Treatment of Ulcerative Colitis: Medications, Surgery, Lifestyle Changes
How is Ulcerative Colitis Treated?
Ulcerative colitis is treated on the basis of the severity and occurrence of symptoms and based on these are mainly two types of treatments:
- The first line of treatment for ulcerative colitis is inducing remission which involves relieving symptoms. Remission is nothing but a time period where there are no symptoms of ulcerative colitis.
- The second line of treatment for ulcerative colitis involves maintaining remission.
The treatment is mostly based on medication and surgery may be recommended in rare cases of ulcerative colitis. Healthcare professionals that carry out the treatment for ulcerative colitis include:
- Doctors who are specialist like surgeons or gastroenterologists.
- Specialist nurses.
- General physicians.
Nurses or other specialist care personals take care of things during the treatment you can seek any advice or help when needed. Some of the treatment procedures of ulcerative colitis are mentioned below along with the relative pros and cons.
Medications for Treating Ulcerative Colitis
Aminosalicylates for Treating Ulcerative Colitis
Usually the medications like mesalazine, sulphasalazine etc… belonging to the group of aminosalicylates (5-ASAs) are very effective in treating inflammation. It is generally used in the initial cases of ulcerative colitis when it is mild. 5-ASAs can also be used temporarily to suppress the symptoms. However it can continue for a long run to restrict further development. Aminosalicylates or 5-ASAs for treating ulcerative colitis can be taken in various forms like:
- In the form of tablets or capsules.
- The capsule can be taken as suppository which involves direct insertion into rectum.
- As enema in which involves injecting fluid into the large intestine.
The use of aminosalicylates or 5-ASAs largely depends on the severity of condition. There are very few cases of side effects, which includes one or more of the following:
Corticosteroid Medicines for Treating Ulcerative Colitis
Corticosteroids can be used as an alternative medication to 5-ASAs (aminosalicylates) for ulcerative colitis and works more effectively against inflammation especially when it is not effective. Steroids can be taken in various forms like orally, enema, suppository etc.
However corticosteroids are known to have more side effects and thus not recommended as long term treatment option for managing ulcerative colitis. Some of the common side effects in case of long usage includes cataracts, osteoporosis.
Some of the side effects associated with short term use of corticosteroids for ulcerative colitis are as follows:
- Increase in body weight.
- Increase in appetite.
- Sudden mood swings (such as feeling of irritation.)
- Insomnia (difficulty in getting sleep or remaining asleep.)
Immuno Suppressant Medicines for Treating Ulcerative Colitis
Tacrolimus, azathioprine etc… are the common immune suppressants for treating ulcerative colitis that are used as medications for suppressing immune system temporarily.
However they can be used only for treatment of mild cases or to suppress symptoms if other medications are not effective. It is an effective mode of treatment for ulcerative colitis but takes some time to start acting. It can take up to three months to start working.
The medication is often associated with infections thus it is necessary to pay attention and inform your general physician about the occurrence of any infection immediately.
It can also cause anemia reducing the RBC (red blood cell) count in the blood. Thus it is necessary to go for regular blood test or any other issues.
Other medications which may help in relieving signs and symptoms of ulcerative colitis include:
- Antibiotics for ulcerative colitis: Patients suffering from ulcerative colitis and who have fever are given antibiotics for preventing or controlling infection.
- Anti-diarrheals for ulcerative colitis: Patients with severe diarrhea are given loperamide (Imodium); however, anti-diarrheals should be used with great caution, as they increase the risk of toxic megacolon.
- Pain relievers for ulcerative colitis: Patients having mild pain may benefit from acetaminophen (Tylenol); however, NSAIDs like ibuprofen (Advil, Motrin etc.), naproxen (Aleve) or aspirin should be avoided as they may make symptoms worse.
- Iron supplements for ulcerative colitis: These are given for chronic intestinal bleeding, as patients can develop iron deficiency anemia. Iron supplements help in restoring iron levels to normal and help in reducing or preventing this type of anemia.
How to Treat Severe Flare-Ups Caused by Ulcerative Colitis?
The severe cases such as flare-ups of ulcerative colitis cannot be managed at home and need special attention in a medical facility like hospital as it can easily lead to dehydration or any other serious complications like rupturing of colon.
In hospital, an immunosuppressant or corticosteroid medication like infliximab or ciclosporin can be injected directly into the veins along with other necessary fluids to manage the flare-ups caused by ulcerative colitis.
Ciclosporin Medicines for Treating Ulcerative Colitis
Ciclosporin also has a very similar mechanism of working which involves suppressing the working of immune system. However, it is more effective than most of the other medications and starts working very quickly in just a matter of days.
Ciclosporin is injected directly into the veins along with the drip and the treatment is continued for about a week. Some of the common side effects of ciclosporin in treating the flare-ups caused by ulcerative colitis include:
- A tremor (an unregulated trembling or shaking of some parts of the body)
- Increased growth of hair
- Feeling of tiredness
- Swelling in gums
In some rare cases it can also lead to serious side effects like affecting proper functioning of liver and kidney, increased blood pressure etc. and thus doctors keep an eye on signs and symptoms of such disorders.
Biologic Medications for Treating Ulcerative Colitis Flare-ups
There is group of medicines like golimumab, vedolizumab, adalimumab, Infliximab etc… which can help in reducing inflammation by blocking the receptors of proteins which causes inflammation leading to ulcerative colitis flare-ups.
These medicines are generally recommended only for adults. However Infliximab can be used for children belonging to age group of 6 to 17 years, only if other medicines fail to respond. The treatment can be continued for about a year safely if it shows good results. The following guidelines must always paid attention to:
- Golimumab, adalimumab and infliximab for treatment of ulcerative colitis is used especially when conventional therapy does not work.
- Treatment using vedolizumab for more serious cases of ulcerative colitis.
Infliximab Medication for Treating Ulcerative Colitis Flare-ups
Infliximab medication for reducing ulcerative colitis flare-ups is injecting into the body starting with a prescribed dose one every hour or two. Later the infusion is continued after a period of two and six and eight weeks. The next dose is given after every eight weeks if there is a need.
Infliximab medicine for ulcerative colitis has the following side effects:
- Higher chances of infection, the infections like fever, coughs, sore throat are common and must be immediately brought in notice of the general physican.
- Vertigo which is a weird condition where you feel everything around you is moving. Feeling of dizziness.
- Difficulty in breathing, headache, reactions, allergies etc…
Usually the reactions can be felt just after a couple of hours from infusion but in other cases, it may take longer up to weeks. It is strongly recommended to report any symptoms immediately to your doctor. If there are any signs of infections, anti allergic medications like epinephrine can be used.
Infliximab must be used carefully as it is not suitable for every individual especially against an individual who have had tuberculosis (TB) or hepatitis B in the past. Also in case of patients with medical history of hepatitis C or HIV, it must be used cautiously as there is a high risk of reactions being reactivated. People with multiple sclerosis and heart diseases cannot be treated with infliximab.
Surgery for Treating Ulcerative Colitis
Surgery may be the only option for treating ulcerative colitis if the symptoms fail to respond to medication and start disrupting your daily life severely. During the surgery for ulcerative colitis, the colon is permanently removed and the procedure is known as colectomy. Thus in the absence of large intestine, small intestine is used for passing waste out of the body in one of the following ways:
- An ileostomy surgery for treating ulcerative colitis: In this case, a hole is created in the abdomen, which is internally connected to the end of small intestine. The waste materials can be passed out through this hole and collected by attaching a bag.
- An ileo-anal pouch (also known as a J-pouch) surgery for treating ulcerative colitis: In this case, a small segment of the small intestine is modified into a pouch internally, which is further connected to the anus enabling the passage to stool in a normal way.
Ileo-anal pouches are more popular because of the ease and no requirement of external bag. The removal of colon is the permanent treatment but the aftereffects and risk factors of the surgery must be considered carefully.
Lifestyle Changes for Ulcerative Colitis
- Restricting the dairy products is a good lifestyle change for ulcerative colitis.
- Increasing your fiber intake is a good lifestyle change for ulcerative colitis. Include high-fiber foods, such as vegetables and whole grains and fresh fruits. However, patients suffering from IBD or inflammatory bowel disease will have worsening of diarrhea, pain and gas with raw fruits and vegetables; so, they should steam, bake or stew them.
- Avoid those foods which make your symptoms worse such as "gassy" foods like beans, broccoli and cabbage, raw fruit juices, popcorn, caffeine and carbonated beverages.
- Eating small and frequent meals is an excellent lifestyle change for ulcerative colitis.
- Increasing your fluid/ liquid intake is another wonderful lifestyle change for ulcerative colitis. Avoid beverages which contain caffeine as they can worsen your diarrhea and also carbonated drinks, as they produce gas.
- Multivitamins should be taken as ulcerative colitis may interfere with absorption of nutrients.
- A dietitian should be consulted if you are losing weight or if your diet has become very restricted.
- Stress should be avoided as it can aggravate your signs and symptoms and may trigger ulcerative colitis flare-ups.
- Exercising daily is a finest lifestyle change for ulcerative colitis. Biofeedback is a stress-reduction technique which helps in reducing muscle tension and slowing the heart rate.
- Relaxation and breathing exercises should be done regularly.
- Hypnosis may help in reducing abdominal pain and bloating.
- Indulge in other relaxation techniques or hobbies such as reading, listening to music, painting, talking to friends, playing games or taking a nice, long warm bath.