Treatment for UC depends on the severity of the disease and its symptoms. Each person experiences UC differently, so treatment is adjusted for each individual.
Medication Therapy
While no medication cures UC, many can reduce symptoms. The goals of medication therapy are to induce and maintain remission—periods when the symptoms go away for months or even years—and to improve quality of life. Many people with UC require medication therapy indefinitely, unless they have their colon and rectum surgically removed.
- Aminosalicylates, medications that contain 5-aminosalicyclic acid (5-ASA), help control inflammation. Depending on which parts of the colon and rectum are affected by UC, 5-ASAs can be given orally; through a rectal suppository, a small plug of medication inserted in the rectum; or through an enema—liquid medication put into the rectum. Unless the UC symptoms are severe, people are usually first treated with aminosalicylates. These medications are also used when symptoms return after a period of remission.
- Corticosteroids, such as prednisone, methylprednisone, and hydrocortisone, also reduce inflammation. They are used for people with more severe symptoms and people who do not respond to 5-ASAs. Corticosteroids, also known as steroids, can be given orally, intravenously, or through an enema, a rectal foam, or a suppository, depending on which parts of the colon and rectum are affected by UC. Side effects include weight gain, acne, facial hair, hypertension, diabetes, mood swings, bone mass loss, and an increased risk of infection. Because of harsh side effects, steroids are not recommended for long-term use. Steroids are usually prescribed for short-term use and then stopped once inflammation is under control. The other UC medications are used for long-term symptom management.
- Immunomodulators, such as azathioprine, 6-mercaptopurine and cyclosporine suppress the immune system. These medications are prescribed for people who do not respond to 5-ASAs.
Immunomodulators are given orally, but they are slow-acting and can take 3 to 6 months to take effect. People taking these medications are monitored for complications including nausea, vomiting, fatigue, pancreatitis, hepatitis, a reduced WBC count, and an increased risk of infection. Cyclosporine is only used with severe UC, because one of its frequent side effects is toxicity, which means it can cause harmful effects to the body over time.
- Infliximab is an anti-tumor necrosis factor (anti-TNF) agent prescribed to treat people who do not respond to the other UC medications or who cannot take 5-ASAs. People taking Infliximab should also take immunomodulators to avoid allergic reactions. Infliximab targets a protein called TNF that causes inflammation in the intestinal tract. The medication is given through intravenous infusion—through a vein—every 6 to 8 weeks at a hospital or outpatient center. Side effects may include toxicity and increased risk of infections, particularly tuberculosis.
Other medications may be prescribed to decrease emotional stress or to relieve pain, reduce diarrhea, or stop infection.
Hospitalization
Sometimes UC symptoms are severe enough that a person must be hospitalized. For example, a person may have severe bleeding or diarrhea that causes dehydration. In such cases, health care providers will use intravenous fluids to treat diarrhea and loss of blood, fluids, and mineral salts. People with severe symptoms may need a special diet, tube feeding, medications, or surgery.
Surgery
About 10 to 40 percent of people with UC eventually need a proctocolectomy—surgery to remove the rectum and part or all of the colon.1 Surgery is sometimes recommended if medical treatment fails or if the side effects of corticosteroids or other medications threaten a person’s health. Other times surgery is performed because of massive bleeding, severe illness, colon rupture, or cancer risk. Surgery is performed at a hospital by a surgeon; anesthesia will be used. Most people need to remain in the hospital for 1 to 2 weeks, and full recovery can take 4 to 6 weeks.
A proctocolectomy is followed by one of the following operations:
- Ileoanal pouch anastomosis, also called “pouch surgery,” makes it possible for people with UC to have normal bowel movements, because it preserves part of the anus. For this operation, the surgeon preserves the outer muscles of the rectum during the proctocolectomy. The ileum—the lower end of the small intestine—is then pulled through the remaining rectum and joined to the anus, creating a pouch. Waste is stored in the pouch and passes through the anus in the usual manner. Bowel movements may be more frequent and watery than before the procedure. Inflammation of the pouch, called pouchitis, is a possible complication and can lead to symptoms such as increased diarrhea, rectal bleeding, and loss of bowel control. Pouch surgery is the first type of surgery considered for UC because it avoids a long-term ileostomy.
Ileoanal pouch Anastomosis
- Ileostomy is an operation that attaches the ileum to an opening made in the abdomen, called a stoma. The stoma is about the size of a quarter and is usually located in the lower right part of the abdomen near the beltline. An ostomy pouch is then attached to the stoma and worn outside the body to collect stool. The pouch needs to be emptied several times a day. An ileostomy performed for UC is usually permanent. A specially trained nurse will teach the person how to clean, care for, and change the ostomy pouch and how to protect the skin around the stoma.
The type of surgery recommended will be based on the severity of the disease and the person’s needs, expectations, and lifestyle. People faced with this decision should get as much information as possible by talking with their doctors; enterostomal therapists, nurses who work with colon surgery patients; other health care professionals; and people who have had colon surgery. Patient advocacy organizations can provide information about support groups and other resources.