People with ulcerative colitis may experience flare-ups, during which symptoms temporarily worsen, as well as periods of remission when 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
- 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.
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.
If a person stops taking their UC medication, there
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
According to the Crohn’s & Colitis Foundation (CCF), around 90% of people who cannot take sulfasalazine can take mesalamine (mesalazine), which has fewer side effects.
Mesalamine is available as:
- an oral medication
- a suppository
- 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 rather than low dose mesalamine (less than 2 g/d), sulfasalazine, or nothing.
However, a doctor might recommend 2–4 g/d of sulfasalazine 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 UC, biologics can help reduce harmful inflammation in the gut. They can also help a person achieve and maintain remission.
Clinical remission
This
Endoscopic remission
A person is considered in endoscopic remission if their colonoscopy looks normal.
This type of remission means that a person has a lower risk of having recurrent symptoms. However, a colon biopsy may show microscopic disease activity. A person in this type of remission should continue to take the medication their doctor has prescribed.
Histologic remission
Histologic, or deep remission, occurs when no inflammation can be seen in a colonoscopy and biopsy. People in this remission have a low risk of needing surgery or having colon cancer in the future.
People experiencing remission should continue taking medications as recommended by their doctor.
Even if a person has no symptoms, the medications can prevent flare-ups.
The following lifestyle and dietary changes can also help maintain remission:
Managing stress
Many people with UC report that stress causes their symptoms to flare up.
A 2013 study investigates 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 talk therapy or mindfulness meditation to help relieve stress.
Exercising
According to a
- obesity
- colon cancer
- loss of bone density
- low mood
- stress
The study investigated the association between exercise and disease flare-ups among people with IBD in remission.
In the study, 1,308 participants had Crohn’s disease and 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 maintain colitis remission will require more research.
Avoiding certain pain relievers
The following over-the-counter or prescription pain relievers
- nonsteroidal anti-inflammatory drugs, or NSAIDs, such as ibuprofen and aspirin
- COX-2 inhibitors, including the brands Celebrex and Vioxx
Identifying and avoiding trigger foods
According to the CCF, some people with UC experience an increase in cramping, bloating, and diarrhea after eating certain foods.
Although 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 are in raw green vegetables, grains, and most fruits
If UC symptoms seem to worsen after eating certain foods, a person can keep a food diary and record 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
The following supplements may help maintain UC remission:
Vitamin D
Vitamin D may reduce inflammation in the colon. Some researchers estimate that
Participants with low vitamin D also needed more:
- medications
- emergency department visits
- hospital admissions
- 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
In a meta-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 the chemical curcumin.
In a
Compared with the placebo group, fewer people who took curcumin experienced a relapse 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 maintain remission. A person is likely to benefit from:
- managing stress, when possible
- exercising regularly
- 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.