Last Updated on June 26, 2023 by Steven Root
Introduction
Ulcerative colitis is a chronic disease of the colon that causes inflammation and ulcers in the digestive tract. Ulcerative colitis treatment options vary depending on the severity of the disease and the individual’s health.
We define ‘treatment’ as a therapy or strategy designed to remedy a specific health condition.
This article will cover the following:
- Diet Changes
- Lifestyle Changes
- Reducing Exposure to Environmental Triggers
- Medications
- Surgery
Diet Changes
Whilst evidence based scientific studies on the relationship between ulcerative colitis and diet are scarce, it is common knowledge amongst sufferers that ulcerative colitis is significantly affected by what we eat.
Studies such as this one do exist, however, and diet should be an area of focus for future research under the ulcerative colitis treatment umbrella. Whether or not this will happen though remains to be seen. Getting a study like this funded will be difficult because there is little to no money to be made. Sad but true.
That being said, there are a multitude of diets and dietary changes that can help significantly in alleviating ulcerative colitis symptoms. These changes are highly dependent on the individual’s symptoms, allergies & intolerances, religious beliefs, cultural factors, dietary preferences, and more.
Some of these diets are:
- The Specific Carbohydrate Diet
- The Elemental Diet
- The Carnivore Diet
- A Vegan Diet
- A Ketogenic Diet
- And more..
With all of these diets, potential IBD triggers such as dairy, gluten, certain other lectins, certain nightshades etc, are generally removed.
All of these diets, when being used as an ulcerative colitis treatment option, will generally start with a very small list of foods. This small food list, devoid of known IBD triggers, is known as an elimination diet. Because the list is small, it is then more possible to reliably point fingers at problem foods as they are slowly added and tested.
See here for professional help in designing a diet to mitigate against ulcerative colitis symptoms.
Lifestyle Changes
In addition to diet, lifestyle factors can significantly impact ulcerative colitis. Here are some changes you might consider:
Regular Exercise
Regular exercise, to the extent that it is possible for the patient, should be talked about as an integral part of managing ulcerative colitis. It can diminish IBD symptoms and affect the immunological response (source), as well as improve the mental health of IBD patients.
Not only does it promote overall health and well-being, but it can also help reduce the risk of certain complications associated with ulcerative colitis. For example, exercise helps reduce the risk of osteoporosis, which can be a side effect of long-term corticosteroid use.
Low-impact activities such as walking, light weights, swimming, or cycling can be ideal for those with ulcerative colitis, as these are less likely to cause discomfort or provoke symptoms. It is important to start slow and gradually increase the intensity and duration of exercise as your body adjusts.
And do not overdo it. During flare-ups, it may be necessary to reduce the intensity or frequency of exercise, or even take a break. Consultation with a healthcare provider or specialist can help to establish an exercise plan that suits your individual needs and conditions.
Stress Management
Stress may not cause ulcerative colitis, but it can certainly exacerbate symptoms and trigger flare-ups. Therefore, managing stress can play a crucial role in managing the disease.
A resource that I point many of my clients to is a book called Letting Go by David Hawkins. It lays out an excellent methodology for the release of the negative emotions that so often drive our stress such as fear, anger, bitterness, and resentment. It is beautifully simple.
Techniques like meditation, mindfulness exercises, deep breathing exercises, and yoga can also help reduce stress levels and promote relaxation.
Speaking to a therapist can help, and cognitive-behavioral therapy (CBT) can also be beneficial. CBT is a type of talk therapy that helps individuals manage stress and anxiety by modifying negative thinking patterns and developing better mental habits.
This article here unpacks the link between ulcerative colitis and stress in more detail.
Limiting or Avoiding Alcohol
Alcohol can interfere with digestion and may trigger symptoms in some people with ulcerative colitis (source).
While moderate alcohol consumption may be acceptable for some individuals, it’s crucial to understand how your body reacts to alcohol. If alcohol worsens your symptoms, it might be necessary to limit consumption or abstain altogether.
It’s important to seek professional help if you’re struggling to quit or limit alcohol consumption. Support groups and counseling can provide the necessary tools to be successful.
Regular Check-ups
Regular check-ups allow healthcare providers to monitor the disease, adjust treatment plans as necessary, and screen for potential complications.
Preventative screenings, such as colonoscopies, are particularly important for individuals with ulcerative colitis, as the disease increases the risk of colon cancer. Regular screenings can help detect any precancerous changes in the colon at an early stage.
Understandably, colonoscopies can be scary and there is also the fear that there may be disruption to the microbiome and gut lining, increasing susceptibility to a flare or complication of the disease. So whilst it may be necessary to undergo a colonoscopy from time to time, other, less invasive tests such as fecal calprotectin and CRP can also help to monitor inflammation in the gut.
Engaging with healthcare professionals and maintaining a proactive approach towards health can significantly contribute to the effective management of the disease.
Quality Sleep
Quality sleep is an often overlooked, yet vital aspect of managing ulcerative colitis. Lack of quality sleep can impair immune function, potentially leading to exacerbation of ulcerative colitis symptoms (source).
If you have sleep issues, it might be beneficial to discuss them with a healthcare provider.
In some cases, sleep disturbances could be related to anxiety or depression, which are common in individuals with ulcerative colitis. As anxiety and depression are worked through, perhaps utilizing some of the strategies mentioned in the section above under Stress Management, it is common to see sleep quality improve.
Reducing Exposure to Environmental Triggers
An often ignored part of ulcerative colitis treatment plans, reducing exposure to environmental triggers can be beneficial. Let’s review some of the possible changes that we can make:
Limiting Antibiotic Use
Antibiotics are helpful in fighting bacterial infections but they should be used judiciously, since they don’t distinguish between harmful bacteria and beneficial bacteria in your gut. By the killing of beneficial bacteria, antibiotics can disrupt the gut microbiome, alter the immune response, and potentially worsen ulcerative colitis symptoms.
Some studies have even found antibiotic use to be a risk factor for the initial development of the disease (source).
We should limit our antibiotic use to those times when it is necessary, and always under the guidance of a healthcare provider. If you’re prescribed antibiotics, discuss the potential impacts on ulcerative colitis with your provider.
Probiotics, which are beneficial bacteria, may help restore the balance in your gut microbiome after or even during antibiotic use.
Avoiding Non-Steroidal Anti-Inflammatory Drugs (NSAIDs)
Non-steroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen, aspirin, and naproxen, can irritate the lining of the stomach and intestines, and potentially trigger flares in individuals with ulcerative colitis (source).
Whilst reputable studies showing a strong link between NSAID use and ulcerative colitis are still relatively scarce, if you have ulcerative colitis, it’s generally advised to avoid NSAIDs and opt for other forms of pain relief. For example, acetaminophen (Tylenol) is usually a safer choice for minor aches and pains.
Some people with ulcerative colitis however, may need to use NSAIDs for other health conditions, such as arthritis. If this is the case, it is important to discuss the potential risks with your healthcare provider since there may be other options.
Ensuring Clean Air
Living in high pollution areas may contribute to inflammation and exacerbate symptoms of ulcerative colitis. In fact, prolonged exposure to air pollution has been shown to increase the risk of developing ulcerative colitis (source).
Whilst it may not be possible to completely avoid air pollution based on where you live, measures can be taken to ensure that the air in your home is clean.
HEPA filters are generally available to be purchased worldwide and can help filter out particulate matter. Particulate matter contains microscopic solids or liquid droplets that are so small that they can be inhaled, causing serious health problems.
Avoiding Pesticides
Pesticides are chemicals used to kill crop pests, including insects, weeds, and fungi. However, these substances can be harmful to people with ulcerative colitis.
The most well known pesticide that can negatively impact ulcerative colitis is glyphosate (Roundup). Even at levels deemed as safe for humans, colitis onset was shown to increase (source).
Exposure to pesticides can occur through the consumption of non-organic fruits and vegetables, contact with treated plants, and inhalation or skin contact during pesticide application. Washing fruits and vegetables thoroughly, or choosing organic options, can reduce exposure through food.
For home and garden use, consider natural or non-toxic alternatives to chemical pesticides. And if using chemical pesticides is unavoidable, ensure appropriate safety measures are taken, including wearing protective clothing and avoiding contact with treated areas for the recommended period.
Ensuring Clean Water
The need for clean water is becoming increasingly clear, perhaps even more so for those suffering from ulcerative colitis. This study (source) as well as several others show that Per- and polyfluoroalkyl substances (PFAS) are increased in patients with late-onset ulcerative colitis.
Other contaminants such as iron have also been linked to the development of ulcerative colitis. This study (source) showed that the risk of developing inflammatory bowel disease increased by 21% when the iron content of the drinking water increased by 0.1mg/L.
There are multiple online resources for checking the purity of drinking water and it is encouraged that you look into this in your local area, and generally, if possible, avoid drinking tap water.
Bottled spring water and reverse osmosis water have generally been shown to have fewer contaminants and therefore be safer to drink for those with ulcerative colitis.
Medications in Ulcerative Colitis Treatment
The drugs below are often prescribed to help manage ulcerative colitis. Drugs should not be used in isolation as a form of ulcerative colitis treatment. Rather, if they are used, they should be used in conjunction with implementing the dietary and lifestyle strategies mentioned above.
Aminosalicylates
Aminosalicylates are often the first line of medical treatment for those diagnosed with ulcerative colitis. These drugs, which include mesalamine (Lialda, Apriso), balsalazide (Colazal), and olsalazine (Dipentum), work by reducing inflammation in the lining of the colon. They’re usually administered orally, but they can also be administered rectally in the form of enemas or suppositories as well.
It ss believed that they intervene in the chemical processes of the immune system that trigger inflammation. The effectiveness of aminosalicylates can vary, and some people may experience side effects like nausea, vomiting, and headache1.
Whilst aminosalicylates can help to bring about remission in mild to moderate cases of ulcerative colitis, they are not curative. Patients need to follow their healthcare provider’s instructions regarding dosage and frequency of these medications carefully to maximize their benefit and minimize potential side effects.
Corticosteroids
Corticosteroids, such as prednisone and hydrocortisone, are powerful anti-inflammatory drugs. They are often prescribed to control severe ulcerative colitis symptoms when aminosalicylates aren’t effective. Corticosteroids can rapidly control inflammation and are usually used for a short time to bring about a quick remission. They are often followed by a prescription for a longer-term medication to maintain remission.
Corticosteroids aren’t recommended for long-term use due to their side effects. These can include weight gain, mood swings, insomnia, increased susceptibility to infections, bone fractures, high blood pressure, diabetes, damage to other organ systems, and more (source).
Healthcare providers usually aim to limit the use of corticosteroids to as short a period as possible, tapering the dosage down rather than stopping them abruptly. Patients should follow their doctor’s guidance closely when taking these medications and promptly report any side effects.
Immunosuppressants
Immunosuppressants are medications that dampen or reduce the body’s immune response, thereby decreasing inflammation in the colon. These medications are often used when aminosalicylates and corticosteroids aren’t sufficient to control ulcerative colitis symptoms. Examples include azathioprine (Imuran), 6-mercaptopurine (6-MP), cyclosporine (Sandimmune), and methotrexate (Rheumatrex).
These drugs require regular blood tests to monitor their effects on the body’s blood cells and liver. Side effects can include nausea, fatigue, and in some cases, a decreased ability to fight off infections, development of certain cancers, and more.
While immunosuppressants can sometimes be very effective in managing ulcerative colitis symptoms and maintaining remission, they are certainly not without their own risks. Patients should have regular check-ups and screenings while taking these medications.
Biologics
Biologics are a type of medication that specifically targets proteins involved in the inflammatory process. Sometimes called anti TNF therapy, biologics interfere with the action of a protein called tumour necrosis factor (TNF) which is over-active in the body.
They are often used for moderate to severe ulcerative colitis cases not responding well to other treatments. Examples include infliximab (Remicade), adalimumab (Humira), and golimumab (Simponi).
Biologics are administered through intravenous infusion or injection. Side effects include fever, rash, increased susceptibility to infections, damage to other organ systems, development of certain types of cancers, and more.
Despite the risks, biologics have offered hope to those with the condition who haven’t responded to other therapies.
As with all medications, these benefits and risks should be discussed with your healthcare provder.
Janus Kinase Inhibitors
Janus kinase inhibitors are a newer class of oral medications that block certain immune responses, thereby reducing inflammation. Tofacitinib (Xeljanz) is one such drug approved for the treatment of ulcerative colitis.
These inhibitors work by interrupting the signaling pathway that leads to inflammation. This pathway involves Janus kinases, enzymes that play a key role in the immune system’s function. By inhibiting these enzymes, these drugs can help to lower inflammation (source).
As with all medications, Janus kinase inhibitors are not without potential side effects, which can include diarrhea, headache, and cold-like symptoms. Rare but serious side effects may include increased risk of infection, blood clots, and more. As these are relatively new drugs, long-term safety data is still being collected.
Surgery
When other treatments are ineffective, surgery might be an option. Common surgeries include:
Colectomy
A colectomy is a surgical procedure to remove all or part of your colon. It may be considered when medications aren’t effective, or when complications arise. Such complications include perforation, uncontrollable bleeding, or a high risk of colon cancer.
A colectomy can be performed in several ways: open surgery, laparoscopically, or robot-assisted laparoscopically. Regardless of how it is performed, the goal is to remove the diseased part of the colon to relieve symptoms and improve the patient’s quality of life.
However, a colectomy can also introduce new challenges. It may require a temporary or permanent ostomy, which involves creating an opening (stoma) in the abdomen for waste to leave the body. This demands significant lifestyle changes and can sometimes have a significant emotional impact on the patient.
Proctocolectomy with Ileal Pouch-Anal Anastomosis (IPAA)
When both the colon and rectum are severely affected, a proctocolectomy with ileal pouch-anal anastomosis (IPAA) may be performed. This procedure involves removing the colon and rectum and creating a pouch from the end of the small intestine (ileum). This pouch is then attached directly to the anus, allowing the patient to pass waste normally.
IPAA is a complex operation usually performed in two or even three stages. The advantage of this surgery is that it eliminates the disease and allows the patient to maintain relatively normal bowel function, without the need for a permanent ostomy.
However, complications can occur, including pouchitis, which is inflammation of the ileal pouch. This can lead to increased bowel movements, abdominal cramping, fever, and more. Long-term care and monitoring will be necessary if you choose to undergo this procedure.
Proctocolectomy with Ileostomy
A proctocolectomy with ileostomy is another surgical option for people with ulcerative colitis. This surgery involves the removal of the entire colon and rectum, followed by the creation of an ileostomy. An ileostomy is a stoma, or opening in the abdomen, that’s made from the end of the small intestine. A special bag, outside the body, is attached to this stoma to collect waste.
This procedure is often recommended for individuals who have inherently higher surgical risks, have problems with their anal sphincter, or prefer not to worry about potential complications from a pouch.
Living with an ileostomy requires a significant lifestyle adjustment. There can be issues with the stoma, such as irritation or even blockage, and then of course need to manage the ostomy bag. Psychological and emotional support are often important components of care following this surgery.
Summary
Ulcerative colitis treatment encompasses a wide range of approaches. These range from dietary modifications and lifestyle changes, to removing environmental triggers, to medications and surgery.
Regular check-ups should be part of any treatment plan and always consult with a healthcare professional to construct the most appropriate treatment plan.
