How is ulcerative colitis treated?

There’s no cure for ulcerative colitis, but treatments can calm the inflammation, help you feel better and get back to your daily activities. Usually, healthcare providers manage the disease with medications. If your tests reveal infections that are causing problems, your healthcare provider will treat those underlying conditions and see if that helps.

Surgery is an option if medications aren’t working or you have complications, such as bleeding or abnormal growths. You might develop precancerous lesions, or growths that can turn into colorectal cancer. A doctor can remove these lesions with surgery or during a colonoscopy.

Medications

Healthcare providers use several types of medications to calm inflammation in your large intestine. Reducing the swelling and irritation lets the tissue heal. It can also relieve your symptoms so you have less pain and less diarrhea. Your provider may recommend:

  • Aminosalicylates: For mild to moderate ulcerative colitis, your healthcare provider may prescribe sulfasalazine (Azulfidine®). Let your provider know if you’re allergic to sulfa. He or she can prescribe a sulfa-free aminosalicylate instead, such as mesalamine (Canasa®, Delzicol®, Asacol® HD, Pentasa®, Lialda®, Apriso®). The medications come in both pill form and enema or suppository form, which can better reach the inflammation low down in the colon or rectum.
  • Corticosteroids: If you have a severe form of ulcerative colitis, you may need a corticosteroid such as prednisone (Deltasone®) or budesonide (Entocort® EC, Uceris®). Because corticosteroids have serious side effects, healthcare providers only recommend them for short-term use. Other medications will be used to help maintain the remission.
  • Immunomodulators: Your healthcare provider may recommend an immunomodulator. These medicines include 6-mercaptopurine (Purixan®, Purinethol®), azathioprine (Azasan® and Imuran®), or methotrexate (Trexall®). These medications help calm the overactive immune system.
  • Biologics: Biologics treat moderate to severe ulcerative colitis by targeting parts of the immune system to quiet it down. Medications like infliximab (Remicade®), adalimumab (Humira®), golimumab (Simponi®), certolizumab pegol (Cimzia ®), vedolizumab (Entyvio®), and ustekinumab (Stelara®) are biologics.
  • Janus kinase (JAK) inhibitors: Drugs like tofacitinib (Xeljanz®) stop one of your body’s enzymes (chemicals) from triggering inflammation.

Surgery

You might need surgery that removes your colon and rectum to:

  • Avoid medication side effects.
  • Stop uncontrollable symptoms.
  • Prevent or treat colon cancer (people with ulcerative colitis are at greater risk).
  • Eliminate life-threatening complications such as bleeding.

There are two kinds of surgery for ulcerative colitis:

Proctocolectomy and ileoanal pouch

The proctocolectomy and ileoanal pouch (also called J-pouch surgery) is the most common procedure for ulcerative colitis. This procedure typically requires more than one surgery, and there are several ways to do it. First, your surgeon does a proctocolectomy — a procedure that removes your colon and rectum. Then the surgeon forms an ileoanal pouch (a bag made from a part of the small intestine) to create a new rectum. While your body and newly made pouch is healing, your surgeon may perform a temporary ileostomy at the same time. This creates an opening (stoma) in your lower belly. Your small intestines attach to the stoma, which looks like a small piece of pink skin on your belly.

After you heal, waste from your small intestines comes out through the stoma and into an attached bag called an ostomy bag. The small bag lies flat on the outside of your body, below your beltline. You’ll need to wear the bag at all times to collect waste. You’ll have to change the bag frequently throughout the day.

Your medical team will teach you how to care for the stoma and empty the attached bag. You can also use a fabric cover for the pouch so that even when you’re undressed, the waste isn’t visible. With proper care, the pouch doesn’t smell and isn’t noticeable under clothes.

Once you and the ileoanal pouch have healed, your surgeon will discuss taking down the ileostomy.

Your new ileoanal pouch still collects stool. That allows waste to exit your body through your anus as it would normally. Afterward, because you have less space in your large intestine to store poop, you’ll have frequent bowel movements (on average 4 to 8 times a day once your body has adjusted). But you should feel a lot better when you recover from the surgery. The pain and cramping from ulcerative colitis should be gone.

Proctocolectomy and ileostomy

If an ileoanal pouch won’t work for you, your healthcare team might recommend a permanent ileostomy (without an ileoanal pouch). Your surgeon does a proctocolectomy to remove your colon and rectum. The second part of this surgery, done at the same time, is to perform a permanent ileostomy (as described above).

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