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

Treatments don’t cure UC. But getting on the right medication should make your flares shorter and less frequent.

Sometimes, a treatment you try won’t be the right one for you, or the treatment you’re currently on may stop working. If your medication doesn’t manage your flares, here are eight steps you can take to start feeling better again.

1. Learn about your options

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

Drugs that treat UC include:

Aminosalicylates

These medications help control inflammation in people with mild to moderate UC. They may be the first drugs you receive. You can take them by mouth, or as an enema or suppository.

Steroid drugs (corticosteroids)

These medications help control more severe symptoms. You should only use them for short periods because they can cause side effects like weight gain and weakened bones. Steroid medications are available as a pill, foam, or suppository. The oral form is more potent, but it causes more side effects than topical forms.

Immunosuppressants

These medications are for people who don’t get better on aminosalicylates. They reduce the immune system response to prevent damage to the colon.

Biologic drugs

These medications block an immune system protein that contributes to inflammation. You get them through an IV or injection that you give yourself. Biologics are for people with a moderate to severe disease that hasn’t improved with other treatments.

Monoclonal antibodies

These medications can be used in adults with moderate to severe UC. If you haven’t experienced relief with aminosalicylates, steroid drugs, immunosuppressants, or biologics, you may want to talk to your doctor about this type of medication.

2. Make sure you’re sticking to protocol

Treating ulcerative colitis 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 to do if you accidentally miss a dose.

If you develop side effects from the drugs you’re on, make an appointment with your doctor to discuss switching to another drug. Don’t stop taking medication on your own.

3. Watch for symptoms

A sudden return of symptoms like belly pain, diarrhea, and bloody stools can be an obvious sign that you’ve entered a flare-up and may need to adjust your treatment. But 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, like joint pain or mouth sores

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

4. Ask about adding another medication

Sometimes one drug isn’t enough to tackle severe UC symptoms. Your doctor might give you a second drug to help you get more control over your disease. 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. But it can also increase your chances of experiencing side effects. Your doctor will help you balance the benefits and risks of the medications you take.

5. Know when it’s time to switch drugs

If you begin to have more frequent flare-ups, it may be time to talk to 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 enema to a pill.

If your symptoms get worse, it’s time to consider switching to a stronger medication. Your doctor might prescribe an immunosuppressant or biologic, or steroids for a short period.

6. Look at your diet

Medication isn’t the only way to control 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 if they bother you:

  • milk and other dairy products
  • coffee, tea, sodas, and other caffeinated drinks and foods
  • alcohol
  • fruit and fruit juices
  • fried foods
  • high-fat foods
  • spices
  • high-fiber foods, including whole-grain bread
  • cruciferous vegetables like 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.

7. Consider whether it’s time for surgery

Most people with UC can manage their disease with medication alone. But about one-quarter may need surgery because they’re not getting better or they have complications.

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

8. The bottom line

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 odds of controlling ulcerative colitis.