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Ulcerative Colitis Treatment: Diet, Medications, and More

Ulcerative colitis

Coping with ulcerative colitis is no easy thing. The chronic disease, which may affect as many as 1.3 million people in the United States, causes inflammation and sores in the lining of your colon and rectum.

As the inflammation worsens, the cells that line these areas die off, resulting in bleeding, infection, and diarrhea. The condition can cause:

  • fever
  • anemia
  • fatigue
  • joint pain
  • appetite loss
  • weight loss
  • skin lesions
  • nutritional deficiencies
  • stunted growth in children

The exact cause of ulcerative colitis is unclear. Many experts believe it results from an abnormality of the immune system and an inability to handle bacteria in the digestive tract.

Your doctor may request a blood test, stool samples, barium enema, and colonoscopy. This will allow them to determine whether your symptoms are being caused by ulcerative colitis rather than another condition like Crohn’s disease, diverticular disease, or cancer.

Ulcerative colitis should be confirmed by a tissue biopsy during a colonoscopy.

If you’re diagnosed with ulcerative colitis, it’s vital to map out a treatment plan that controls and prevents attacks so that your colon can heal.

Because the symptoms and effects of the disease vary, there’s no single treatment that works for everyone. Treatments often focus on diet and nutrition, stress, and medication.

It’s best to consume smaller amounts of food throughout the day. Avoid raw and high-fiber foods if these are problem foods for you. Examples of these foods include:

  • nuts
  • seeds
  • beans
  • whole grains

Fatty and greasy foods also contribute to inflammation and pain. In general, safe foods include:

  • low-fiber grains,
  • baked chicken, pork, and fish
  • steamed/baked or stewed fruits and vegetables

Sipping water throughout the day can aid in digestion and reduce inflammation.

Anxiety and nervousness can worsen symptoms. Exercise and relaxation techniques that help you manage and reduce your stress levels can be helpful. These include:

  • biofeedback
  • massages
  • meditation
  • therapy

Your doctor may prescribe medication to induce or maintain remission. Although several types of medications exist, each drug falls into four primary categories.


These drugs contain 5-aminosalicyclic acid (5-ASA), which helps control inflammation in the intestine. Aminosalicylates can be administered orally, through an enema, or in a suppository. They typically take four to six weeks to work. However, they may cause side effects, including:

  • nausea
  • vomiting
  • heartburn
  • diarrhea
  • headache


This group of steroid drugs — including prednisone, budesonide, methylprednisolone, and hydrocortisone — reduce inflammation. They’re often used if you’re living with moderate to severe ulcerative colitis, including if you haven’t responded favorably to 5-ASA drugs.

Corticosteroids can be administered orally, intravenously, through an enema, or in a suppository. Side effects include:

  • acne
  • facial hair
  • hypertension
  • diabetes
  • weight gain
  • mood swings
  • bone mass loss
  • increased risk of infection

Steroids are ideally used on a short-term basis to lessen the effects of an ulcerative colitis flare-up, rather than as a daily medication to control symptoms.

When ulcerative colitis is very severe, your doctor may prescribe a daily dose of steroids to help you maintain a normal lifestyle.


These drugs, including azathioprine and 6-mercapto-purine (6-MP), reduce inflammation of the immune system — though they can take as long as six months to effectively work.

Immunomodulators are administered orally and typically used if you don’t respond favorably to the combination of 5-ASAs and corticosteroids. Potential side effects include:

  • pancreatitis
  • hepatitis
  • reduced white blood cell count
  • increased risk of infection


These are a newer class of drugs used as an alternative to immunomodulators to treat people who haven’t responded well to other treatments.

Biologics are more complex and target specific proteins. They can be given through intravenous infusion or injections. Currently, there are four FDA-approved biologic medications to treat UC:

  • tofacitinib (Xeljanz)
  • adalimumab (Humira)
  • golimumab (Simponi)
  • infliximab (Remicade)
  • vedolizumab (Entyvio)

If other forms of treatment haven’t worked, you may be a candidate for surgery. Some ulcerative colitis patients eventually have their colons removed as a result of severe bleeding and illness — or increased risk of cancer. Four types of surgeries exist:

  • restorative proctocolectomy with ileal pouch-anal anastomosis
  • total abdominal colectomy with ileorectal anastomosis
  • total abdominal colectomy with end ileostomy
  • total proctocolectomy with end ileostomy

If you’re living with ulcerative colitis, avoid nonsteroidal anti-inflammatory drugs (NSAIDs), which may make symptoms worse.

Talk with your doctor to create a treatment strategy that best addresses your healthcare needs. Also, schedule an exam annually or every two years, per your doctor’s recommendation, due to an increased risk of cancer that’s linked to ulcerative colitis.

With the right approach, it’s possible to manage your ulcerative colitis and live a normal lifestyle.

Ulcerative colitis can be challenging to treat. However, there are various treatment options available. Talk with your doctor about your symptoms. Together you can develop a treatment plan that works best for you.

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