Ulcerative colitis: treatment
Treatment of ulcerative colitis will depend on the severity of the disease and the effect the symptoms are having on your daily life. It will also depend upon whether you are in remission or are having a flare-up of your disease.
This kind of anti-inflammatory medication includes:
- sulfasalazine (brand names Salazopyrin, Pyralin);
- mesalazine (brand names Mesasal, Salofalk, Pentasa, Mezavant);
- olsalazine (Dipentum); and
- balsalazide (Colazide).
These medicines are available to take orally (as tablets, capsules or granules) and/or rectally (as an enema, foam or suppositories).
These medicines have a similar structure to aspirin and are often used to prevent relapse. This is called maintenance treatment and it has been shown that people on maintenance therapy with aminosalicylates often have fewer relapses (flare-ups) than other people.
These medicines can also help to control symptoms during a flare-up. Often your doctor will suggest you increase the dose during a flare-up, and possibly take a rectal preparation in addition to your oral medicine.
Common side effects include:
- diarrhoea; and
- abdominal pain.
For flare-ups or relapses, corticosteroids can be used to reduce inflammation. Steroids may be given as tablets to be taken by mouth or as enemas, foams or suppositories to be put directly into the rectum.
Mild attacks or attacks where only the rectum is involved are often treated with steroid enemas or rectal foam. If the inflammation is more severe or the colitis involves parts of the bowel which can’t be reached with enemas or suppositories, then steroid tablets can be prescribed.
Corticosteroids are not usually given for long periods, but as a short-term treatment for disease flare-ups. Long-term corticosteroid treatment is not recommended because it does not prevent flare-ups and is associated with side effects including:
- rounding of the face (moon face);
- weight gain;
- mood changes;
- thinning of the bones (osteoporosis);
- cataracts; and
If you have a severe attack of ulcerative colitis, you may need treatment in hospital with intravenous corticosteroids.
Immunosuppressants are medications that suppress the activity of the body’s immune system. They may be prescribed as maintenance therapy in people who have ulcerative colitis that is difficult to control.
Immunosuppressant medicines used to treat ulcerative colitis include:
- azathioprine (for example, Imuran, Thioprine);
- mercaptopurine (Puri-Nethol); and
Infliximab (brand name Remicade), adalimumab (Humira), golimumab (Simponi) or vedolizumab (Entyvio) are medicines that may be used if other medicines are poorly tolerated or ineffective.
Side effects can include:
- liver problems;
- increased risk of developing certain cancers; and
- low white blood cell count.
When taking some of these medicines, frequent blood tests are needed to check on your blood cell counts and liver function.
Medications for diarrhoea and pain are also often prescribed.
If maintenance medicines don’t help and you are still having flare-ups and the disease is seriously affecting your quality of life, or if your colon shows evidence of changes which your doctor believes could lead to cancer, then surgery may be recommended. However, only a minority of people with ulcerative colitis require surgery.
Surgery usually involves removal of both your colon and rectum (proctocolectomy), followed by one of the options below.
Proctocolectomy with ileostomy
If both your colon and rectum are removed the surgeon may perform an ileostomy where the ileum (the part of the intestine before the colon and rectum) will be made to discharge its contents out of the body through a hole in the abdomen. A bag will need to be worn outside the body to enable the drainage of waste.
Proctocolectomy with continent ileostomy
This is a variation of the operation above. The colon and rectum are still removed, but the surgeon uses the ileum to construct a pouch inside the abdominal wall. There is a small opening in the person’s side and periodically the person must insert a tube to empty the pouch.
Proctocolectomy with ileoanal anastomosis
Alternatively, you may be able to have a different kind of operation that eliminates the need to use a bag altogether. A pouch is constructed from the end of the ileum and then attached directly to the anus, allowing you to expel your waste normally. However, this type of operation, which may be carried out in one or 2 stages, can result in frequent bowel movements in the long term.
Although the decision to have surgery will have to be carefully considered by you and your doctors, it does mean your condition should no longer be a problem.
You may notice that some foods (particularly spicy or fatty foods or those which contain lots of fibre, such as fruits) make your symptoms worse when you are having a flare-up. If so, you should avoid these. However, you should not restrict your intake of dietary fibre as a matter of course.
Some people with ulcerative colitis lose weight and find it hard to maintain a healthy weight. Your doctor will advise you if you need to take nutritional supplements. Eating a healthy diet is very important if you have ulcerative colitis.
Blood loss in ulcerative colitis can lead to anaemia. If you become anaemic your doctor will probably recommend that you take iron tablets.
Although the disease can be disabling during flare-ups, people with ulcerative colitis are able to lead normal lives relatively free of symptoms during the times the disease is in remission. Medical treatment can greatly improve the quality of life for people with the condition, and research into new treatments is continuing all the time. For those few whose disease is disabling, surgery does represent a cure, although it often involves an ileostomy.
Can ulcerative colitis lead to cancer?
If you have widespread ulcerative colitis, your risk of developing colon cancer is higher than people who do not have ulcerative colitis. This is particularly true if you have had colitis for many years.
Your doctor will probably advise you to have regular examination by colonoscopy. Biopsies (small tissue samples) will probably be taken at the colonoscopy for microscopic examination to detect any changes in bowel tissue that might lead to cancer. Your doctor will advise you on how often you should have these examinations depending on how long you have had ulcerative colitis.
2. Ulcerative colitis (revised February 2011). In: eTG complete. Melbourne: Therapeutic Guidelines Limited; 2015 Jul. http://online.tg.org.au/complete/ (accessed Oct 2015).
3. National Institute of Diabetes and Digestive and Kidney Diseases. Ulcerative colitis (updated 3 Sep 2014). http://www.niddk.nih.gov/health-information/health-topics/digestive-diseases/ulcerative-colitis/Pages/facts.aspx (accessed Oct 2015).