Ulcerative Colitis (UC) Treatment: Medication, Surgery, and More

Ulcerative colitis (UC) is a common form of inflammatory bowel disease (IBD). It’s a chronic condition, meaning it requires lifelong treatment and lifestyle changes to manage symptoms effectively.

A variety of treatments are available for UC, including medication, surgery, and other options. Finding the best treatment for you can take time and may involve some trial and error, as symptoms, causes, and severity vary from person to person. Working with a gastroenterologist, a doctor who treats digestive conditions like UC, can help you find a treatment that works for you.

Anti-Inflammatory Drugs

• Sulfasalazine (Azulfidine)
• Olsalazine (Dipentum)
• Mesalamine (Delzicol, Lialda, Apriso)
• Balsalazide (Colazal)

Immunomodulators

• azathioprine (Azasan, Imuran)
• 6-mercaptopurine (Purinethol, Purixan)
• cyclosporine (Gengraf, Neoral, Sandimmune)
• tacrolimus (Astagraf XL, Envarsus XR, Prograf)

Biologics

• Tumor Necrosis Factor (TNF) Inhibitors Doctors often prescribe these medications for moderate to severe UC. Medications in this class include infliximab (Remicade), adalimumab (Humira) and golimumab (Simponi).
• Interleukin (IL)-23 Inhibitors These medications block IL-23 proteins in the immune system. Often first-line treatments for UC, the IL-23 inhibitor class includes drugs like ustekinumab (Stelara), as well as newer drugs like risankizumab (Skyrizi), mirikizumab (Omvoh), and guselkumab (Tremfya). These medications are indicated for moderate to severe UC, but many gastroenterologists prescribe them as a first-line treatment option.
• Integrin Receptor Antagonists Vedolizumab (Entyvio), an integrin receptor agonist, works by stopping inflammatory cells from reaching the inflammation site. These medications are indicated for moderate to severe UC, but many gastroenterologists prescribe them as a first-line treatment option.

Small Molecule Drugs

• Janus Kinase (JAK) Inhibitors These medications target the parts of the immune system that cause inflammation in the intestines. This medication class includes tofacitinib (Xeljanz), upadacitinib (Rinvoq) and filgotinib (Jyseleca).
• Sphingosine-1-Phosphate (S1P) Receptor Modulators These medications target the immune system’s inflammatory response. This medication class includes ozanimod (Zeposia) and etrasimod (Velsipity).

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Other Medications

• Antispasmodics These medications help with cramps.
• Antidiarrheal Medicines Although these medications can help with diarrhea, don’t use them without guidance from your healthcare team. For people with UC, they could lead to an enlarged colon.
• Iron Supplements These can help manage iron deficiency caused by persistent intestinal bleeding.
• Pain Relievers Medications like acetaminophen (Tylenol) can help ease mild pain. However, you should avoid taking medications such as ibuprofen and naproxen. These medications, known as nonsteroidal anti-inflammatory drugs (NSAIDs), can irritate your stomach and make your UC symptoms worse.

• Uncontrolled bleeding
• Perforation (a hole or holes in the intestine)
• Strictures (a narrowing of part of the intestine due to scar tissue)
• Unresectable high-grade or multifocal dysplasia (precancerous cells that raise your risk for colorectal cancer)
• Slowed growth in children
• Intractable fulminant colitis (a rare but severe form of UC)
• Toxic megacolon (severe inflammation and enlargement of the colon)
• Cancer

Proctocolectomy With Ileoanal Anastomatosis (J-Pouch) Surgery

Proctocolectomy With End Ileostomy

Continent Ileostomy (Kock Pouch)

“I always recommend lifestyle modifications to my patients,” says Supriya Rao, MD, a gastroenterology, internal medicine, obesity medicine, and lifestyle medicine physician and a professor of gastroenterology at Tufts University School of Medicine in Boston. “Your gut thrives on the boring stuff — whole foods, plant-based diet devoid of processed foods and red meat, no smoking or drinking alcohol, staying hydrated with water, getting movement or exercise in each day, reducing your stress (yoga, meditation, or mindfulness) and getting good, quality sleep each night.”

Diet

If you don’t know what foods might be causing your flares, you may want to try keeping a food journal and record what you eat, and any symptoms you might experience. This may help you figure out what foods are causing your UC symptom flares.

Exercise

Stress Management

Stress is a common trigger of UC, meaning it can cause your symptoms to worsen. “One person with UC I work with found that flare-ups were triggered by stress, hence mental health strategies including cognitive behavioral therapy became even more important alongside GI treatment,” says Matt Grammer, a licensed professional clinical counselor with supervision designation and founder of Therapy Trainings, a continuing education company for mental health professionals.

• Exercise
• Deep breathing
• Mindfulness and meditation
• Talk therapy
• Yoga

Taking care of your mental health can play an important role in your UC treatment and your overall health. That’s because people with IBD may be at increased risk of developing mental health conditions like depression or anxiety.

• Psychotherapy (talk therapy), such as cognitive behavior therapy (CBT) or mindfulness-based therapy. This involves working with a therapist and finding ways to cope with stress, depression, or other mental health issues.
• Medications that treat depression or anxiety
• Progressive muscle relaxation, an intervention that involves tensing and relaxing muscles throughout your body to relieve any tension in those areas that makes pain or stress worse
• Support groups

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• Exercise

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• Several treatment options are available to help manage UC, including medications and surgery.
• Lifestyle changes, including managing stress, dietary changes, and taking steps to improve your mental health, can also help.
• Some people may try complementary and integrative therapies like acupuncture or probiotics, but there’s currently not enough evidence to support their effectiveness for UC.
• You should speak with a member of your treatment team before stopping or starting a new therapy for UC.