I've had ulcerative colitis for seven months now, after being initially admitted to the hospital with heavy bleeding. I have been on the usual medication: daily enemas, suppositories and Sulfasalazine 500mg six times a day. I have improved a lot since treatment first began, but now seem to be just staying the same with no further improvement. Seven months seem a long time to get this condition under control. How long does it take, on average, for someone to get to the stage where he can begin to lead a normal life without worrying where the nearest lavatory is?

Anthony

Ulcerative colitis is a chronic, inflammatory condition involving the inner lining of the rectum and colon. It typically appears as bloody diarrhea, with abdominal pain, weight loss and fevers.

The first-line therapy for ulcerative colitis includes anti-inflammatory agents such as mesalamine (Sulfasalazine, Asacol) and steroids (Prednisone). The preparations used depend partly on what area of the colon is affected. If most of the colon is involved, then oral medications are used. If only the rectum and sigmoid colon are involved, sometimes only local therapy (suppositories and/or enemas) are used. In many cases, both local therapy and oral medications are used.

Generally, the mesalamine compounds are preferred because they are as effective as steroids in many cases, but produce fewer long-term side effects (although many patients have allergic reactions to Sulfasalazine). Steroids are effective in moderate to severe cases, but can have severe long-term side effects, such as osteoporosis and bone fractures.

After mesalamine is begun, patients will usually begin to improve quickly, often within days. However, a remission -- defined by a return to normal stools without blood or abdominal pain -- may take months. Steroids will speed the time to remission, but many gastroenterologists will not use them except in severe cases because it is hard to wean patients off of these drugs.

In your case, I wonder what you mean by "improved a lot," what your symptoms are now, and how they differ from when you were diagnosed. It may be that you need to add another anti-inflammatory medication to achieve a complete remission, especially if your ulcerative colitis is very extensive. Alternatively, you may be suffering from an infection (possibly bacterial) that is preventing further improvement. You should follow up with your gastroenterologist to discuss the possibilities. Another colonoscopy might be necessary to determine how active your ulcerative colitis really is.

It is also important to keep in mind that ulcerative colitis, unlike the similar Crohn's disease, is curable with surgery. A small subset of patients have severe ulcerative colitis that does not respond well to medications. Rather than taking more potentially toxic medications, these patients can be cured by surgical removal of the colon. In this operation, the small intestine is hooked up to the anus, enabling these patients to maintain a normal lifestyle.