Ulcerative colitis (UC) causes inflammation and sores in the lining of your large intestine (colon). Over time, the disease can permanently damage your colon and lead to complications like severe bleeding or a hole in the colon.

Drug treatments can prevent your immune system from overreacting, and bring down inflammation in your colon. Treatment also helps relieve symptoms like diarrhea and bleeding and prevents you from getting serious complications of the disease.

Talk to your doctor about all of your treatment options. It’s important to stick with the medication your doctor prescribes. Only by taking your medication can you control your symptoms and stay in remission long-term.

Here are 12 things you should know about treatment for UC.

1. Your disease will determine which treatment you get

UC treatment includes these drugs:

  • 5-aminosalicylic acid (5-ASA) drugs such as sulfasalazine
  • steroid drugs such as prednisone, prednisolone, and budesonide
  • immunosuppressants such as 6-mercaptopurine (6-MP) and azathioprine
  • biologics such as infliximab (Remicade) and adalimumab (Humira)
  • a monoclonal antibody like vedolizumab (Entyvio)

Your doctor will help you choose a treatment based on three factors:

  • the stage of your UC (whether it’s active or in remission)
  • how much of your intestine the disease affects
  • how severe your condition is

Mild UC is treated differently than severe forms of the disease.

2. Treatment has two goals

UC isn’t curable. Its symptoms come and go. You’ll have periods of symptoms, called flare-ups. They’ll be followed by symptom-free periods that last for months or years, called remissions.

Treatment for UC aims to do two things:

  • put you into remission
  • keep you in remission and prevent your symptoms from coming back

3. Topical treatments may be enough for mild UC

If you have mild diarrhea, rectal pain, or bleeding, your doctor might prescribe topical 5-ASA or corticosteroids. You rub these treatments onto your rectum to bring down inflammation in the area.

4. Most people with mild UC will go into remission

Up to 90 percent of people with mild UC will go into remission from using topical or oral medications like 5-ASA. Up to 70 percent will stay in remission.

5. UC drugs can cause side effects

The downside of treatment is that it can cause side effects. The side effects depend on the drug you take.

Common side effects from the 5-ASA drugs and sulfasalazine include:

  • headaches
  • nausea
  • cramps
  • gas
  • watery diarrhea
  • fever
  • rash

Common side effects from steroid drugs include:

  • increased appetite
  • weight gain
  • acne
  • fluid buildup
  • mood swings
  • trouble sleeping

Biologic drugs can make it harder for your body to fight off infections.

Your doctor should monitor you closely while you’re on these drugs. If your side effects are severe or unbearable, you may need to switch to another medication.

6. You may need more than one treatment to keep you in remission

Everyone responds differently to UC treatments. Some people will need more than one drug to control their symptoms. For example, your doctor might prescribe both a biologic and an immunosuppressant medication.

Adding on another drug can increase the effectiveness of your treatment. But taking more than one medication can also increase the number of side effects you experience. Your doctor will balance your need for symptom control with possible risks of treatment when choosing a medication for you.

7. UC treatment is long-term

Going into remission doesn’t mean your treatment ends. You’ll have to keep taking medication long-term to keep your disease under control and prevent a relapse. You may be able to go on a lower dose of the drug once your disease is in remission.

8. Good bacteria might help you feel better

UC has been linked to harmful bacteria in the gut. Probiotics are beneficial bacteria that help get rid of bad germs. Adding these supplements to your treatment could help keep you in remission.

Antibiotics are another treatment for UC. They help kill off harmful bacteria in your gut.

9. You don’t need to change your diet dramatically

There’s no evidence that going on a strict diet can put you into remission or keep you there. Cutting out certain foods could rob you of nutrients you need to stay healthy.

You may want to avoid certain foods — like dairy products — if they seem to aggravate your symptoms. But talk to your doctor or a dietitian before making any radical changes to your diet.

10. Surgery is a possibility

Between one-third and one-quarter of people with UC won’t see any relief with medication alone. Surgery to remove the colon may be considered. Surgery is also necessary if a hole develops in the colon.

11. For severe symptoms, you may need to visit a hospital

If you have severe diarrhea or bleeding and your disease isn’t responding to treatment, you may need to stay in a hospital for a short period of time. The doctors and other medical staff will give you fluids to prevent dehydration. You’ll also get medications to relieve your symptoms.

12. You can live well with UC

Once you find a drug that works for you, you’ll have fewer flare-ups and more remissions. Thanks to better medical treatments, most people with UC can keep their disease under good control and live normal, active lives.