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If you've been diagnosed with ulcerative colitis (UC), understanding the different treatment options is essential for managing your symptoms and achieving long-term remission. In this article, we’ll discuss ulcerative colitis treatment options, including medications, surgical intervention and lifestyle modifications that are often used in combination for optimal treatment outcomes.
Popular Medications
Medications are the cornerstone of UC treatment. They help reduce inflammation, achieve and maintain disease remission and prevent complications.
Medications commonly used to treat UC include:
- Aminosalicylates (5-ASA). Mesalamine, balsalazide and sulfasalazine, work by reducing inflammation in the lining of the colon. They are often recommended for mild to moderate UC.
- Corticosteroids. Prednisone and budesonide, work by suppressing the immune system and reducing inflammation. Due to their undesirable side effects, they are typically reserved for short-term flare-ups as opposed to long-term management.
- Immunomodulators. Azathioprine, mercaptopurine and methotrexate, work by modifying the immune response and reducing inflammation. These drugs are typically used for patients who do not respond to aminosalicylates or corticosteroids.
- Biologics. These drugs, including anti-TNF agents (i.e. infliximab) and integrin inhibitors (i.e. vedolizumab), work by targeting specific components of the immune system. They are used for moderate to severe UC that has not responded to other treatment options.
- Janus kinase (JAK) inhibitors. These drugs, including tofacitinib, work by targeting the JAK pathway involved in the immune response. They are used for moderate to severe UC when other biologic drugs have been ineffective.
Other Medications
Other medications may be recommended to relieve specific symptoms of UC, including diarrhea, abdominal cramping and pain and anemia. These medications may include:
- Anti-diarrheal medication. Loperamide may be effective for severe diarrhea. However, this medication should be used with caution and only with the advice of your doctors because it may increase the risk of an enlarged colon (toxic megacolon).
- Pain medications. Acetaminophen may be effective for mild pain. However, anti-inflammatory medications, including ibuprofen and naproxen, are not recommended because they can worsen your symptoms and increase your disease severity.
- Antispasmodics. Hyoscyamine or dicyclomine may be recommended to relieve abdominal cramping and pain.
- Iron supplements. These supplements may be recommended if you have intestinal bleeding and have developed iron deficiency anemia.
Lifestyle Modifications
Making these lifestyle changes can help to decrease symptom severity and improve your overall well-being:
- Eat a well-balanced diet. It should be tailored to your tolerances can help to manage your symptoms. It’s important to identify and avoid food triggers, eat smaller and more frequent meals and ensure adequate intake of nutrients.
- Stress can worsen symptoms of UC. It’s important to learn ways to manage your stress appropriately. Techniques such as meditation, yoga, exercise and mindfulness can help manage stress and improve your mental health.
- Stay hydrated. Long-term diarrhea increases your risk of dehydration, which can lead to weakness and kidney issues. Drinking plenty of water throughout the day can help you stay hydrated, especially during a flare-up.
Surgical Options
Surgical intervention may be needed for individuals with severe UC that does not respond to medical treatment. It's also an option for those who develop serious complications including bleeding, perforation or cancer. Three surgical options include:
- Proctocolectomy with ileal pouch-anal anastomosis (IPAA). This procedure involves removing the entire colon and rectum and creating a pouch from the end of the small intestine, which is then attached to the anus. This allows for normal bowel movements without the need for an ostomy.
- Proctocolectomy with ileostomy. This procedure involves removing the entire colon and rectum and creating an external stoma (ileostomy) for waste removal.
- Continent ileostomy (Koch pouch). This procedure involves removing the entire colon and rectum, creating an ileal stoma opening in the belly and placing a one-way valve into the opening. To remove waste, a tube is placed into the valve, which allows for control over the timing of bowel elimination.
Learn more about improving your gut health by checking out our article on gut health vitamins.