Ulcerative colitis is a type of inflammatory bowel disease that causes ulcers (sores) and chronic inflammation in the gastrointestinal tract. Ulcerative colitis usually affects the innermost lining of the large intestine, or the colon, and also the rectum. Symptoms of Ulcerative colitis tend to develop gradually over a period of time, instead of sudden onset. When you have Ulcerative colitis, you will experience periods when you remain symptom-free, known as remissions. Then you will have periods when you experience the symptoms of the disease, periods known as flare-ups. There is no cure for Ulcerative Colitis, but the right treatment can help you manage these flare-ups and also reduce their occurrence. However, what do you do when your treatment stops working? Here we take a look at some steps to take when ulcerative colitis treatment stops working.
Effective Treatment for Ulcerative Colitis
It is first of all necessary to understand what effective treatment looks like for Ulcerative Colitis. Overall, your doctors consider your Ulcerative Colitis treatment to be successful if you are able to form stools without urgency, cramping, or bleeding.
There are two parts to an effective treatment for Ulcerative Colitis. The first is controlling the symptoms, and the second part is to maintain that control over the symptoms. Both of these factors are very important to determine whether or not the treatment is effective and successful. If you are experiencing lesser flare-ups and are able to live a better quality of life than what you were living before you began the treatment, then these are some of the biggest signs that your treatment is working.
The effective management of your condition requires you to be aware of all the treatment options there are for Ulcerative Colitis. Medication for Ulcerative Colitis can come in various forms – from enemas,(1) suppositories, to pills and shots, to even intravenous infusion(2) or a combination of these.
However, sometimes, a treatment just does not work for you, or it may stop working. If the medications are not helping in managing your flare-ups, then here is what you can do to start feeling better again.
Steps to Take When The Ulcerative Colitis Treatment Stops Working
Step 1: Learn About All The Other Treatment Options
The first step to do when the doctor comes to the conclusion that your current Ulcerative Colitis treatment is not working is to learn about all the other treatment options available.
Ulcerative Colitis medications work to reduce inflammation and also allow your colon to heal. Knowing which drugs are available and which ones will work best for your condition will help you make an informed decision about the next stage of treatment with your doctor.
Generally, there are five broad classes of medications that are used to treat Ulcerative Colitis. These are:
Corticosteroids like methylprednisolone and prednisone, which work by suppressing your immune system. Steroid medications are available as a foam, pill, or suppository. The oral form of these steroid drugs are said to be more powerful, but it also causes more side effects than the topical types of corticosteroids. Corticosteroids are used for treating flare-ups, but they should not be used for a long time due to the side effects. Some of the side effects of corticosteroids include weakened bones and weight gain.(3)
Aminosalicylates (5-ASA) such as mesalamine and sulfasalazine, works by reducing the inflammation of the large intestine.(4)
Biologic therapies are drugs that are made from living organisms and disrupt the specific substances in the body that are the cause of inflammation.(5) Biologic drugs can be administered through an IV or an injection that you have to give yourself. Biologic drugs are generally good options for those who have a moderate to severe disease that has not improved with any other treatments.
Immunomodulators work by suppressing the immune response that causes inflammation of the colon. Even though they take several months to work, immunomodulators help maintain remission.(6)
Monoclonal antibiotics for treating fistulas and infections.(7) These drugs are ideal for those with moderate to severe Ulcerative Colitis, and if you have not experienced any improvement with steroid drugs, immunosuppressants, biologics, or aminosalicylates. If monoclonal antibiotics are something you think may help your condition, then you should discuss it with your doctor.
Step 2: Follow your Treatment Protocol
Treating Ulcerative Colitis is not a short-term protocol. You have to be committed to it for the long term as there is no cure for Ulcerative Colitis, and your treatment will help you keep the symptoms of the disease under control. So even if you are not feeling well, stopping your medication or skipping doses is only going to cause your symptoms to return.
When you get a new prescription from your doctor, make sure that you clearly understand how and when you have to take your medication. Ask your doctor what you should do if a dose is missed accidentally.
If you experience any side effects from the new medications or the ones you are on, make sure to make an appointment with your doctor to switch to a new medicine or treatment regimen at the earliest. Do not stop taking the medication on your own without consulting your doctor.
Step 3: Closely Monitor Your Symptoms
A sudden return of your symptoms such as diarrhea, abdominal pain, or bloody stools are likely to be a sign that you are experiencing a flare-up, and your treatment may need to be adjusted. However, sometimes, the symptoms of a flare-up may be subtler and not immediately apparent.
This is why it is essential to keep track of even the smallest change you feel. Let your doctor know if you experience any of the following:
- If you notice blood in your stool
- If you are having more bowel movements than usual
- If you see a change in the amount or texture of your bowel movements
- If you feel tired or seem to have less energy than usual
- If you are losing weight or if you notice a loss in appetite
- If you notice any other symptoms such as mouth sores or joint pain
It is a good idea to maintain a symptom diary to help keep track of your day to day condition. This will also help you explain your symptoms in detail to your doctor.
Step 4: Adding Another Drug May Help
In some cases, only one medication may not be enough to help with severe Ulcerative Colitis symptoms. Your doctor is likely to prescribe a second drug to help you manage and control your disease better. For example, your doctor may prescribe an immunosuppressant and a biologic medication together.
Taking more than one medication for Ulcerative Colitis is known to increase the chances of treatment success but at the same time, it also increases the chances of experiencing more side effects. Your doctor will make you aware of how to deal with the side effects of the medications you are taking.
Step 5: Know When You Need To Switch
When you start experiencing more frequent flare-ups, it is an indication that it might be time to switch to a new medication. You should discuss the same with your doctor so that your doctor can think about changing your treatment regime. It might involve changing you to a different version of the same drug, for example, changing from an aminosalicylate enema to a pill form.
If your symptoms start to get worse, then your doctor may also switch you to a stronger medication. Your doctor is likely to prescribe a biologic drug or an immunosuppressant or even corticosteroids for a short time.
Step 6: Make Some Dietary Changes
Keep in mind that medication is not the only way of controlling your symptoms. Many times, modifying your diet may also help because there are many foods and drinks that are known to aggravate your Ulcerative Colitis symptoms. You should avoid or restrict the intake of these foods if you know that they aggravate your symptoms. Some of these foods and beverages that worsen Ulcerative Colitis symptoms include:
- Coffee, sodas, tea, and other caffeinated drinks
- Milk and other dairy products
- Fried foods
- Fruit and fruit juices
- High-fat foods
- Beans and other legumes
- High-fiber foods such as whole-grain bread
- Cruciferous vegetables such as broccoli and cabbage
- Red meats in general
- Artificial sweeteners and colors
At the same time, here are some foods that are known to help in Ulcerative Colitis:
- White bread without seeds
- White rice
- White pasta, noodles, and macaroni
- Crackers and cereals made from refined white flour
- Canned or cooked fruits
- Pureed vegetable soups
- Cooked vegetables without seeds or skins
- Tender, soft meats, and fish
- Peanut butter or other nut butter
- Oils like coconut oil and olive oil
Remember that your diet has a vital role to play in your overall health and can also help you recover from acute Ulcerative Colitis symptoms such as diarrhea, abdominal pain, etc. Maintaining a food diary will help you pinpoint exactly which foods and drinks worsen your symptoms.
Step 7: Do Not Take Surgery Off The Table
Most people get scared at the thought of having to undergo any type of surgery. While most people with Ulcerative Colitis are able to manage their condition with medications only, but there are some who may require surgery as the medicines are not helping them get better or they have other complications.(8)
While it is natural to feel hesitant about surgery, but the advantage of having surgery in Ulcerative Colitis and getting the colon and rectum removed is that you will be ‘cured’ and free from most of your symptoms. However, since Ulcerative Colitis is an autoimmune disease and it affects your immune system, signs of the disease that extends beyond the digestive system, such as skin conditions and joint pain, may recur even after surgery.
It is best to discuss your concerns regarding surgery with your doctor.
The treatment of Ulcerative Colitis comes with a certain level of trial and error until you find which treatment works the best for you. Symptoms of Ulcerative Colitis tend to come and go, and the disease is more severe in some people rather than in others. This is why the treatment regime for every Ulcerative Colitis patient varies according to their own condition and symptoms.
It is essential to schedule regular appointments with your doctor in order to stay on top of your disease. Also, keep a close watch on your symptoms and note what triggers them. Remember that the more you know about your disease, the closer you will be able to follow your treatment plan, and the higher are the chances of controlling the disease.
- Sutherland, L.R., Martin, F., Greer, S., Robinson, M., Greenberger, N., Saibil, F., Martin, T., Sparr, J., Prokipchuk, E.D. and Borgen, L., 1987. 5-Aminosalicylic acid enema in the treatment of distal ulcerative colitis, proctosigmoiditis, and proctitis. Gastroenterology, 92(6), pp.1894-1898.
- Järnerot, G., Rolny, P. and Sandberg-Gertzen, H., 1985. Intensive intravenous treatment of ulcerative colitis. Gastroenterology, 89(5), pp.1005-1013.
- Turner, D., Walsh, C.M., Steinhart, A.H. and Griffiths, A.M., 2007. Response to corticosteroids in severe ulcerative colitis: a systematic review of the literature and a meta-regression. Clinical Gastroenterology and Hepatology, 5(1), pp.103-110.
- Ford, A.C., Achkar, J.P., Khan, K.J., Kane, S.V., Talley, N.J., Marshall, J.K. and Moayyedi, P., 2011. Efficacy of 5-aminosalicylates in ulcerative colitis: systematic review and meta-analysis. The American journal of gastroenterology, 106(4), p.601.
- Lim, W.C. and Hanauer, S.B., 2004. Emerging biologic therapies in inflammatory bowel disease. Reviews in gastroenterological disorders, 4(2), pp.66-85.
- Nguyen, G.C., Harris, M.L. and Dassopoulos, T., 2006. Insights in immunomodulatory therapies for ulcerative colitis and Crohn’s disease. Current gastroenterology reports, 8(6), pp.499-505.
- Rahimi, R., Nikfar, S., Rezaie, A. and Abdollahi, M., 2007. A meta-analysis of antibiotic therapy for active ulcerative colitis. Digestive diseases and sciences, 52(11), pp.2920-2925.
- Crohnscolitisfoundation.org. (2019). [online] Available at: https://www.crohnscolitisfoundation.org/sites/default/files/legacy/assets/pdfs/living-with-ulcerative.pdf [Accessed 23 Nov. 2019].
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