Ulcerative colitis treatment may involve dietary strategies, stress management, and medication. If these methods are not successful, a doctor may recommend surgery.

Coping with ulcerative colitis (UC) can present challenges.

According to a large study published in 2023, this chronic disease may affect about 1.25 million people in the United States.

It causes inflammation and sores in the lining of your colon and rectum. As the inflammation worsens, the cells that line these areas die off, resulting in bleeding, infection, and diarrhea.

UC can lead to:

  • fever
  • anemia
  • fatigue
  • joint pain
  • appetite loss
  • weight loss
  • skin lesions
  • nutritional deficiencies
  • stunted growth in children

The exact cause of UC is unclear, but many experts believe that it results fromTrusted Source an atypical immune system response.

Your doctor may order a blood test, stool samples, a barium enema, and a colonoscopy. These medical tests will allow them to determine whether the cause of your symptoms is UC or another condition, such as Crohn’s disease, diverticular disease, or cancer.

UC should be confirmed by a tissue biopsy during a colonoscopy.

If you receive a UC diagnosis, it’s vital to work with your doctor or healthcare team to create a treatment plan that manages and prevents flares so that your colon can heal.

Because the symptoms and effects of the disease vary, there’s no single treatment that works for everyone. Treatment often involves a combination of diet and nutrition, stress management, and medication.

To best manage UC, you may find it helpful to eat a nutritious, balanced diet and to avoid raw and high fiber foods if they tend to trigger your symptoms. Examples of foods to avoid with UC include:

  • nuts
  • seeds
  • beans
  • whole grains

Fatty and greasy foods can also contribute to bloating and pain.

In general, foods that may be easier on your digestive system when you have UC include:

  • low fiber grains
  • baked chicken, pork, and fish
  • steamed, baked, or stewed fruits and vegetables

Sipping water throughout the day can also aid in digestion and help reduce inflammation.

Anxiety and nervousness can worsen UC symptoms. Getting physical activity regularly and practicing relaxation techniques may help you reduce or cope with stress, contributing to a decrease in symptoms. You might want to try practices such as:

  • biofeedback
  • massages
  • meditation
  • therapy

Your doctor might prescribe medication to induce or maintain remission. Medications for UC fall into four primary categories.

Aminosalicylates

These drugs contain 5-aminosalicylic acid (5-ASA), which helps manage inflammation in your intestines.

Aminosalicylates can be given orally (by mouth), through an enema, or in a suppository.

These medications typically take about 4 weeks to work. They may cause side effects such as:

  • nausea
  • vomiting
  • heartburn
  • diarrhea
  • headache

Corticosteroids

These are steroid drugs — including prednisone, budesonide, methylprednisolone, and hydrocortisone — that help reduce inflammation.

Your doctor might recommend corticosteroids if you have moderate to severe UC, including if you have not responded favorably to 5-ASA drugs.

Corticosteroids can be given orally, intravenously (directly into a vein), through an enema, or in a suppository. The possible side effects include:

  • acne
  • facial hair
  • hypertension
  • diabetes
  • weight gain
  • mood swings
  • bone mass loss
  • increased risk of infection

Ideally, steroids are used on a short-term basis to lessen the effects of a UC flare-up, rather than as a long-term daily medication to manage symptoms.

But if your UC is very severe, your doctor might prescribe a daily dose of steroids to help you maintain your typical lifestyle.

Immunomodulators

Immunomodulators, including azathioprine and 6-mercapto-purine (6-MP), help reduce inflammation in your immune system. But they can take as long as 6 months to be effective.

You can take immunomodulators orally. Your doctor might recommend them if your UC doesn’t respond well to the combination of 5-ASAs and corticosteroids. Possible side effects include:

  • pancreatitis
  • hepatitis
  • reduced white blood cell count
  • increased risk of infection

Biologics

These medications belong to a newer class of drugs that are used as an alternative to immunomodulators to treat UC in people who have not responded well to other treatments.

Biologics are more complex than other types of medication for UC. They target specific proteins. You might receive each dose of a biologic medication as an intravenous injection or as an infusion (a slow injection over a period of time).

Several biologic medications are FDA approved to treat UC:

  • adalimumab (Humira)
  • golimumab (Simponi)
  • guselkumab (Tremfya)
  • infliximab (Remicade)
  • mirikizumab (Omvoh)
  • risankizumab (Skyrizi)
  • ustekinumab (Stelara)
  • vedolizumab (Entyvio)

JAK inhibitors

Janus kinase (JAK) inhibitors are a type of disease-modifying antirheumatic drugs (DMARDs). They contain small molecules that are broken down by your digestive system and absorbed into your bloodstream.

JAK inhibitors work quickly, blocking pathways of inflammation in your body.

The FDA has approved two JAK inhibitors to treat UC: tofacitinibTrusted Source (Xeljanz) and upadacitinib (Rinvoq).

If other forms of treatment have not worked, you may be a candidate for surgery.

Some people with UC eventually decide to have their colon removed because of severe bleeding and illness or because of an increased risk of cancer.

Four types of surgery are available to treat UC:

  • restorative proctocolectomy with ileal pouch-anal anastomosis
  • total abdominal colectomy with ileorectal anastomosis
  • total abdominal colectomy with end ileostomy
  • total proctocolectomy with end ileostomy

If you have UC, it’s a good idea to avoid nonsteroidal anti-inflammatory drugs (NSAIDs), which may worsen your symptoms.

Also, because UC is linked to an increased risk of colorectal cancer, it’s recommended that you schedule an exam every 1 to 2 years, especially if you’ve had UC for 8 years or longer. Your doctor can advise on the right screening schedule for you.

You can work with your doctor to create a treatment strategy that best addresses your healthcare needs.

With the right treatment approach, it’s possible to manage your UC and live life to the fullest.

UC can be challenging to treat, but several treatment options are available.

Talk with your doctor about your symptoms. Together, you and your doctor can develop a treatment plan that works for you.