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 usually involves taking various types of medicine, 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
- specialist nurses
Your care will often be co-ordinated by your specialist nurse and your care team, and they'll usually be your main point of contact if you need help and advice.
Aminosalicylates, also known as 5-ASAs, are medicines that help to reduce inflammation. This in turn allows damaged tissue to heal.
They're usually the first treatment option for mild or moderate ulcerative colitis.
5-ASAs can be used as a short-term treatment for flare-ups. They can also be taken long term, usually for the rest of your life, to maintain remission.
5-ASAs can be taken:
- orally – by swallowing a tablet or capsule
- as a suppository – a capsule that you insert into your bottom (rectum), where it dissolves
- through an enema – where fluid is pumped into your large intestine
How you take 5-ASAs depends on the severity and extent of your condition.
If you have mild-to-moderate ulcerative colitis, you'll usually be offered a 5-ASA to take in suppository or enema form.
If your symptoms do not improve after 4 weeks, you may be advised to take 5-ASA in tablet or capsule form as well.
These medicines rarely have side effects, but some people may experience:
They can be used with or instead of 5-ASAs to treat a flare-up if 5-ASAs alone are not effective.
Like 5-ASAs, steroids can be administered orally, or through a suppository or enema.
But unlike 5-ASAs, corticosteroids are not used as a long-term treatment to maintain remission because they can cause potentially serious side effects, such as weakening of the bones (osteoporosis) and cloudy patches in the lens of the eye (cataracts), when used for a long time.
Side effects of short-term steroid use can include:
- weight gain
- increased appetite
- mood changes, such as becoming more irritable
- difficulty sleeping (insomnia)
Immunosuppressants, such as tacrolimus and azathioprine, are medicines that reduce the activity of the immune system.
They're usually given as tablets to treat mild or moderate flare-ups, or maintain remission if your symptoms have not responded to other medicines.
Immunosuppressants can be very effective in treating ulcerative colitis, but they may take a while to start working.
The medicines can make you more vulnerable to infection, so it's important to report any signs of infection, such as a high temperature or sickness, promptly to a GP.
They can also lower the production of red blood cells, making you prone to anaemia.
You'll need regular blood tests to monitor your blood cell levels and 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 dehydration and potentially fatal complications, such as your colon rupturing.
In hospital, you'll be given medicine and sometimes fluids directly into a vein (intravenously).
The medicines you have may be a type of corticosteroid or an immunosuppressant medicine called infliximab or ciclosporin.
Ciclosporin is given slowly through a drip in your arm (an infusion) and treatment will usually be continuous, for around 7 days.
Side effects of intravenous ciclosporin can include:
- an uncontrollable shaking or trembling of part of the body (a tremor)
- excessive hair growth
- extreme tiredness (fatigue)
- swollen gums
- feeling and being sick
Ciclosporin can also cause high blood pressure and reduced kidney and liver function, but you'll be monitored regularly during treatment to check for signs of these.
Biologic medicines are medicines that reduce inflammation of the intestine by targeting proteins the immune system uses to stimulate inflammation.
These medicines block these receptors and reduce inflammation.
They may be used to treat moderate to severe ulcerative colitis if other options are not suitable or not working.
Biologic medicines are given in hospital as an infusion through a drip in your arm every 4 to 12 weeks, or as an injection every 1 to 4 weeks.
Your treatment team will then see how you respond to treatment. If your symptoms are under control (remission) for a year or more, they may recommend treatment is stopped.
Biologic medicines affect your immune system and can increase your risk of getting infections. Talk to a GP if you have any symptoms of a possible infection, such as coughs, a high temperature or a sore throat.
There are now new types of medicines called JAK inhibitors, such as tofacitinib and filgotinib, that can be used to treat ulcerative colitis.
These work by blocking enzymes (proteins) that the immune system uses to trigger inflammation.
JAK inhibitors can be taken as tablets.
JAK inhibitors may be recommended for people with moderate to severe ulcerative colitis if standard treatments or biologics have not worked, or are not suitable.
JAK inhibitors are not recommended for use in pregnancy. Women should use reliable contraception when taking them, for at least 4 weeks after finishing the course.
A medicine called ozanimod may be recommended for people with moderate to severe ulcerative colitis if standard treatments or biologic medicines have not worked or are not suitable.
It comes as tablets that you take once a day. You'll usually take it long term. You'll have regular checks with your treatment team to see if it's working well for you.
Ozanimod affects your immune system and can increase your risk of getting infections. Talk to a GP if you have any symptoms of a possible infection, such as coughs, a high temperature or a sore throat.
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's not responding to medicines, surgery may be an option.
Surgery for ulcerative colitis involves permanently removing the colon (a colectomy).
Once your colon is removed, 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 tummy; special bags are placed over this opening to collect waste materials after the operation
- an ileoanal pouch (also known as a J-pouch) – where part of the small intestine is used to create an internal pouch that's then connected to your anus, allowing you to poo normally
As the colon is removed, ulcerative colitis cannot come back again after surgery.
But it's important to consider the risks of surgery and the impact of having a permanent ileostomy or ileoanal pouch.
Your healthcare team will discuss the best option with you.
Help and support
Living with a condition like 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.
Page last reviewed: 1 November 2022
Next review due: 1 November 2025