When you have ulcerative colitis (UC), an immune system misfire causes your body’s defenses to attack the lining of your large intestine (colon). The intestinal lining becomes inflamed and forms sores called ulcers, which can lead to symptoms like bloody diarrhea and an urgent need to go.

UC doesn’t manifest the same way in each person. It also doesn’t stay the same over time. Your symptoms may show up for a while, get better, and then come back again.

Your doctor’s goal in treating you is to keep your symptoms at bay. These symptom-free periods are called remissions.

Which drug you take first depends on how severe your symptoms are.

  • Mild: You have up to four loose stools a day and mild belly pain. Stools may be bloody.
  • Moderate: You have four to six loose stools a day, which may be bloody. You may also have anemia, a shortage of healthy red blood cells.
  • Severe: You have more than six bloody and loose stools per day, plus symptoms like anemia and a fast heart rate.

Most people with UC have a mild-to-moderate disease with alternated periods of symptoms, called flares, and remissions. Getting you into remission is the goal of treatment. As your disease gets worse or better, your doctor may need to adjust your medications.

Here are eight reasons why your UC treatment can change over time.

The first treatment many people with mild-to-moderate UC try is an anti-inflammatory drug called an aminosalicylate. This class of drugs includes:

  • sulfasalazine (Azulfidine)
  • mesalamine (Asacol HD, Delzicol)
  • balsalazide (Colazal)
  • olsalazine (Dipentum)

If you took one of these drugs for a while and it didn’t improve your symptoms, your doctor might switch you to another drug in the same class. Another option for stubborn symptoms is to add another drug, like a corticosteroid.

UC can worsen over time. If you started with a mild form, but now your symptoms are severe, your doctor will adjust your medication.

This might mean prescribing you another drug, like a corticosteroid. Or, you could start on an anti-TNF drug. These include adalimumab (Humira), golimumab (Simponi), and infliximab (Remicade). Anti-TNF drugs block an immune system protein that promotes inflammation in your gastrointestinal (GI) tract.

UC symptoms come and go over time. When you have symptoms like diarrhea, belly pain, and urgency, it means you’re experiencing a flare. During a flare, you may have to adjust your dose or change the type of medication you take to manage your symptoms.

Taking a UC drug will help manage your disease and prevent flares. You may need to supplement it with other medications to treat specific symptoms such as:

  • fever: antibiotics
  • joint pain or fever: nonsteroidal anti-inflammatory drugs (NSAIDs) such as aspirin, ibuprofen (Advil, Motrin), or naproxen (Aleve)
  • anemia: iron supplements

Some of these drugs might irritate your GI tract and make your UC worse. That’s why it’s important to check with your doctor before taking any new medication — even one you buy at your local drugstore without a prescription.

Any drug can cause side effects, and UC treatments are no different. Some people who take these drugs may experience:

  • nausea
  • headache
  • fever
  • rash
  • kidney problems

Sometimes side effects can become bothersome enough that you have to stop taking the drug. If this happens, your doctor will switch you to another medication.

Corticosteroid pills are good for treating flares or controlling moderate-to-severe UC, but they’re not for long-term use. Your doctor should put you on corticosteroids only to control your symptoms, and then take you back off them.

Long-term steroid use can cause side effects like:

  • weakened bones (osteoporosis)
  • weight gain
  • an increased risk of cataracts
  • infections

To keep you in remission without the risk of steroid side effects, your doctor can switch you to an anti-TNF drug or a different type of medication.

Medication may keep your UC symptoms at bay for a while, but sometimes it can stop working later on. Or, you may try a few different drugs with no luck. At that point, it may be time to consider surgery.

The type of surgery used to treat UC is called proctocolectomy. During this procedure, both your colon and rectum are removed. The surgeon then creates a pouch — either inside or outside of your body — to store and remove waste. Surgery is a big step, but it can relieve UC symptoms more permanently than medication.

If you’re in remission, congratulations! You’ve achieved your treatment goal.

Being in remission doesn’t necessarily mean that you get to stop taking your medication. However, it may allow you to lower your dose, or come off of steroids. Your doctor might keep you on some form of treatment long-term to prevent new flares and make sure you stay in remission.

UC can change over time. Along with alternating flares and remissions, your disease can gradually get worse. Seeing your doctor for regular checkups can ensure that you catch and treat any new or worsening symptoms early.

If you’re on a medication and still don’t feel well, let your doctor know. You don’t have to live with uncomfortable diarrhea, cramps, and other symptoms.

By adding a new drug to your current treatment or switching your medication, your doctor should be able to find something that works better for you. If you’ve tried several treatments without success, surgery may offer you a more permanent solution to your symptoms.