Treatments for ulcerative colitis can prevent your immune system from overreacting and reduce inflammation in your colon. Treatments can also relieve symptoms and prevent complications of the disease.

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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 such as severe bleeding or a hole in your colon.

You’ll want to discuss all of your treatment options with a doctor. Once you’ve developed a treatment plan, it will be important to stick with the medication your doctor prescribes.

In preparation for this discussion, this article provides 12 helpful things you should know about treatment for UC.

UC treatment includes these drugs:

  • 5-aminosalicylic acid (5-ASA) drugs such as mesalamine
  • 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)
  • Janus kinase (JAK) inhibitors such as tofacitinib (Xeljanz) and upadacitinib (Rinvoq)
  • 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 is affected
  • how severe your condition is

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

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 called remissions that can last for months or years.

Treatment for UC aims to do two things:

  • put the disease into remission
  • help keep the disease in remission and prevent your symptoms from coming back

If you have mild symptoms of UC and these symptoms also appear mild on a colonoscopy, your doctor might prescribe topical treatments. The type of topical treatment depends on the extent of your UC.

If your UC involves more than a third of your colon, your doctor will most likely recommend an oral pill (non-topical treatment). However, if the left side of your colon is affected, a doctor might prescribe an enema. If only the rectum is affected, a doctor might prescribe a suppository.

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 include:

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

Common side effects from steroid drugs include:

  • increased appetite
  • weight gain
  • acne
  • fluid buildup
  • sudden changes in mood
  • trouble sleeping

Biologic drugs can make it harder for your body to defend itself against infections.

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

Everyone responds differently to UC treatments.

Some people will need more than one drug to manage their symptoms. For example, your doctor might prescribe both a biologic and an immunosuppressant medication.

Adding 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 managing your symptoms with possible risks of treatment when choosing a medication for you.

Studies have found sulfasalazines, such as mesalamine, thiopurines, and anti-tumor necrosis factor (TNF) antibodies, to be effective at causing remission of UC.

If a drug leads to remission, the person will continue to take it. If they stop, the symptoms may return.

Going into remission doesn’t mean your treatment ends. You’ll have to keep taking medication long-term to help keep your disease well-managed and prevent a relapse.

You may be able to take a lower dose of the drug once your disease is in remission.

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.

Not all probiotics are the same, however, and not all of them have evidence to show they can help with UC. Talk with your doctor before using this option.

There’s no evidence that following a strict diet can put your UC into remission or keep it there. In fact, cutting out certain foods could prevent you from getting the nutrients you need to stay healthy.

You may want to avoid certain foods — like dairy products — if they seem to worsen your symptoms. However, talk with your doctor or a dietitian before making any major changes to your diet.

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 as a last resort if you don’t respond to medications. Surgery is also necessary if a hole develops in the colon.

If you have severe diarrhea or bleeding and your disease isn’t responding to treatment, you may need to be admitted to a hospital for a short stay.

The doctors and other medical staff will give you fluids to prevent dehydration. You’ll also get medications to help relieve your symptoms.

Once you find a drug that works well for you, you’ll have fewer flare-ups and more remissions.

Thanks to new and better medical treatments, most people with UC can keep their disease well managed and live active lives.

What is the fastest way to calm ulcerative colitis symptoms?

Tips you can try to calm symptoms of ulcerative colitis include limiting fiber, eating smaller meals, exercising, and reducing stress. You can also talk with your doctor about anti-inflammatory medications or a combination of anti-inflammatory and immunosuppressant medications to relieve symptoms and prevent flare-ups.

What helps reduce inflammation when treating ulcerative colitis?

Aminosalicylates, also known as 5-ASAs, are usually the first treatment option for mild to moderate ulcerative colitis. These medications help reduce inflammation and allow damaged tissue in the colon to heal.

Talk with your doctor about what treatment options might work best for you.

What is the most successful treatment for ulcerative colitis?

According to the Crohn’s and Colitis Foundation, the most effective treatment plan for ulcerative colitis is multifaceted. This means it may involve medications, diet, and sometimes surgery.

You’ll want to talk with a doctor to develop a treatment plan that works best for you. And you may need to update and refine this plan to make sure it stays effective.

What is the first-line treatment for a UC flare-up?

There is no such thing as a universal first-line treatment for UC flare-ups. Treatment depends on the person, their health, and the severity of their disease.

Some patients can start with mesalamine (5-aminosalicylic acid or 5-ASA), while others need biologics (such as infliximab, adalimumab, and golimumab) right away.

Talk with a doctor about what to do when these flare-ups occur. It’s important to have a plan in place before they happen.

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