Ulcerative colitis - Treatment 

Treating ulcerative colitis 

Ulcerative colitis: Claire's story

Claire has ulcerative colitis, an inflammatory bowel disease. She talks about how she was diagnosed, the treatment options available and how she manages the condition.

Media last reviewed: 21/10/2013

Next review due: 21/10/2015

Help and support

Living with a condition such as ulcerative colitis, especially if your symptoms are severe, can be a frustrating and isolating experience. Talking to others with the condition can provide support and comfort.

A good place to find out what support is available is through Crohn's and Colitis UK.

Compare your options

Take a look at a simple guide to the pros and cons of different treatments for ulcerative colitis

Treatment for ulcerative colitis depends on how severe the condition is and how often your symptoms flare up.

The main aims of treatment are to:

  • reduce symptoms, known as inducing remission (a period without symptoms)
  • maintain remission

This will usually involve taking various types of medication, although surgery may sometimes be an option.

Your treatment will normally be provided by a range of healthcare professionals, including specialist doctors (such as gastroenterologists or surgeons), GPs and specialist nurses.

Your care will often be co-ordinated by your specialist nurse and your care team, and they will usually be your main point of contact if you need help and advice.

Aminosalicylates

Aminosalicylates (ASAs), such as sulphasalazine or mesalazine, are medications that help to reduce inflammation. They are usually the first treatment option for mild or moderate ulcerative colitis.

ASAs can be used as a short-term treatment to treat flare-ups. They can also be taken long term, usually for the rest of your life, to maintain remission.

ASAs can be taken:

  • orally  by swallowing a tablet or capsule
  • as a suppository  a capsule that you insert into your rectum (bottom), where it then dissolves
  • through an enema  where fluid is pumped into your large intestine

How you take ASAs will depend on the severity and extent of your condition.

The side effects of ASAs can include headaches, feeling sick, diarrhoeaabdominal (tummy) pain and a rash.

Corticosteroids

Corticosteroids, such as prednisolone, are a more powerful type of medication used to reduce inflammation. They can be used with or instead of ASAs to treat a flare-up if ASAs alone are not effective.

Like ASAs, steroids can be administered orally, or through a suppository or enema.

However, unlike ASAs, corticosteroids are not used as a long-term treatment to maintain remission because they can cause potentially serious side effects, such as osteoporosis (weakening of the bones) and cataracts (cloudy patches in the lens of the eye) when used for a long time.

Side effects of short-term steroid use can include acne, increased appetite, mood changes (such as becoming more irritable) and mood swings.

Read more about the side effects of corticosteroids.

Immunosuppressants

Immunosuppressants, such as tacrolimus and azathioprine, are medications that reduce the activity of the immune system. They are usually given as tablets to treat mild or moderate flare-ups, or maintain remission if your symptoms haven't responded to other medications.

Immunosuppressants can be very effective in treating ulcerative colitis, but they often take a while to start working (usually between two and three months).

The medicines can make you more vulnerable to infection, so it is important to report any signs of infection, such as fever or sickness, promptly to your GP.

They can also lower the production of red blood cells, making you prone to anaemia. You will need regular blood tests to monitor your blood cell levels and to check for any other problems.

Treating severe flare-ups

While mild or moderate flare-ups can usually be treated at home, more severe flare-ups should be managed in hospital to minimise the risk of dehydrationmalnutrition and potentially fatal complications, such as your colon rupturing.

In hospital, you will be given medication and fluids intravenously (directly into a vein). The medication you have will usually be a type of corticosteroid or an immunosuppressant medication called ciclosporin.

If ciclosporin is also unsuitable, you may be given a medication called infliximab.

Ciclosporin

Ciclosporin works in the same way as other immunosuppressant medications (see above) – by reducing the activity of the immune system. However, it is more powerful than the medications used to treat milder cases of ulcerative colitis and starts to work much sooner (normally within a few days).

Ciclosporin is given slowly through a drip in your arm (known as an infusion) and treatment will usually be continuous, for around seven days.

Side effects of intravenous ciclosporin can include:

  • a tremor (an uncontrollable shaking or trembling of part of the body)
  • excessive hair growth
  • fatigue (extreme tiredness)
  • swollen gums
  • feeling and being sick
  • diarrhoea

Ciclosporin can also cause more serious problems such as high blood pressure and reduced kidney and liver function, but you will be monitored regularly during treatment to check for signs of these.

Infliximab

Infliximab is a type of medication that works by targeting a protein called TNF-alpha, which the immune system uses to stimulate inflammation.

Infliximab is given as an infusion over the course of two hours. You will be given further infusions after two weeks, and again after six weeks. Infusions are then given every eight weeks, if treatment is still required.

Common side effects of infliximab can include:

  • increased risk of infection  report any symptoms of a possible infection, such as coughs, high temperature or sore throat, to your GP
  • vertigo (the sensation you or the environment around you is moving) and dizziness
  • an allergy-like reaction, causing breathing difficulties, urticaria (hives) and headaches

In most cases, a reaction to the medication occurs in the first two hours after the infusion has finished. However, some people experience delayed reactions days, or even weeks, after an infusion. If you begin to experience the symptoms listed above after having infliximab, seek immediate medical assistance.

You will be carefully monitored after your first infusion and, if necessary, powerful anti-allergy medication, such as epinephrine, may be used.

Infliximab is not usually suitable for people with a history of tuberculosis (TB) or hepatitis B, because there have been a number of cases where infliximab has "reactivated" dormant infections. The medication is also not recommended for people with a history of heart disease.

Surgery

If you have frequent flare-ups that have a significant effect on your quality of life, or you have a particularly severe flare-up that isn't responding to medication, surgery may be an option.

Surgery for ulcerative colitis involves permanently removing the colon (known as a colectomy).

During the operation, your small intestine will be used to pass waste products out of your body instead of your colon. This can be achieved by creating:

  • an ileostomy  where the small intestine is diverted out of a hole made in your abdomen. Special bags are placed over this opening, to collect waste materials after the operation
  • an ileo-anal pouch  where part of the small intestine is used to create an internal pouch that is then connected to your anus, allowing you to pass stools normally

Ileo-anal pouches are increasingly used because an external bag to collect waste products is not required.

As the colon is removed, ulcerative colitis cannot recur after surgery. However, it's important to consider the risks of surgery and the impact of having a permanent ileostomy or ileo-anal pouch.

Read more about ileostomies and ileo-anal pouches.



Page last reviewed: 20/03/2014

Next review due: 20/03/2016

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Comments

The 4 comments posted are personal views. Any information they give has not been checked and may not be accurate.

User764803 said on 15 April 2013

i have had UC since i was 11 i am now 20 i think that the NHS has helped me greatly in coping with my illness and i have got the best of care if i have a problem i call and then get me seen ASAP. i have been on meds which have helped control my symptoms i control it though diet and meds the NHS helped me find a diet that worked for me and this ment i have been able to live a mostly normal life

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julieparr said on 21 July 2012

I have had amazing NHS treatment, UC for over 20 years,unfortunately medical treatment stopped working after 15 years and I was unable to work so had surgery, which was best for me as i am now symptom free (heaven) everyone from gastro team/surgical team/stoma team have been fantastic.

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Anonymous said on 13 July 2012

I disagree with your comments regarding tretment with the NHS. I have UC and have done since I was 16, Im now 50. In my experience Ive been looked after very well and there is loads of help with the nacc, I also have great IBD nurses at my local hospital who I can call any time for advice. Ive also been taken care of by many very good consultants and profs over the years. I think you have been really unlucky with your care so far.

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User585853 said on 22 August 2011

Frankly I am amazed at this information, it really doesnt equate with my experience.
Nearly two years ago I presented to my GP with symptoms and since then they have constantly failed to diagnose me despite increasing severity of symptoms. I was only diagnosed once I was admitted as a surgical emergency due to rectal bleeding and increasing stomach pain.
After discharge I was bunged a prescription and told that side effects were rare. Since then I have had time off with work due to side effects and I am currently unable to take the meds...I was offered a second medication which still didnt work and left me sick with side effects.
Nothing has been offered to me since; neither have I been given any support or information about next line options.
If you think you have UC dont expect choice or quality service within the NHS, you will be sadly dissappointed and this overly simplistic information is unhelpful. Also the low residue diet is unhelpful as you can experience bouts of extreme constipation but in my experience the clinicians will tell you this doesnt fit with a diagnoses of UC. From speaking with others, don't believe them!

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