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People with ulcerative colitis may experience flare-ups, during which symptoms temporarily worsen, as well as periods of remission, during which symptoms disappear.

Ulcerative colitis (UC) is a long-term inflammatory bowel disease (IBD) that affects the large intestine, or colon. The goal of medical treatment for UC is to achieve and maintain remission.

In people with UC, the colon becomes inflamed and develops small, pus-producing ulcers.

The symptoms of UC include abdominal discomfort, diarrhea, and a frequent need to have a bowel movement.

This article outlines the medicines, lifestyle changes, and dietary adjustments that may help people maintain remission and prevent flare-ups of UC.

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Symptoms improve during remission.

Remission occurs when UC medications control or resolve inflammation of the colon, leading to an improvement in symptoms.

The length of remission varies from weeks or months to years. If the medications are working and no other factors trigger a flare-up, the disease can remain in remission for a long time.

Even if UC stays in remission for years, it is essential to keep using the medications to help prevent future flare-ups.

Treatments that may help achieve or maintain UC remission include:

Aminosalicylates

Aminosalicylates are drugs that reduce inflammation in the lining of the colon. They can treat mild to moderate UC.

The two most common aminosalicylates are:

  • sulfasalazine
  • mesalamine

Around 90 percent of people who cannot take sulfasalazine can take mesalamine (mesalazine), which has fewer side effects.

Mesalamine is available as an oral medication, a suppository, and an enema formulation.

Current guidelines recommend prescribing one of the following for people with extensive mild to moderate UC:

  • standard-dose mesalamine (2–3 grams per day (g/d))
  • diazo-bonded 5-ASA, such as the prodrugs balsalazide and olsalazine, which convert into mesalamine in the gut

The guidelines recommend these over low-dose mesalamine (less than 2 g/d), sulfasalazine, or nothing.

However, a doctor might recommend sulfasalazine 2–4 g/d for the following people, if alternatives are too expensive:

  • those who are already taking sulfasalazine and who are in remission
  • those with prominent symptoms of arthritis

However, sulfasalazine can lead to adverse effects and not everyone tolerates them well.

Suppositories and enema formulations can target specific parts of the colon and rectum. They may provide extra symptom relief for people who use them alongside oral medications.

Corticosteroids

Corticosteroids are powerful and fast-acting anti-inflammatories. Doctors may prescribe them to temporarily treat UC flare-ups. Most people notice an improvement in symptoms within days of taking corticosteroids.

These drugs can have serious side effects, however, so doctors warn against long-term use.

Immunomodulators

Immunomodulators are medications that modify the immune system, decreasing the body's inflammatory response.

Unlike corticosteroids, people can use immunomodulators to maintain long-term remission. This may reduce the need for repeated corticosteroid treatments.

Biologics

The term "biologics" refers to any drug that the body or another organism naturally produces.

For people with for UC, biologics can help reduce harmful inflammation in the gut. They can also help a person achieve and maintain remission.

People experiencing remission should continue taking medications as the doctor recommends.

Even if a person has no symptoms, the medications can prevent flare-ups.

The following lifestyle and dietary changes can also help to maintain remission:

Managing stress

Many people with UC report that stress causes their symptoms to flare up.

A 2013 study investigated whether stress and depression increase the risk of UC relapse among people in remission.

The researchers assessed participants' levels of stress and depression at 3-month intervals for up to 1 year. Of the 75 participants, 28 experienced a recurrence of symptoms during this time.

The researchers found that short-term stress may increase the risk of relapse, but depression did not have the same effect.

A doctor may be able to recommend a form of talking therapy or mindfulness meditation to help relieve stress.

Exercising

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Regular exercise can help prevent complications of UC.

Exercise may help reduce the risk of the following physical and mental health conditions associated with IBD:

A 2015 study investigated the association between exercise and disease flare-ups among people with IBD in remission.

Of the 1,308 participants, 549 had UC or indeterminate colitis (IC), which is when it is unclear whether a person has Crohn's disease or UC.

Participants with UC or IC who had higher exercise levels at the start of the study were less likely to develop active disease 6 months later.

However, the benefit of exercise was not statistically significant. Confirming whether exercise can help to maintain colitis remission will require more research.

Avoiding certain pain relievers

According to the Crohn's and Colitis Foundation (CCF), the following over-the-counter or prescription pain relievers can cause intestinal ulcers:

  • aspirin
  • nonsteroidal anti-inflammatories, or NSAIDs, such as ibuprofen
  • COX-2 inhibitors, including the brands Celebrex and Vioxx

The CCF recommend that people avoid taking these drugs unless they are necessary to treat a serious health issue, such as heart disease.

Identifying and avoiding trigger foods

According to the CFF, some people with UC experience an increase in cramping, bloating, and diarrhea after eating certain foods.

Although these trigger foods vary from person to person, some common examples include:

  • fatty foods
  • spicy foods
  • sugary foods
  • sugar substitutes
  • alcohol
  • caffeinated drinks
  • foods containing lactose
  • insoluble fibers, which raw green vegetables, grains, and most fruits contain

If UC symptoms seem to get worse after eating certain foods, consider keeping a food diary and recording symptoms every day to check for a pattern.

If a person suspects that a type of food is making their UC symptoms worse, they can also try eliminating it from their diet and seeing if symptoms improve.

Taking supplements

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Some supplements may help maintain remission..

The following supplements may help maintain UC remission:

Vitamin D

Vitamin D may reduce inflammation in the colon. Some researchers estimate that 60–70 percent of people with IBD have insufficient vitamin D levels.

Participants with low vitamin D also needed more medications, emergency department visits, hospital admissions, and surgeries.

The authors also found that participants accessed health services less often after receiving vitamin D supplements.

Vitamin D supplements are available for purchase online.

Probiotics

Research from 2018 suggests that an imbalance in intestinal bacteria may cause the inflammation that occurs in people with UC.

In a different analysis from 2019, researchers found that people who took probiotics and an aminosalicylate had higher remission rates than those who only took an aminosalicylate.

Probiotics may help reduce UC symptoms by:

  • preventing the growth of harmful gut bacteria
  • regulating the immune system
  • reducing inflammation in the colon
  • improving the function of the intestinal barrier, which prevents toxins and harmful bacteria from entering the bloodstream

Probiotics are available for purchase online.

Curcumin

Some plants in the ginger family produce curcumin, a chemical.

In 2012, researchers investigated whether curcumin could help maintain UC remission.

Compared to the placebo group, fewer people in the group that took curcumin relapsed after 6 months. However, the results were not statistically significant, and confirming the benefits of curcumin will require more research.

Curcumin supplements are available for purchase online.

Prescription medications, as well as some lifestyle and dietary changes, can help people with UC to maintain remission. A person is likely to benefit from managing stress, exercising regularly, and taking care to avoid food triggers.

Certain supplements may also help prevent UC flare-ups. Anyone interested should speak with their doctor about adding these supplements to their treatment plan.