If left untreated, the pain associated with ulcerative colitis (UC) can make it hard to work, exercise, or enjoy daily activities. Managing the disease with medication, stress reduction, and diet can help manage and lower pain.

Managing Ulcerative Colitis Pain: How to Find Relief During a Flare-Up
Are you suffering from ulcerative colitis pain? This video shares some recommendations for relief during flare-ups.
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UC is a type of inflammatory bowel disease (IBD) that can cause varying levels of pain. This pain may be long lasting, or it may fade when the inflammation lessens. The degree of pain depends on how much inflammation you have in your colon and where it’s located.

Treatment can help you manage the pain. A doctor may recommend a combination of medications, dietary changes, and other complementary therapies, which are reviewed in this article.

According to the Crohn’s & Colitis Foundation, about a third of people with UC experience ongoing abdominal pain. The two most common locations for pain in UC are the rectum and the lower left side of the abdomen.

If you have a type of UC known as left sided UC, your left side may also feel tender to the touch.

With mild UC, you may experience pressure and cramping. As the disease progresses and inflammation and ulcers in your colon increase, the pain may present as feelings of gripping or extreme pressure that tightens and releases over and over again. You may also experience gas pain and bloating, which can make the sensation feel worse.

The pain associated with UC can affect your overall quality of life. If you have long-term (chronic) unmanageable pain at any level, consider discussing the following treatment options with a doctor so that you can feel better.

How long does colitis flare-up last?

Periods of remission between flare-ups are common in mild UC. During remission, symptoms may decrease or disappear completely.

When your symptoms flare up, they may last a few days but sometimes even weeks or months. That said, people living with moderate to severe UC generally don’t go into remission and can have chronic pain.

There are several treatments for UC. The most effective method will depend on your particular case and symptoms. Treatment includes medicationsTrusted Source and various lifestyle changesTrusted Source.

Over-the-counter (OTC) medication

If you have mild pain, OTC medications like acetaminophen (Tylenol) may be enough to help you feel relief.

Should you avoid any pain relievers with ulcerative colitis?

If you have UC, it’s best to avoid pain relievers like nonsteroidal anti-inflammatory drugs (NSAIDs). This is because these drugs can cause flare-ups and make other symptoms, such as diarrhea, worse.

Medications to avoid can include:

  • ibuprofen (Motrin IB, Advil)
  • aspirin (Bufferin)
  • naproxen (Aleve, Naprosyn)

Anti-inflammatory medication

Inflammation is the root cause of most UC-related pain. Certain medications can help reduce inflammation in your colon. A doctor can help you decide which kind is right for you based on which part of your colon is affected and the severity of your disease.

Anti-inflammatory medications that may help can include corticosteroids, such as prednisone and hydrocortisone. However, doctors generally only recommend using these in the short term before transitioning to other medications, as these can have side effects.

Amino salicylates are another class of anti-inflammatory medication. Doctors sometimes prescribe these for UC pain. There are many kinds, including:

  • mesalamine (Asacol, Lialda, Canasa)
  • sulfasalazine (Azulfidine)
  • balsalazide (Colazal, Giazo)
  • olsalazine (Dipentum)

Anti-inflammatory drugs can be taken by mouth as tablets or capsules. Alternatively, healthcare professionals can administer them through suppositories, enemas, or intravenous (IV) injections. Most can cause side effects of varying kinds.

You may need to try more than one type of anti-inflammatory drug before you find one that best eases your symptoms. Each medication is sold under several brand names.

Immunomodulators

Doctors may prescribe immunomodulators alone or in addition to anti-inflammatory medications. All these drugs help lower pain by working to stop your immune system from triggering inflammation. There are several types, including azathioprine (Azasan, Imuran) and mercaptopurine (Purixan).

However, they may cause serious side effects, including pancreatitis and a lowered ability to fight off serious infections and some cancers, such as skin cancer. That said, doctors monitor you while you take them and have you undergo regular testing as needed.

Biologics

Biologics are another type of immunomodulator. One type of biologic is TNF-alpha inhibitors.

Anti-TNF alpha medications are now first-line treatments for people with moderate to severe UC. They’re typically reserved for people who haven’t had success with other therapies. They help stop pain by nullifying a protein produced by the immune system. One type of anti-TNF alpha medication is infliximab (Remicade).

Integrin receptor antagonists are another form of biologics. These include vedolizumab (Entyvio), which has been approved to treat UC in adults.

However, treatment with biologics does carry an increased risk of infection. They also put you at risk of reactivated tuberculosis (TB) and hepatitis B.

Janus kinase (JAK) inhibitors

JAK inhibitors are oral medications that block a specific enzyme involved in inflammation.

JAK inhibitors, such as tofacitinib (Xeljanz) and upadacitinib (Rinvoq), can be effective in treating moderate to severe UC in instances where biologics are not effective.

What you eat won’t cause UC, but certain foods may worsen your symptoms and cause additional cramping and pain. Keeping a food diary can help you identify any food triggers you may have.

Common foods that people with UC typically avoid can include:

  • dairy products high in lactose, such as milk
  • high fat foods, such as greasy or fried items, beef, and sugary, high fat desserts
  • processed foods, such as frozen dinners and boxed rice
  • high fiber foods, such as whole grains
  • gas-producing vegetables, such as Brussels sprouts and cauliflower
  • spicy food
  • alcoholic drinks
  • caffeinated beverages, such as coffee, tea, and cola

It may help to eat several small meals a day rather than three large ones. You should also try drinking lots of water — at least eight 8-ounce (oz) glasses per day. This may put less strain on your digestive system, produce less gas, and help bowel movements move through your system smoothly.

Once thought to cause UC, stress may trigger UC flare-ups in some people. Managing and reducing stress may help ease UC symptoms like pain.

Different stress-management techniques work for different people. You might find that a simple walk in the woods and deep breathing are what benefit you the most. Yoga, mindfulness meditation, and exercise may also help reduce stress in some people with UC.

A 2019 review found that mindfulness interventions can be effective in relieving stress and depression and improving the quality of life in people with IBD. However, it didn’t lead to significant symptom relief. More research specific to UC is needed.

In extreme cases, surgery may be the best way to treat UC and its pain. There are two different options for surgery to manage severe UC. Both options have pros and cons, so it’s best to discuss them with a doctor.

Proctocolectomy with end ileostomy

Also known as a full proctocolectomy, this surgery requires the removal of the entire colon, rectum, and anus.

A surgeon then forms a stoma using the end of the small intestine to remove waste from the body.

Proctocolectomy with J-pouch formation

This surgery requires the removal of your entire colon and rectum.

During surgery, a pouch constructed from the end of your small intestine is attached to your anus. This allows for relatively usual waste elimination to occur, meaning you won’t have to wear an external bag.

Alternative treatments such as acupuncture may help reduce and regulate bowel inflammation, lowering UC pain.

Another form of alternative treatment called moxibustion is a type of heat therapy that may also help ease UC symptoms. It uses dried plant materials burned in a tube to warm the skin, often in the same areas targeted by acupuncture.

Pain can range from mild to severe, depending on the severity of UC symptoms. You may experience long periods of remission from these symptoms followed by flare-ups in which the symptoms return or worsen.

These symptoms can make it hard to perform your daily activities.

Medication can help reduce the symptoms of flare-ups and lengthen the time of remission. Diet, exercise, stress management, and other alternative therapies may help.

If you’re experiencing pain due to UC, talk with a doctor about your treatment options to manage the condition and lower pain.