Ulcerative colitis (UC) is a type of inflammatory bowel disease that can cause varying levels of pain. UC is caused by chronic, long-term inflammation that leads to open sores known as ulcers in the innermost lining of your colon, or large intestine, and rectum. Having a higher level of pain can be a sign that the disease is flaring up or even getting worse.
How much inflammation you have in your colon and where this inflammation is located usually determines where you’re most likely to feel pain. Abdominal cramping and mild to severe pain in both the abdomen and rectum are common. The pain may be long-lasting, or it may fade when the inflammation recedes.
Long periods of remission between flare-ups are common. During remission, your symptoms may decrease or disappear completely.
People with mild UC may experience pressure and cramping only. As the disease progresses with more inflammation and ulcers in your colon, the pain may manifest as feelings of gripping or extreme pressure that tightens and releases over and over again. Gas pain and bloating may also occur, making the sensation feel worse.
If you have a type of UC known as left-sided ulcerative colitis, your left side may also feel tender to the touch.
If left untreated, the pain associated with UC can make it hard to work, exercise, or enjoy daily activities. Keeping the disease under control through medication, stress reduction, and diet can help to manage and reduce pain.
The pain associated with UC can diminish your overall quality of life. If you have chronic, unmanageable pain at any level, there are many treatment options you can discuss with your doctor that can help you feel better. They can also get you back into the swing of your day-to-day activities. Your doctor may recommend a combination of medications, dietary changes, and other complementary therapies to help manage your UC pain.
If you have mild pain, medications such as acetaminophen (Tylenol) may be enough to do the trick.
But don’t turn to other popular over-the-counter (OTC) pain medications instead. The following OTC drugs shouldn’t be taken for UC pain as they can cause flare-ups and make other symptoms, such as diarrhea, worse:
- ibuprofen (Motrin IB, Advil)
- aspirin (Bufferin)
- naproxen (Aleve, Naprosyn)
What you eat won’t cause UC, but certain foods may exacerbate your symptoms and can cause additional cramping and pain. Keeping a food diary can help you identify any food triggers you may have. Common foods to avoid include:
- dairy products high in lactose, such as milk
- high-fat foods, such as greasy or fried items, beef, and sugary, high-fat desserts
- processed foods, such as frozen dinners and boxed rice
- high-fiber foods, such as whole grains
- gas-producing vegetables, such as Brussels sprouts and cauliflower
- spicy food
- alcoholic drinks
- caffeinated beverages, such as coffee, tea, and cola
It may help to eat several small meals a day rather than three large ones. You should also drink lots of water — at least eight 8-ounce glasses a day. This may put less strain on your digestive system, produce less gas, and help bowel movements move through your system smoothly.
Once thought to cause UC, stress is now considered a trigger for UC flares in some people. Managing and reducing stress may help to alleviate UC symptoms, such as inflammation, and pain.
Different stress-busting techniques work for different people, and you might find that a simple walk in the woods and deep breathing are what benefit you the most. Yoga, mindfulness meditation, and exercise may also help reduce stress in people with UC.
Inflammation is the root cause of most UC-related pain. A number of medications can help reduce inflammation in your colon. Your doctor can help you to decide which kind is right for you based on which part of your colon is affected as well as your pain level.
Anti-inflammatory medications that may help include corticosteroids, such as prednisone and hydrocortisone.
Amino salicylates are another class of anti-inflammatory medication. These are sometimes prescribed for UC pain. There are many kinds, including:
- sulfasalazine (Azulfidine)
- mesalamine(Asacol, Lialda, Canasa)
- balsalazide (Colazol, Giazo)
- olsalazine (Dipentum)
Anti-inflammatory drugs can be taken orally as tablets or capsules or be administered through suppositories or enemas. They can also be given intravenously. Most anti-inflammatory medications can cause side effects of varying kinds. You may need to try more than one type before you find the best one for your symptoms. Each medication is sold under a number of brand names.
Immunosuppressant drugs may be prescribed alone or in addition to anti-inflammatory medications. They reduce pain by working to stop your immune system from triggering inflammation. There are a number of different types, including:
- azathioprine (Azasan, Imuran)
- mercaptopurine (Purixan)
- cyclosporine (Sandimmune)
Immunosuppressant medications are typically used in people who don’t respond well to other types of drugs and are meant for short-term use. They can be damaging to the liver and pancreas. They may cause serious side effects, including a lowered ability to fight off serious infections, and some cancers, such as skin cancer. Cyclosporine has been linked to fatal infections, seizures, and kidney damage.
Biologics are another type of immunosuppressant medication. One type of biologic is tumor necrosis factor alpha inhibitors (TNF-alpha). TNF-alpha medications are meant for use in people with moderate to severe UC who haven’t responded well to any other type of treatment. They help stop pain by nullifying a protein produced by the immune system. One type of TNF-alpha medication is infliximab (Remicade).
Integrin receptor antagonists are another form of biologics. These include vedolizumab (Entyvio), which has been approved to treat UC in adults.
Biologics have been linked to serious forms of infection and tuberculosis.
In extreme cases, surgery may be the best way to eliminate UC and its pain. The surgery most used is called a proctocolectomy. It requires the removal of your entire colon and rectum. During surgery, a pouch constructed from the end of your small intestine is attached to your anus. This allows for relatively normal waste elimination to occur, meaning you won’t have to wear an external bag.
Complementary and alternative remedies
Alternative treatments such as acupuncture may help to reduce and regulate bowel inflammation, reducing UC pain.
Another form of alternative treatment called moxibustion may also have a positive effect on UC symptoms. Moxibustion is a type of heat therapy. It uses dried plant materials burned in a tube to warm the skin, often in the same areas targeted by acupuncture.
A review of several studies indicated that acupuncture and moxibustion may be effective when used alone, together, or as complements to medication. But the reviewers indicated that more research is needed before these techniques can be considered proven treatments for UC symptoms and pain.