Treatment options for ulcerative colitis  

Treatment
Pros
Cons

Medication

Aminosalicylates

A type of medication that can be taken as tablets, an enema or a suppository, to help reduce inflammation

  • Can help reduce inflammation in mild or moderate cases of ulcerative colitis
  • Can be taken as a short-term treatment for a flare-up, or for longer to prevent flare-ups (maintain remission)
  • May not be effective in more severe cases
  • Side effects can include diarrhoea, nausea, headache, abdominal (tummy) pain and rashes
  • Small risk of rare but serious blood disorders, such as neutropenia and agranulocytosis (deficiency of white blood cells)
Corticosteroids

More powerful medication to reduce inflammation, can be taken as tablets, an enema, a suppository or intravenously (directly into a vein)

  • Can quickly reduce inflammation in mild or moderate cases of ulcerative colitis where aminosalicylates alone are ineffective
  • Can be used to treat severe flare-ups in hospital
  • Side effects can include acne, increased appetite and mood swings
  • Not used for long-term treatment to prevent flare-ups because of potential harmful side effects, such as osteoporosis (weakening of the bones)
Immunosuppressants

Medication that works by reducing the immune system's activity. Can be taken as tablets or intravenously

  • Can help reduce inflammation in mild or moderate cases of ulcerative colitis where other medications have been ineffective
  • Can be taken as a short-term treatment for a flare-up, or for longer to prevent flare-ups (maintain remission)
  • Can be used to treat severe flare-ups in hospital
  • Tablets can take two to three months to start working
  • Side effects can include increased vulnerability to infection, a reduction in red blood cells (anaemia), nausea and vomiting
  • Regular blood tests are needed to check for side effects
Infliximab

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

  • Can be used to treat severe flare-ups in hospital
  • Should only be used if other medications are ineffective or unsuitable
  • Side effects can include increased vulnerability to infection, dizziness and an allergy-like reaction
  • Not suitable for people with a history of tuberculosis (TB), hepatitis B or heart disease

Surgery

Ileostomy

A procedure where the colon and rectum are removed and the small intestine is diverted out of a hole made in your abdomen (tummy), to allow the passage of stools into an external bag

  • Ulcerative colitis cannot recur after the operation, as the colon is removed 
  • Risks can include the opening in your abdomen becoming blocked and your bowel rupturing; "phantom rectum" (feeling like you need to go to the toilet, even though you do not have a working rectum); and irritation of the skin around the opening
  • Need to wear external bags to collect digestive waste for the rest of your life
Ileo-anal pouch

A procedure where the colon and rectum are removed and part of the small intestine is used to create an internal pouch. This is then connected to your anus, allowing you to pass stools in a normal way

  • Ulcerative colitis cannot recur after the operation, as the colon is removed
  • No need to wear an external bag to collect digestive waste
  • Waste materials can be expelled in a normal way
  • Usually need to have a temporary ileostomy beforehand to allow the pouch to heal
  • Risks can include inflammation of the internal pouch (pouchitis), accidental leaks and infertility (in women)
  • Can take a while to learn how to properly control the passing of stools