Ulcerative Colitis (UC) is considered one major category of Inflammatory Bowel Disease, or IBD. Unlike Crohn’s, Ulcerative Colitis is a chronic inflammatory condition that is limited to the colon and affects the innermost lining of the colon. The lining becomes inflamed and develops ulcers.1 This can lead to frequent discomfort and feeling the need to empty the colon. UC most often begins gradually and can become worse over time. With symptoms ranging from mild to severe, Ulcerative colitis can be debilitating and can sometimes lead to life-threatening complications. While it has no known cure, treatment can greatly reduce signs and symptoms of the disease and even bring about long-term remission.2 The location of inflammation may affect the symptoms presented as well as what treatments may be needed.
Doctors often classify ulcerative colitis according to its location. Types of ulcerative colitis include: 3
- Ulcerative proctitis: confined to the area closest to the rectum, and rectal bleeding may be the only sign of the disease. This form of ulcerative colitis tends to be the mildest.
- Proctosigmoiditis: involves the rectum and sigmoid colon (lower end of the colon).
- Left-sided colitis: begins at the rectum and continues through the descending colon.
- Pancolitis: often affects the entire colon
- Acute severe ulcerative colitis: a rare form of colitis that affects the entire colon that may cause severe pain, an inability to eat, fever, diarrhea, and bleeding.
Signs and Symptoms of Ulcerative Colitis
The most common symptoms of Ulcerative Colitis are:4
- Urgent bowel movements
- Abdominal cramping
- Weight loss
- Anemia (reduced number of red blood cells)
Other symptoms include:4
- Blood, mucous, or pus in bowel movements.
- Severe cramping
- Skin rashes
- Mouth sores
- Joint pain
- Red, painful eyes
- Liver disease
- Poor nutrition
Symptoms may vary depending on the location and severity of the disease. Ulcerative Colitis has also been associated with other medical conditions, including osteoporosis, liver disease, and colon cancer.3
Treatments for Ulcerative Colitis
Currently, there is no cure for Ulcerative Colitis, and there is no standard treatment that works for everyone. Therefore, there are numerous treatment options and combinations that may help to combat the signs and symptoms of UC. The goal of these treatments is to reduce the inflammation that triggers those symptoms, limit complications and flare-ups, and to achieve and maintain long-term remission.
Treatments, in partnership with a medical team, will be tailored to the individual patient. Several factors will help to determine what treatment options will be best for the patient. Those factors are the severity of the disease, the location of the disease, other medical conditions (comorbidities), the bodies response to past medications, and the side effects of medications.5
Always consult a doctor before beginning treatment.
Many people with UC need medications. These medications are designed to suppress the body’s immune response to abnormal inflammation. This immune suppression offers relief from many of the common symptoms of Ulcerative Colitis.
There are 5 major categories of medicine used to treat UC, and other IBD.
Antibiotics are used to prevent or treat complications that involve infection, such as abcesses and fistulas. Antibiotics can help to reduce the amount of drainage produced by, and sometimes heal, fistulas and abcesses. Many medical professionals also think that antibiotics can help reduce harmful intestinal bacteria that may play a role in the body’s abnormal immune response, that leads to inflammation.
The most commonly prescribed antibiotics are Ciproflaxin (Cipro) and Metronidazole (Flagyl).
Typically prescribed to individuals newly diagnosed with Ulcerative Colitis who present mild to moderate symptoms, aminosalicylates contain 5-aminosalicylic acid (5-ASA), which helps to control imflammation. Given orally or rectally, they work best when the disease is present in the colon, but are not particularly effective if the disease is present in the small intestine.
The most commonly prescribed aminosalicylates are sulfasalazine (Azulfidine), balsalazide (Colazal) and olsalazine (Dipentum), and mesalamine (Asacol HD, Delzicol, Pentasa, & others). 5-ASAs are highly effective for inducing remission and preventing relapse in UC.6
Unlike corticosteroids, which affect the entire body, biologic treaments act more selectively. Designed to target proteins made by the immune system, biologic therapies, or biologics, neutralize those proteins by introducing antibodies into the body to decrease inflammation. Biologics help to place patients in remission, particularly when other treatments haven’t worked.
Biologics are divided into additional categories based of the type of protein targeted by the medications. Those categories are anti-tumor necrosis factor (TNF) therapies, anti-integrin therapies, and anti-interleukin-12 and interleukin-23 therapy.
The most commonly prescribed therapies for each category are listed below:
- Anti-TNF therapies – Adalimumab (Humira), Golimumab (Simponi), and Infliximab (Remicade).
- Anti-integrin therapies – Natalizumab (Tysabri) and Vedolizumab (Entyvio).
- Anti-interleukin therapy – Ustekinumab (Stelara).
Corticosteroids, commonly known as steroids, help decrease inflammation and to help reduce the immune system’s activity. Doctors often prescribe steroids for individuals with moderate to severe symptoms, however, not for long-term use.
The most commonly prescribed corticosteroids are budesonide (Entocort EC), hydrocortisone, methylprednisolone (Solu-medrol), prednisolone, and prednisone.
Immunomodulators are designed to reduce immune system activity, which results in less gastrointestinal inflammation. Doctors prescribe these medications to help patients maintain remissision or if they do not respond to other treatments. Immunomodulators can take up to 3 months to start working.
The most common immunomodulators are 6-Mercaptopurine (Purinethol, Purixan), Azathioprine (Azasan, Imuran), Tofacitinib (Xeljanz), and Cyclosporine (Sandimmune).
Note: Cyclosporine is most often prescribed to those with severe Ulcerative Colitis symptoms due to the medicines serious side effects. Consult a doctor to learn about the risks and benefits of Cyclosporine before beginning treatment.
Other medications such as anti-diarrheals, pain relievers, and supplements (iron, calcium, vitamin B-12 and D) may be prescribed, or recommended, as needed. For mild pain, a doctor may recommend acetaminophen, such as Tylenol, because other common pain relievers, like ibuprofen (Advil, Motrin) and naproxen sodium (Aleve), can make symptoms worse. 7
If symptoms are severe, it may be necessary for the patient to rest their bowels for a few days to several weeks. This can involve drinking only approved liquids or not eating or drinking anything. Doctors will often, during sustained bowel rest, ask patients to drink nutritional supplements or begin nutrition therapy.
Nutrition therapy is when a doctor recommends altering the nutrients an individual takes in or how those nutrients are taken in. This can be through recommending a specific diet to reduce the size and number of stools, recommending a feeding tube be inserted into the stomach or small intestine (enteral nutrition), or by recommending that nutrients be injected directly into a vein (parenteral nutrition).8 Doctors may require this treatment be administered during a hospital stay or may allow treatment to be given via at-home medical care.
Enteral and Parenteral nutrition are typically used to prep an individual for surgery or if medications are failing to control symptoms. Whereas, a low residue or low-fiber diet may be recommended to reduce the risk of intestinal blockage, as well as reduce the size and frequency of bowel movements, to avoid hospitalizations, surgeries, and further complications.9
In most cases, with or without nutrition therapy, the instestines will heal during bowel rest.
Even with medications, diet and lifestyle changes, and other treatments, many people with Crohn’s disease eventually require surgery. Approximately 45% of people diagnosed with Ulcerative Colitis will undergo surgery.10 While surgery will not cure Crohn’s disease, it can treat complications and relieve symptoms. Doctors often recommend surgery to treat instestinal obstructions, fistulas, bleeding that is life threatening, negative side effects from medications, or symptoms when other treatments do not work. A surgeon will perform different types of operations depending on the symptoms and area affected.
Many people with UC have used lifestyle modifications, such as dietary changes and exercise, and forms of complementary and alternative medicine. However, there are few well-designed studies that help to confirm the safety and effectiveness of complementary and alternative medicine.11
There is no evidence to support that certain foods actually cause Ulcerative Colitis, however certain foods and beverages can aggravate the signs and symptoms of UC, especially during a flare-up. For individuals affected by Ulcerative Colitis, it can be useful to keep a food diary, cataloging what food and beverages have been consumed each day. This can help them pinpoint what foods are causing symptoms and thus eliminate them. Below are a list of common foods that may cause adverse symptoms:
Other dietary changes, such as eating smaller meals, drinking plenty of fluids, and taking multivitamins, may help limit flare-ups and reduce symptoms.12 Consult a doctor or registered dietitian before making changes to ones diet or before taking any vitamins or supplements.
Complementary and Alternative Medicine
The majority of Complementary and Alternative therapies aren’t regulated by the Food and Drug Administration (FDA), nor have there been many well-designed studies to determine their effectiveness. Despite this, many people with UC have tried some form of alternative therapy.12
Some commonly used therapies include:
• Prebiotics • Probiotics
• Fish oil • Acupuncture
• Tumeric • Homeopathy
• Herbal & nutrional supplements
- Podolsky, Daniel K. “Inflammatory bowel disease.” The New England journal of medicine vol. 347,6 (2002): 417-29.
- “Ulcerative Colitis – Symptoms And Causes”. Mayo Clinic, 2020, https://www.mayoclinic.org/diseases-conditions/ulcerative-colitis/symptoms-causes/syc-20353326#:~:text=Ulcerative%20colitis%20(UL%2Dsur%2D,over%20time%2C%20rather%20than%20suddenly.
- “Ulcerative Colitis | NIDDK”. National Institute Of Diabetes And Digestive And Kidney Diseases, 2020, https://www.niddk.nih.gov/health-information/digestive-diseases/ulcerative-colitis.
- “Ulcerative Colitis: Symptoms, Treatment, Living With It & Diagnosis”. Cleveland Clinic, 2020, https://my.clevelandclinic.org/health/diseases/10351-ulcerative-colitis.
- “Ulcerative Colitis Treatment Options”. Crohn’s And Colitis, 2020, https://www.crohnsandcolitis.com/ulcerative-colitis/treatment.
- Ford, Alexander C et al. “Efficacy of 5-aminosalicylates in ulcerative colitis: systematic review and meta-analysis.” The American journal of gastroenterology vol. 106,4 (2011): 601-16. doi:10.1038/ajg.2011.67
- “Ulcerative Colitis – Harvard Health”. Harvard Health, 2020, https://www.health.harvard.edu/digestive-health/ulcerative-colitis-overview#:~:text=Eating%20a%20well%2Dbalanced%2C%20nutritious,the%20symptoms%20of%20ulcerative%20colitis.
- “Enteral And Parenteral Nutrition – American College Of Gastroenterology”. American College Of Gastroenterology, 2020, https://gi.org/topics/enteral-and-parenteral-nutrition/#:~:text=What%20do%20Enteral%20and%20Parenteral,of%20a%20person’s
- “Inflammatory Bowel Disease (IBD) – Diagnosis And Treatment – Mayo Clinic”. Mayoclinic.Org, 2020, https://www.mayoclinic.org/diseases-conditions/inflammatory-bowel-disease/diagnosis-treatment/drc-20353320.
- Surgery For Crohn’S Disease And Ulcerative Colitis. Crohn’S & Colitis Foundation Of America, p. 3, https://www.crohnscolitisfoundation.org/sites/default/files/legacy/assets/pdfs/surgery_brochure_final.pdf.
- Fact Sheet: Complementary And Alternative Medicine. Crohn’S & Colitis Foundation, 2015, p. 1, https://www.crohnscolitisfoundation.org/sites/default/files/legacy/assets/pdfs/complementary-and-alternative.pdf.
- “Ulcerative Colitis – Diagnosis And Treatment – Mayo Clinic”. Mayoclinic.Org, 2020, https://www.mayoclinic.org/diseases-conditions/ulcerative-colitis/diagnosistreatment/drc20353331#:~:text=5%2Daminosalicylic%20acid%20(5%2DASA)%20is%20often%20the,)%20and%20olsalazine