Ulcerative colitis (UC) is a chronic inflammatory condition of the lower gastrointestinal (GI) tract. It is associated with periods where symptoms worsen and an individual experiences diarrhea, bloating, discomfort, and pain. These periods are called flares.

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UC is a type of inflammatory bowel disease (IBD), which also includes Crohn’s disease.

Approximately 600,000–900,000 people in the United States have UC.

Like other IBD conditions, UC tends to fluctuate between periods of remission, with few or no symptoms, and periods of exacerbation, which health experts call flares. Symptoms include diarrhea, blood or pus in stool, and abdominal pain.

According to the Crohn’s & Colitis Foundation (CCF), 33% of individuals with UC experience chronic abdominal pain. For this reason, managing UC pain is often an important part of a person’s treatment plan.

This article discusses UC treatments and management strategies that can help a person alleviate flares and reduce pain.

Relief from UC pain can come from both lifestyle changes, that can help alleviate inflammatory pain, and medical interventions.

Medical treatment can include medications that help reduce the inflammatory process of UC, as well as medications that provide relief from pain.

Depending on the severity of a person’s pain and discomfort, a combination of some of these options may be necessary. A person should consult a doctor for the best course of treatment and pain relief options for them.

Individuals can try the following strategies to help reduce inflammation and pain:

When preventive strategies are insufficient, a person may need to take medication.

Some medications can help reduce pain by treating the inflammatory process of the condition. Other medications can provide pain relief, but they will not treat the underlying cause of the pain.

Medications targeting UC inflammation

The type and combination of medications a doctor recommends will vary from person to person. One treatment for UC is 5-aminosalicylic acid (5-ASA) medications, such as sulfasalazine and mesalamine. These medications contain 5-ASA, which helps reduce gut inflammation.

Additional drugs that treat the UC inflammatory process directly include:

  • corticosteroids
  • immunomodulating drugs
  • biologics

Pain relief medication

A person can also take pain relievers to reduce the discomfort they experience during flares.

These medications include the following:

  • Opioids: Opioids, such as oxycodone or Vicodin, can provide pain relief for UC symptoms. However, individuals should use opioids with caution, as taking these medications can lead to physical dependence and addiction.
  • Antidepressants: Certain antidepressants may improve gut discomfort by influencing the serotonin in a person’s body.
  • Nonsteroidal anti-inflammatory drugs (NSAIDs): NSAIDs, such as ibuprofen and naproxen, can provide pain relief, but they can also cause damage to the GI tract. For this reason, they may not be the most suitable choice for people with IBD.
  • Medical cannabis: This may help reduce pain. However, research on medical cannabis is still limited, and the legal status of medical cannabis varies by state.

Medications that reduce bowel spasms may also prove helpful.

Probiotics are live bacteria that can be useful to the human body. They may confer digestive benefits by balancing a person’s gut microbiome, which is the natural bacterial population in the human digestive tract.

A person can consume probiotics as a supplement or by eating probiotic foods.

There is some evidence that good bacteria can help improve digestion. Probiotics might cut pain resulting from UC flares. One 2023 paper concludes that probiotics are beneficial for inducing and maintaining UC remission.

There is some evidence of an improvement in mild to moderate UC symptoms after a fecal microbiota transplantation. While more research on this is necessary, the existing research supports the idea that IBD symptoms may have some association with gut bacteria.

A person with UC may want to avoid certain foods, as some foods may be triggering pain and discomfort.

Potential trigger foods include:

  • fiber that is difficult to digest, such as raw green or cruciferous vegetables, whole nuts and grains, and fruit with seeds and skin
  • dairy
  • sugary foods and foods that contain sugars that are hard to absorb, such as sorbitol or mannitol
  • high fat or greasy foods
  • alcohol
  • caffeine
  • spicy foods

To reduce painful flares, the CCF suggests that a person should stay hydrated and prepare their meals in advance.

Preplanning meals and using simple cooking techniques, such as grilling, steaming, boiling, or poaching, can also help a person stick to less triggering foods.

However, research has not been able to show conclusively that specific foods trigger symptoms of UC. More research is currently underway. If people choose to avoid specific food groups, they may be depriving themselves of adequate nutrition.

For this reason, the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK) recommends that people try to eat a balanced diet.

A person should also seek guidance from a doctor to determine the best diet for them. The doctor will help them establish whether they truly need to exclude a particular food from their diet.

Learn more about how to maintain a UC diet here.

Stress, anxiety, and depression may play a role in causing painful IBD symptoms.

Research shows that people with mood disorders and Crohn’s disease may be more susceptible to flares than individuals with mood disorders who have UC.

However, 15 studies involving more than 5,000 people with IBD — including UC — showed an association between mood disorders and abdominal pain.

Therefore, learning and using coping techniques for stress may help an individual reduce the likelihood of painful flares.

When other interventions do not help or when there are complications, a person may need surgery to get relief from pain and discomfort.

Reasons for surgery include:

  • severe bleeding
  • perforation of the bowel
  • severe inflammation of the colon
  • cancer
  • strictures

Surgical options include a colectomy or ileostomy.

In severe cases, a surgeon may need to remove the entire colon.

Learn more about surgical treatment for UC here.

The exact cause of UC pain varies between individuals and may change between flares. Figuring out the exact source of pain is one of the most important steps toward treating it.

A person with UC can experience the following types of pain:

  • abdominal pain from diarrhea or inflammation in the gut
  • pain from scar tissue in the GI tract that results from repeated periods of inflammation
  • pain from the digestion of food passing over inflamed tissue
  • visceral hypersensitivity, which is when bowel nerves become oversensitive
  • pain on the left side of the abdomen from left-sided colitis

Additionally, in some cases, a person with UC may experience nonabdominal pain, such as joint pain or painful skin rashes.

To diagnose UC, a doctor will begin with a thorough physical examination. They will also ask a person questions about their symptoms, overall health and lifestyle, diet, family medical history, and other factors that may help inform the diagnosis.

The next step typically involves getting a blood test and giving a stool sample for testing. These tests will help eliminate other causes of a person’s symptoms, such as a viral or bacterial illness. A blood test can also help indicate whether the person has bleeding in their colon.

Moreover, the person may need to get image testing of their GI tract.

A doctor may also order an endoscopy or colonoscopy. These procedures can include taking a biopsy sample from the colon, as well as removing or collecting a sample of polyps for examination.

Below are some commonly asked questions about colitis pain and treatment.

What helps a colitis flare up?

Eating frequent and small meals, drinking plenty of fluids, and managing stress levels are a few things that can help a colitis flare up.

What is the best home remedy for colitis flare up?

Some potential home remedies for a UC flare up include the following natural substances:

  • Andrographis paniculata extract
  • aloe vera gel
  • wheatgrass juice
  • Plantago ovata seeds
  • Boswellia serrata gum resin

A 2019 study suggests that specific compounds in these herbal remedies support immune activity and provide antioxidants that reduce inflammation.

As such, people with UC may use them as supplementary treatments alongside traditional medicines.

How frequent is ulcerative colitis pain?

The frequency of the pain due to UC varies. Some people have frequent flares that include pain, while others can have few or no symptoms for years before experiencing discomfort for the first time.

People with frequent flares are much more likely to feel UC pain regularly. Individuals whose flares are more spaced out will have more sporadic pain.

People without a diagnosis should seek guidance from a doctor if they experience UC symptoms for more than a few days. Symptoms of UC may indicate other conditions, so a doctor will need to rule out all potential causes.

Individuals with a UC diagnosis should contact a doctor to determine the appropriate treatment and to create a plan of action for when a painful flare occurs.

A person should also contact a healthcare professional whenever their pain worsens, or a new type of pain appears.

Read this article in Spanish.