surgery most often requires two or three operations. After the operations, stool will collect in the internal pouch and pass through the anus during bowel movements.
• ileostomy. Surgeons attach the end of your ileum to an opening in your abdomen called a stoma. After an ileostomy, stool will pass through the stoma. You’ll use an ostomy pouch—a bag attached to the stoma and worn outside the body—to collect stool.

Surgery may be laparoscopic or open. In laparoscopic surgery, surgeons make small cuts in your abdomen and insert special tools to view, remove, or repair organs and tissues. In open surgery, surgeons make a larger cut to open your abdomen.

If you are considering surgery to treat ulcerative colitis, talk with your doctor or surgeon about what type of surgery might be right for you and the possible risks and benefits.

How do doctors treat symptoms and complications of ulcerative colitis?

Doctors may recommend or prescribe other treatments for symptoms or complications of ulcerative colitis. Talk with your doctor before taking any over-the-counter medicines.

To treat mild pain, doctors may recommend acetaminophen instead of nonsteroidal anti-inflammatory drugs (NSAIDs). People with ulcerative colitis should avoid taking NSAIDs for pain because these medicines can make symptoms worse.

To prevent or slow loss of bone mass and osteoporosis, doctors may recommend calcium and vitamin D supplements or medicines, if needed. For safety reasons, talk with your doctor before using dietary supplements or any other complementary or alternative medicines or practices.

Doctors most often treat severe complications in a hospital. Doctors may give

• antibiotics, if severe ulcerative colitis or complications lead to infection
• blood transfusions to treat severe anemia
• IV fluids and electrolytes to prevent and treat dehydration

Doctors may treat life-threatening complications with surgery.