Ulcerative colitis (UC) is a lifelong condition. Once it appears, patients may experience symptoms of varying intensity for the rest of their lives, usually in alternating periods of activity and remission.

UC treatment attempts to reduce or eliminate the inflammation caused by the disease, as well as its symptoms (e.g., diarrhea, abdominal pain). Long-term treatment with medication is often recommended. Surgery may be required when medication is ineffective, complications of the condition arise or to treat cancerous or precancerous changes in the large intestine. Less than half of all patients with UC will require surgery at some point during the course of the condition. Removal of the large intestine is the only cure for UC.

Medication is usually the first line of treatment for patients with UC. Patients planning to become pregnant should consult their physician since some of the drugs used to treat UC may cause birth defects. In addition, patients and their physicians will want to weigh the risks and benefits of the different types of drugs. Not all medications will work for all patients.

Medications used to reduce the inflammation caused by UC include:

• Aminosalicylates. Reduce inflammation in the lining of the digestive tract. The active component of these drugs is a compound called 5-aminosalicylic acid (5-ASA) – the most common treatment choice for inflammatory bowel disease (IBD). Aminosalicylates can be taken orally or rectally (in enema or suppository form). Side effects may include nausea, vomiting, heartburn, diarrhea and headaches. This type of drug is used for patients with mild to moderate UC.
  
  
• Corticosteroids. Used to control inflammation when 5-ASA drugs are not effective. Corticosteroids can be taken orally, rectally or intravenously. Long-term use of corticosteroids can increase a patient’s risk of serious side effects, including high blood pressure, osteoporosis and diabetes. Fluid retention and a rounded/swollen appearance of the face may also occur. The risk of side effects varies depending on the type of corticosteroid used. Corticosteroids are used for patients with moderate to severe UC.
  
  
• Immunosuppressants. Suppress the body’s ability to create the disease-fighting substances (antibodies) that are attacking the normal tissue lining in patients with UC, causing inflammation. This decreases immune system activity in patients with UC. Usually taken orally, these drugs may not have an impact for weeks or months. Possible side-effects include nausea, vomiting, diarrhea and an increased risk of infections. These medications are used to treat active, severe cases of UC.

Various medications can also be used to treat the symptoms or complications of UC. These medications include:

• Antidiarrheals. Used to relieve chronic diarrhea that is one of the most common symptoms of UC.
  
  
• Laxatives. Used in cases where intestinal swelling causes narrowed passageways and leads to constipation.
  
  
• Acetaminophen. Used to relieve pain. Nonsteroidal anti-inflammatory drugs (NSAIDs) such as aspirin and ibuprofen should not be used by patients with UC as they may intensify symptoms.
  
  
• Iron supplements. Used to restore iron loss and treat anemia, which can result from chronic intestinal bleeding.
  

Blood transfusions may be necessary when there is severe blood loss due to inflammation and ulceration of the intestinal lining.

When medications do not adequately treat the symptoms or complications of UC, surgery may be required. A proctocolectomy (removal of the entire colon and rectum) will cure the condition, as well as remove any risk of colon cancer.  

Between 25 and 40 percent of patients with UC will require surgery, according to the National Institutes of Health (NIH). Surgery may be required in cases of massive bleeding, severe illness, colon rupture or to treat cancerous or precancerous changes in the large intestine.  

Surgery to remove most of the large intestine will change the way waste is eliminated from the body. During normal digestion, waste moves from the bottom of the small intestine (ileum) into the large intestine. Fluid and salt are absorbed from stool during its transit through the large intestine’s cecum, colon and rectum. The remaining waste is expelled from the body through the anus. 

During surgery to remove the colon and rectum, the ileum may be reconstructed and/or reconnected to the abdomen or anal area. This allows waste to be expelled from the body in three different ways. Patients undergoing a proctocolectomy will also need at least one of the following procedures performed:

• Ileostomy. When the ileum is connected to an opening in the abdominal wall (stoma), which allows waste to drain into an ileostomy bag worn at the waist.
  
  
• Continent ileostomy. Involves the creation of an internal pouch at the end of the ileum, where waste may be stored. A stoma is also created during this procedure.
  
  
• Ileoanal anastomosis (also known as a “pull-through” operation). When the ileum is reconnected directly to the anal region. A pouch is created at the base of the ileum, allowing waste to be stored there before being expelled normally through the anus. Pouchitis may occur after this procedure.

After a proctocolectomy, stool may be watery and patients may need to expel waste more frequently, since the large intestine is no longer there to absorb water from stool. There is the risk of intestinal obstruction (due to scar tissue buildup) after this surgery, which may require hospitalization or additional corrective surgery. Research also indicates that women who receive a proctocolectomy have an increased risk of infertility.

Hospitalization may be necessary to treat patients with UC when they are malnourished or have experienced severe diarrhea or blood loss. A special diet may be recommended, or intravenous feeding (parenteral nutrition) may be required.