There is no particular treatment for ulcerative colitis, where a combination of medicines and surgery is given to control and recover from the symptoms. Ulcerative colitis is characterized by episodes of symptoms such as abdominal pain and diarrhea, followed by normal functioning of the stomach, again followed by a relapse of the symptoms. This may continue for months or years in certain people, where changes in diet and lifestyle are recommended to avoid symptoms from recurring.
The main aim of medicines is to avoid the symptoms from returning, thus helping the person live a normal life. Drugs such as aminosalicylates, corticosteroids and immunomodulators are recommended for the purpose. Aminosalicylates consist of 5-aminosalycylic acid, also called 5-ASA that helps in controlling inflammation. The medicine Sulfasalazine is made by combining 5-ASA with sulfapyridine, which carries 5-ASA to the digestive tract. However, the component sulfapyridine may cause side effects like vomiting, nausea, headache, and may even worsen diarrhea. Other medicines containing 5-ASA include balsalazide, mesalamine and olsalazine, which have very few minor side effects compared to sulfasalazine. The drugs are recommended for people with mild form of ulcerative colitis.
Corticosteroids such as hydrocortisone, methylprednisone and prednisone are also helpful in reducing inflammation. These are used in treating people suffering from moderate or severe symptoms of ulcerative colitis, especially if the body has not responded well to drugs containing 5-ASA. Corticosteroids are administered based on the location of the inflammation, thus are given intravenously, orally, in a suppository or through enema. The medicines may cause some side effects such as facial hair, mood swings, hypertension, weight gain, acne and bone mass loss. Hence, these are recommended as short term course.
Immunomodulators are recommended for people with severe cases of ulcerative colitis. It is given when the body does not respond to either 5-ASA or corticosteroids. The medicine is to be taken orally, however it does not have an immediate effect and may take more than six months to subside severe symptoms. People taking the drugs are regularly checked for hepatitis, reduction in white blood cells, infections and pancreatitis.
Other medications may be recommended with any of the above medicines to reduce mild symptoms such as pain, infection or diarrhea. In cases where the symptoms cannot be treated through medicines, hospitalization may become necessary. This may happen when the person suffers from severe symptoms such as bleeding or diarrhea leading to extreme dehydration, where doctor may recommend hospitalization to replenish loss of blood and fluids.
About 25-40% people need surgery to cure ulcerative colitis. Surgery entails removal of colon in cases where excessive bleeding has taken place or the colon has ruptured. It may also be removed in case the doctor identifies a risk of cancer in future. The need for surgery entirely depends on the condition of the person and severity of the disease. Doctors try and avoid surgery where ulcerative colitis is generally treated through medications.