With ulcerative colitis (UC), you’ll have flare-ups, or periods when you experience symptoms. Then you’ll have symptom-free periods called remissions.

Nonsurgical treatments do not cure UC, but getting on the right medication should help make your flare-ups shorter and less frequent.

Sometimes a treatment you try won’t be the right one for your condition and needs, or the treatment you’re currently on may stop working in treating your condition. If your medication does not help manage your flare-ups, here are seven steps you can take to start feeling better again.

UC medications bring down inflammation and allow your colon to heal. Knowing which ones are available and the situations they work best for can help you have a more informed discussion about them with your doctor.

Aminosalicylates (5-ASA drugs)

These medications help manage inflammation in people with mild to moderate UC. They may be the first medications you receive.

You can take them:

  • by mouth
  • as an enema
  • as a suppository

Examples include:

  • mesalamine (Apriso, Canasa)
  • olsalazine (Dipentum)
  • balsalazide (Colazal)

Corticosteroids

These medications help manage more severe symptoms. You should only use them for short periods because they can cause side effects such as weight gain and weakened bones.

Steroid medications are available in a variety of forms, including as a foam, suppository, pill, or syrup. The oral form is more potent, but it causes more side effects than topical forms.

Examples are:

  • budesonide (Uceris)
  • prednisone (Prednisone Intensol, Rayos)
  • prednisolone (Prelone)
  • methylprednisolone (Medrol, Depo-Medrol)

Immunosuppressants

These medications are for people who do not get better on aminosalicylates. They reduce the immune system response to help prevent damage to the colon.

They’re available in oral forms, such as pills and suspensions. They’re also available as injectable drugs.

The Food and Drug Administration (FDA) has not approved immunosuppressants as a UC treatment. However, your doctor may prescribe them anyway if they feel it’s best for your care. This is known as off-label drug use.

Examples include:

  • methotrexate (Trexall, Otrexup, Rasuvo)
  • azathioprine (Azasan, Imuran)
  • tacrolimus (Astagraf XL, Envarsus XR, Prograf)

Biologics

Biologics are used to treat moderate to severe disease in people where the condition has not improved with other treatments. These medications block an immune system protein that contributes to inflammation.

Biologics are administered intravenously or through an injection.

Examples of these drugs are:

  • adalimumab (Humira)
  • golimumab (Simponi)
  • infliximab (Remicade)
  • ustekinumab (Stelara)
  • vedolizumab (Entyvio)

Tofacitinib

Tofacitinib belongs to a class of medications known as Janus kinase (JAK) inhibitors. JAK inhibitors block an inflammatory protein, so they work similarly to biologics.

Tofacitinib is available as a tablet or liquid solution under the brand names Xeljanz and Xeljjanz XR.

Treating UC is a long-term commitment. Even if you feel well, skipping doses or stopping your medication could cause your symptoms to come back.

When you get a new prescription, make sure you know exactly how and when to take your medication. Ask your doctor what you should do or call your pharmacy if you accidentally miss a dose.

If you develop side effects from the medications, make an appointment with your doctor to discuss switching to another medication. Do not stop taking medication on your own.

A sudden return of UC symptoms — such as belly pain, diarrhea, and blood stools — can make it obvious that you’ve entered a flare-up and may need to talk with your doctor about adjusting your treatment. Sometimes the symptoms are subtler.

Keep track of any changes in the way you feel, no matter how small they are. Let your doctor know if:

  • you have more bowel movements than usual
  • your bowel movements change in amount or texture
  • you notice blood in your stool
  • you feel tired or have less energy
  • you have less of an appetite, or you’ve lost weight
  • you have other symptoms, such as joint pain or mouth sores

Writing down your symptoms in a diary can help you explain them to the doctor.

Sometimes one medication isn’t enough to tackle severe UC symptoms. Your doctor might give you a second medication to help you manage your condition. For example, you might need to take both a biologic and an immunosuppressant drug.

Taking more than one medication can increase the odds of treatment success. It can also increase your chances of experiencing side effects. The doctor will help you balance the benefits and risks of the medications you take.

If you begin to have more frequent flare-ups, it may be time to talk with your doctor about switching to a new medication. You might start by changing to a different version of the same drug, like going from an aminosalicylate (5-ASA) enema to a pill.

If your symptoms get worse, it’s time to talk with your doctor and consider switching to a stronger medication, such as a biologic or a short course of corticosteroids.

Medication isn’t the only way to manage your symptoms. Changing your diet could help, too.

Certain foods and drinks can aggravate UC symptoms. You might want to avoid or limit these foods and drinks if they bother you:

  • milk and other dairy products
  • coffee, tea, sodas, and other caffeinated products
  • alcohol
  • fruit and fruit juices
  • fried foods
  • high fat foods
  • spices
  • high fiber foods, including whole grain bread
  • cruciferous vegetables such as cabbage and broccoli
  • beans and other legumes
  • steak, burgers, and other red meats
  • popcorn
  • peanuts
  • artificial colors and sweeteners

Keeping a food diary can help you pinpoint which foods worsen your symptoms.

Most people with UC can manage their disease with medication alone. However, some people may need surgery because they’re not getting better or they have complications.

The most common type of surgery is the ileal pouch with anal anastomosis, also known as J-pouch surgery. During this procedure, your surgeon removes both your colon and rectum. They’ll also create an internal pouch to collect your waste and allow for bowel movements. The pouch can take time to get used to.

You may feel hesitant about undergoing surgery. The upside of removing the colon and rectum is that you’ll be “cured” and essentially freed from most symptoms. Since UC affects the immune system, symptoms that extend beyond the digestive system, such as joint pain or skin conditions, may recur after surgery.

If small intestine disease manifests following your surgery, your doctor may update your diagnosis to Crohn’s disease.

Treating UC can take some trial and error. Symptoms come and go, and the disease is more severe in some people than in others.

Schedule regular visits with your doctor to stay on top of your disease. In between visits, keep track of your symptoms and note what seems to trigger them.

The more you know about your disease and the closer you stick with your treatment, the greater your chances of managing your UC.