Ulcerative Colitis Treatments: How to Find the Right One for You

Ulcerative colitis (UC) is a chronic autoimmune condition where your body’s own immune system causes inflammation and damage in your colon, or large intestine.

Experts aren’t exactly sure what causes UC. It runs in families, which suggests genetics likely have a role. Other factors, like where you live and what you eat, may also contribute.

But there are lots of treatment options available for UC. Let’s take a closer look at medications and other approaches that can help you manage UC and improve your quality of life.

Promotional Disclosureinfo_outlined

SPECIAL OFFER

Save over 40% on Qsymia with GoodRx

Discover the once daily Qsymia for weight management. Qsymia is for adults and children 12-17 in combination with a healthy diet and regular exercise.

Save now

What are the symptoms of ulcerative colitis?

Sometimes, UC can be tricky to diagnose because its symptoms can look like ones caused by other medical conditions. Some of the most common symptoms of UC include:

• Frequent stools

• Leaking of stool

• Bloody stool

• Mucus in stool

• Fatigue

• Crampy abdominal pain

• Joint pain

• Skin rashes

• Eye pain

If you’re having one or more of these symptoms, a good place to start is by talking with a healthcare professional. They’ll likely do a series of exams and tests to find out whether you have UC. This will probably include getting blood work and having a colonoscopy. 

Goals of treatment of ulcerative colitis

UC is a chronic condition, which means it’s never fully cured. It’s common for people with UC to have periods of active symptoms, called flare-ups, and periods where symptoms improve, called remissions. 

The main goals of treatment are to:

• Control flare-ups to get you in remission and keep you in remission once you get there

• Improve your quality of life by managing symptoms so they don’t interfere with daily activities

• Avoid serious complications, like severe bleeding or colon cancer

EXPERT PICKS: WHAT TO READ NEXT

• Biologics for ulcerative colitis (UC): Learn more about these common treatments for UC and how they work.

• Foods to avoid with UC: These foods may trigger UC flares and worsen symptoms.

• Next steps with UC: This comprehensive UC guide will help you learn about symptoms, treatments, and managing the condition.

Treatment options for ulcerative colitis

The main treatment options for UC are medications and surgery. Sometimes, a combination of medications and surgery can be used. The treatments that are best for you will depend on your symptoms, other medical conditions you have, and what you may have tried in the past. Based on these factors, you and your healthcare team will determine which treatment plan works best for you.

Below is a summary of medications often used to treat UC and how they work. 

Aminosalicylates

How they work

Aminosalicylates are a type of anti-inflammatory medication. It’s not clear exactly how they work, but they may be similar to ibuprofen and other nonsteroidal anti-inflammatory drugs (NSAIDs). They can be taken as pills or given as enemas or suppositories for a direct effect on your colon. Examples include:

• Sulfasalazine

• Mesalamine

• Balsalazide

• Olsalazine

Who they work for

Aminosalicylates can treat mild or moderate UC flares. People will take a pill, use an enema, or both — depending on which part of the colon is involved. People who are in remission often take them to help stay in remission.

Side effects

Common side effects include:

• Decreased appetite

• Headache

• Nausea

• Vomiting

• Abdominal pain

Corticosteroids

How they work

Corticosteroids are powerful anti-inflammatory medications. Common corticosteroids for UC include budesonide MMX and prednisone.

Who they work for

People take corticosteroids to treat mild flares if aminosalicylates aren’t working. Corticosteroids come in pill form or as topical treatments, like an enema. If your UC flare is more severe to begin with, you might start corticosteroids as the first treatment. Most experts consider budesonide to be a better option than prednisone because it works specifically in your colon to treat ulcerative colitis.

Side effects

Long-term use of corticosteroids can cause numerous problems, such as infections, worsening diabetes, and dependency. Most experts recommend against using them long term. 

Common side effects include:

• Headache

• Nausea

• Abdominal pain

• Weight gain

• Gas

• Acne

• Urinary tract infections (UTIs)

• Joint pain

• Constipation

Biologics

How they work

Biologics are lab-made mimics of natural parts of your immune system. They interfere with the way your immune system works to prevent the inflammation that damages your colon.

Common examples include:

• Infliximab (Remicade)

• Adalimumab (Humira)

• Golimumab (Simponi)

• Vedolizumab (Entyvio)

• Mirikizumab (Omvoh)

• Risankizumab (Skyrizi)

• Guselkumab (Tremfya)

Who they work for

Biologics can treat severe ulcerative colitis flares or moderate flares that aren’t improving with other treatments. You’ll often take them alongside other medications, like immunomodulators. 

Infliximab and vedolizumab require intravenous infusion once every few weeks. Adalimumab or golimumab are injected under your skin every other week. These medications can also be used to stay in remission if they were needed to stop a flare.

Mirikizumab, risankizumab, and guselkumab start with IV infusions and then switch to injections under your skin for maintenance doses at home. This offers added convenience and, in many cases, an improved quality of life.

Side effects

Common side effects include:

• Sinus infections

• Congestion

• Headache

• Abdominal pain

• Rash

• Irritation at the injection site

Tofacitinib (Xeljanz)

How it works

Tofacitinib interferes with the way cells in your immune system talk to each other, which reduces the immune response in your colon.

Who it works for

Tofacitinib is for people with moderate to severe UC flares. It’s a pill taken twice daily.

Side effects

Common side effects include:

• Colds and upper respiratory infections

• High cholesterol

• Headache

• Rashes

• Diarrhea

• Shingles

Immunomodulators

How they work

Immunomodulators interfere with the function of cells in your immune system. This leads to decreased inflammation in your colon. Common examples include:

• Azathioprine

• 6-mercaptopurine

• Tacrolimus

• Cyclosporine

• Etrasimod (Velsipity)

Who they work for

Immunomodulators can help with severe ulcerative colitis flares. Sometimes, you take them alongside other medications, like biologics. Healthcare professionals may use tacrolimus and cyclosporine only for very severe cases that don’t respond to other therapies.

Side effects

Immunomodulators cause many side effects, including:

• Nausea and vomiting

• Rashes

• Hair loss

• Joint pain

• Diarrhea

Are ulcerative colitis medications covered by insurance? 

Many insurance plans cover medications for UC. But all insurance plans are different. Talk with your insurance company to see what’s covered. Often, they’ll ask you to try older, safer treatments — also known as “step-up therapy” — before they’ll cover newer treatments. They may require prior authorization or coinsurance.

Typical treatment plans for ulcerative colitis

The medications you take for UC depend on the severity of your condition and whether you’re in a flare-up or remission. If you’re in a flare-up, you’ll take medicines to get you into remission. If you’re in remission, you’ll take medications to keep you in remission.

Typical treatment for a flare-up

If your flare-up is mild:

• Usually, you’ll start with a topical aminosalicylate, such as an enema or suppository. If that isn’t working, you’ll move on to an oral aminosalicylate.

• If aminosalicylates aren’t working, you’ll transition to a corticosteroid, like budesonide MMX.

• If corticosteroids aren’t working, you’ll move on to a biologic, with or without an immunomodulator.

If your flare-up is severe:

• You’ll probably start with a corticosteroid.

• If that isn’t working, the next step is a biologic with or without an immunomodulator.

• If this doesn’t control your flare-up, you may need admission to the hospital for intravenous medications.

Typical treatment for maintaining remission of ulcerative colitis

Once in remission, treatment depends on how you got there:

• In very mild cases, you might just watch your symptoms without taking medications, but people typically take an aminosalicylate to help them stay in remission.

• If you needed a corticosteroid to get into remission, you might take an immunomodulator to keep you in remission.

• If you needed a biologic agent to get you into remission, you might need to keep taking it long-term to stay in remission.

Nonmedication approaches for treating ulcerative colitis

Although medications are the most effective way to treat UC, there are some nonmedication options that can be helpful.

Dietary changes

Your diet might affect your UC. Eating a diet high in fruits and vegetables can be helpful if you have the condition. However, some foods are thought to contribute to UC and are best avoided, especially during a flare-up. These include:

• Red meat and processed meat

• High-fat diets

• Sugar

• Soft drinks

• Dairy

• Spicy foods

Avoiding NSAIDs

NSAIDs, like ibuprofen (Motrin) and naproxen (Aleve), may make UC flare-ups worse — so it’s probably best to avoid them.

Look after your mental health 

Many people with UC have depression, anxiety, and stress as a result of their condition. It’s not clear that stress causes flare-ups, but it might make flare-ups worse. 

Surgery for ulcerative colitis

Sometimes, UC can cause complications that need surgery to treat. This may be the case when you have:

• Severe symptoms that don’t respond to medications

• Severe, life-threatening bleeding from your colon

• Colon cancer that’s at risk of spreading

In most cases, surgery involves taking out most of your colon in a procedure called a subtotal colectomy. This is because of how severe the inflammation is and how likely the complications are to happen again.

Ulcerative colitis clinical trials

Medical advancements are typically made through research, including clinical trials. Several studies are currently underway with the goal of finding UC treatments. Some trials are researching the relationship between your genetics and UC. This will help researchers discover new information, identify treatment targets, and test new medications. If you’re interested, you can find more information on participating in a research group. 

Is there a cure for ulcerative colitis?

UC is a chronic condition, which means it’s never fully cured. It’s normal for people with UC to have periods of active symptoms, called flare-ups, and periods during which symptoms are improved, called remissions. 

Although you can get into remission with the right treatment, UC is never fully cured because the inflammation can come back. It’s important that you work closely with your healthcare team to make sure you’re on the best treatment plan for you.

Why trust our experts?

Written by:

Michael Dreis, MD

Dr. Dreis is an emergency medicine physician currently practicing in Milwaukee, Wisconsin. He went to medical school at the University of Wisconsin – Madison and completed his residency at Henry Ford Hospital in Detroit, Michigan.

Edited by:

Karla Robinson, MD

Karla Robinson, MD, is a medical editor for GoodRx. She is a licensed, board-certified family physician with almost 20 years of experience in health through varied clinical, administrative, and educational roles.

Our editorial standards

Meet our experts