Ulcerative Colitis Treatment
There’s no single fix for UC — but there are many treatments that work. Here’s what your medical team might use to calm flare-ups, keep you in remission, and help you feel like yourself again.
Treatment looks different for every person with UC. Your medical team will work with you to find the combination that fits your body, your lifestyle, and how your disease behaves. Don’t worry if it takes some time to land on the right plan — that’s normal.
Treatment Goals
Stop inflammation
Calm the irritation in your colon so your gut can heal.
Reach remission
Get to a place with no symptoms — so you feel good again.
Stay in remission
Keep symptoms away and prevent relapses or flare-ups.
Your treatment plan considers your context — like what’s available, whether you can get to infusion appointments, your living situation, and insurance coverage — plus your specific medical, social, psychological, and educational needs. Because it’s complex, treatment is usually managed by a multidisciplinary team.
Finding the Right Treatment
- Some UC medications aren’t yet FDA-approved for minors, so doctors prescribe them off-label when they’re the right fit. This is common in pediatric UC, and your medical team will explain what they’re prescribing and why.
- If you might become pregnant, talk to your medical team — they’ll help you understand which medications are safe and which need to be adjusted. Don’t stop or change your medication on your own.
- Regular blood tests and other checks might be required.
- Treatment depends on the extent and severity of your disease — some medications are used to calm flare-ups, while others mainly help maintain remission.
How Medication Can Be Taken
Types of Medication
Different medications are used depending on their intended effect. Some are short-term to induce remission, while others are long-term maintenance.
Research in UC is very active, and new medications and treatment approaches keep being approved. The list below covers the main types in use today, but it’s not exhaustive — and what’s considered first-line or standard can shift in just a few years. Your medical team stays up to date on the latest options for you.
Corticosteroids
Fast-acting medication for flare-ups
Corticosteroids, like prednisone, are fast-acting and powerful medications used to reduce inflammation by suppressing the immune system. They can be taken orally, rectally (as suppositories), or intravenously. They give the intestines time to heal, but they don’t fully heal the colon’s inflamed layers and can cause many side effects, especially for children and adolescents. For these reasons, they’re usually not used long-term and are typically reserved for moderate to severe flare-ups.
Budesonide, an oral corticosteroid, has fewer body-wide side effects because it acts mainly in the large intestine, but is overall less effective.
Rectal
IV
- Acne
- Increased appetite
- Weight gain and facial roundness
- Mood changes, including irritability
- Difficulty sleeping
These mostly appear with longer-term or repeated use — short courses (a few days or weeks) are less likely to cause problems. Your medical team will monitor you and explain what to watch for.
Antibiotics
Used in specific situations
Antibiotics are sometimes used in specific situations — for example, when there’s a suspected infection alongside UC, or for certain complications. They’re not a routine UC treatment. Your medical team will explain if and when they’re needed.
5-ASA (5-Aminosalicylates)
Mesalazine, Mesalamine — mild to moderate UC and maintenance
5-ASA medications help reduce inflammation and heal the intestinal tissues. They are used for mild to moderate flare-ups and for maintaining remission. These medications come in pill form as well as suppositories or enemas.
Rectal
Biologics
Targeted treatments for moderate to severe UC
Biologics are protein-based medicines made using specially designed cells in a lab. The medicine itself is a purified protein, given as an injection or infusion. Biologics target specific proteins in your immune system to block inflammation, and they have been effective in healing the intestinal tissue and maintaining remission, especially in moderate to severe cases.
The types of biologics include:
Anti-TNF medications (anti-tumor necrosis factor)
- Infliximab (Remicade) — given by infusion.
- Adalimumab (Humira) — given by injection.
- Golimumab (Simponi) — given by injection; sometimes used if other biologics are unsuccessful and in steroid-dependent patients.
Integrin receptor antagonists
- Vedolizumab (Entyvio) — gut-selective, so it has a different safety profile than other biologics; used in moderate to severe UC.
Interleukin-12/23 inhibitors
- Ustekinumab (Stelara) — given by injection.
Injection
Immunomodulators
Adjust the immune system’s response
Immunomodulators “modulate” or change the immune system’s response. They can either boost a body’s immune response (immunostimulators) or suppress it (immunosuppressants). In UC and other autoimmune diseases, they are used to suppress the immune system. They are often prescribed in moderate to severe cases, especially when biologics aren’t as effective as needed.
Types of immunomodulators include:
- JAK Inhibitors (Rinvoq, Xeljanz) — oral medication, used when biologics are insufficient.
- Thiopurine (Azathioprine/Azasan and Mercaptopurine/Purinethol) — usually oral medication (rarely injection); can take months to become effective.
- Ozanimod (Zeposia) — oral medication.
- Etrasimod (Velsipity) — oral medication.
Cyclosporine (Sandimmune, Neoral)
Reserved for severe cases, short-term support
Cyclosporine is usually reserved for severe UC cases and isn’t given long-term, due to potentially serious side effects, including effects on kidney function and blood pressure. It’s often used to temporarily support treatment until other medication takes effect.
Symptomatic Relief Medication
Aside from the medication listed above, ulcerative colitis treatment might include some kind of “symptom-relief” medication. This can include pain relievers or antispasmodics for cramps, among others.
- Anti-diarrheal medication usually isn’t recommended in UC — it can paralyze the colon muscles and cause serious complications such as toxic megacolon.
- NSAIDs like ibuprofen are usually avoided because they can trigger or worsen flares. Acetaminophen (Tylenol) is usually preferred for everyday pain.
- Always check with your medical team before starting a new pain reliever or over-the-counter medication.
Complementary Medication
Complementary medications are those you might take regularly alongside your UC medication but aren’t considered UC-specific medication.
- You may be prescribed supplements such as Vitamin D, Vitamin B12, folate, or iron — depending on any deficiencies found in your blood work.
- You could also be prescribed H2 blockers, like omeprazole, to reduce the risk of stomach inflammation, especially if you are taking corticosteroids or antibiotics.
- Some people also take fish oils or probiotics.
- If you’re having trouble keeping your weight up, your team may suggest nutrition shakes or other supplemental enteral nutrition.
- In some cases your medical team might suggest trying CurQD, an herbal medication which has shown some beneficial effects, especially in moderate to severe cases.
Surgery
Most children and adolescents with UC won’t need surgery. Modern medications have made surgery less common than it used to be — but it’s still an option when other treatments don’t work or for serious complications.
A hospital stay might be necessary during severe flare-ups if you are dehydrated, severely anemic (lacking blood), or you need intravenous medication.
Regular Monitoring
After being diagnosed with ulcerative colitis, you’ll meet with your medical team regularly. The frequency depends on how stable your condition is — whether you are in remission or trying out new medications.
🔍 Monitoring may include:
- Stool tests to check for infection (calprotectin)
- Regular blood tests to check for infections or deficiencies
- Other tests, based on the medication you are taking
- Less frequently, colonoscopies on an outpatient basis
Stress-Reduction
Finding ways to reduce stress is a good idea. Try regular exercise, talking with others about what frustrates or worries you, or practicing relaxation techniques.
TeenHealthInsight is a health education resource — not a substitute for medical advice, diagnosis, or treatment from your doctor or gastroenterologist.