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 an attack or flare-up of your disease.

Medications

Corticosteroids (also known as steroids)

For flare-ups or relapses, steroids such as prednisolone are commonly 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 are often prescribed.

If steroids are given for a long time, side-effects can occur, such as rounding of the face (moon face), mood changes, thinning of the bones (osteoporosis), cataracts and diabetes.

If you have a severe attack of ulcerative colitis, you may be taken into hospital and be given intravenous steroids.

Aminosalicylates

This kind of medication includes sulfasalazine (brand names Salazopyrin, Pyralin), mesalazine (brand names Mesasal, Salofalk, Pentasa), olsalazine (Dipentum) and balsalazide (Colazide). These medications 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 such as aminosalicylates often have fewer relapses (flare-ups) than other people. Although these medicines are mainly used as maintenance treatment they can help to control symptoms during an acute attack of the disease. Often your doctor will suggest you increase the dose during a flare-up.

Immunosuppressants

Immunosuppressants are medications that suppress the activity of the body’s immune system. They may be prescribed if your disease is not responding to steroids, or requires continuous steroids to control symptoms.

Immunosuppressant medicines used to treat ulcerative colitis include azathioprine (for example, Imuran), mercaptopurine (Puri-Nethol), and methotrexate. Infliximab (brand name Remicade) is another medicine that may be used if other immunosuppressants are poorly tolerated or ineffective.

Other medications

Medications for diarrhoea and pain are also often prescribed.

Surgery

If maintenance medications 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.

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.

How can I help myself?

Although doctors say there is no evidence ulcerative colitis is caused by food allergies, 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. If so, you should avoid these. However, you should not restrict your intake of dietary fibre as a matter of course. Sometimes, though, people find that it helps their symptoms during a flare-up if they restrict their fibre intake.

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 usually at the price of an ileostomy.


 
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