Treatment for ulcerative colitis depends mainly on the severity of the disease and usually includes medicines to control symptoms, such as diarrhea, and changes in diet. A few people have symptoms that are persistent and severe, in some cases requiring treatment with additional medicines or surgery.

The goals of treatment include:

• Relieving symptoms and ending sudden (acute) attacks as quickly as possible.
• Treating complications, such as anemia or infection. Treatment may include taking nutritional supplements to restore normal growth and sexual development in children and teens.
• Preventing or delaying new attacks.

Initial treatment

If you don't have any symptoms of ulcerative colitis or if your disease is not active (in remission), you may not need treatment. If you do have symptoms, they usually can be managed with medicines to put the disease in remission. It often is easier to keep the disease in remission than to treat a flare-up.

Mild symptoms may respond to antidiarrheal medicines and changes in your diet. Sometimes you may need to use enemas or suppositories. Talk with your health professional before taking antidiarrheals. Prescription medicines may be used to treat mild symptoms and keep the disease in remission. Usually, corticosteroids (such as hydrocortisone or prednisone) are given for a few weeks to control active disease.

When your symptoms are under control, you may take aminosalicylates (such as sulfasalazine or mesalamine) to keep the disease in remission. Aminosalicylates relieve inflammation in the intestines.

Moderate to severe symptoms usually require corticosteroids to control inflammation. The required dose of steroids may be higher than that needed to treat mild colitis. When inflammation goes away, you will take aminosalicylates to keep the condition in remission. For more information about making good food choices, see:

Eating plan for inflammatory bowel disease.

Immunomodulator medicines, such as azathioprine (AZA) or 6-mercaptopurine (6-MP), also may be needed for severe cases that cannot be controlled with aminosalicylates alone. These medicines suppress the body's immune system to prevent inflammation. Immunomodulators also may be needed to avoid long-term use of steroids, which can cause side effects such as increased risk of infection and osteoporosis.

For severe ulcerative colitis, when corticosteroids don't work, your doctor may have you try infliximab. Infliximab (Remicade) may work to put you in remission when other medicines don't. Infliximab has also been shown to help heal the lining of the intestine.

Ongoing treatment

The goal of ongoing treatment is to keep ulcerative colitis from causing symptoms (keep it in remission). Most people take aminosalicylates (such as sulfasalazine or mesalamine) to prevent symptoms from recurring. Aminosalicylates relieve inflammation in the intestines. If you do have flare-ups, you will be given corticosteroids (such as hydrocortisone or prednisone) to control the inflammation.

Usually, steroids are given only long enough to control inflammation. If your condition is so severe that aminosalicylates alone cannot keep you in remission and you would need long-term use of steroids, you may take immunomodulator medicines (such as azathioprine [AZA], 6-mercaptopurine [6-MP], or cyclosporine). These strong medicines suppress the immune system to prevent inflammation.