Medical treatments can help manage UC pain and improve your overall well-being. A doctor may recommend a combination of medications, dietary changes, and other complementary therapies.

Understanding your triggers can also give you an idea of what to avoid to help calm your symptoms. Speak with your doctor if your treatment is not working.

Treatment might include medications along with various lifestyle changes, depending on your specific symptoms and the type or severity of UC.

Over-the-counter (OTC) medications

If you have mild pain, OTC medications like acetaminophen (Tylenol) may be enough to relieve it.

However, it’s best to avoid pain relievers like nonsteroidal anti-inflammatory drugs (NSAIDs), because they can upset the stomach, triggering flare-ups or worsening existing diarrhea.

Prescribed anti-inflammatories

Inflammation is the cause of most UC-related pain. Your doctor can help determine which medication might best reduce inflammation, depending on which part of your colon is affected and your symptoms.

Anti-inflammatory drugs can be taken by mouth as tablets or capsules. Alternatively, healthcare professionals can administer them through suppositories, enemas, or intravenous (IV) injections.

You may need to try more than one type of anti-inflammatory drug before you find one that best eases your symptoms.

Corticosteroids, such as prednisone and hydrocortisone may help; however doctors generally recommend using these in the short term only before transitioning to other medications, due to potential side effects.

Amino salicylates can also help reduce inflammation and pain. These include:

  • mesalamine (Asacol, Lialda, Canasa)
  • sulfasalazine (Azulfidine)
  • balsalazide (Colazal, Giazo)
  • olsalazine (Dipentum)

Immunomodulators

Doctors may prescribe immunomodulators alone or alongside anti-inflammatory medications. These drugs help lower pain by preventing your immune system from triggering inflammation. There are several types, including azathioprine (Azasan, Imuran) and mercaptopurine (Purixan).

However, they may cause serious side effects, including pancreatitis and a lowered ability to fight off serious infections and some cancers, such as skin cancer. Doctors will closely monitor you while you take them and have you undergo regular testing as needed.

Biologics

Biologics are a type of immunomodulator. One type, anti-TNF alpha medications, is now a first-line treatment for moderate to severe UC.

Biologics are also used where other therapies have not been successful. They help stop pain by inactivating a protein produced by the immune system. One type of anti-TNF alpha biologic is infliximab (Remicade).

Another type of biologic is integrin receptor antagonists. These include vedolizumab (Entyvio), which has been approved to treat UC in adults.

However, treatment with biologics carries an increased risk of infection. They can also cause reactivation of tuberculosis (TB) and hepatitis B infections.

Janus kinase (JAK) inhibitors

JAK inhibitors are oral medications that block a specific enzyme involved in inflammation.

JAK inhibitors, such as tofacitinib (Xeljanz) and upadacitinib (Rinvoq), can be effective in treating moderate to severe UC in instances where biologics are not effective.

Food doesn’t generally cause UC flare ups, but you might find certain foods may worsen your existing pain or cramping when your symptoms are flaring.

Common foods that people with UC typically avoid during an active flare up include:

  • dairy products high in lactose, such as milk
  • high fat foods, such as greasy or fried items, beef, and sugary, high fat desserts
  • processed foods, such as frozen dinners and boxed rice
  • high fiber foods, such as whole grains
  • gas-producing vegetables, such as Brussels sprouts and cauliflower
  • spicy food
  • alcoholic drinks
  • caffeinated beverages, such as coffee, tea, and cola

It may also help to eat several small meals a day rather than three large ones.

Additionally, staying adequately hydrated may put less strain on your digestive system, produce less gas, and help bowel movements pass more smoothly.

If you make dietary changes, do so under the guidance of your doctor to make sure you still get all the nutrients you require.

Once thought to cause UC, stress may trigger UC flare-ups in some people. Managing and reducing stress may help ease UC symptoms, such as pain.

Different stress-management techniques work for different people. You might find that a simple walk in the woods or deep-breathing exercises benefit you the most. Yoga, mindfulness meditation, and physical exercise may also help reduce stress.

A 2019 review found that mindfulness interventions can be effective in relieving stress and depression and improving the quality of life in people with IBD. However, it didn’t lead to significant symptom relief, and more research specific to UC is needed.

In certain cases, surgery may be the best way to treat UC and its pain. There are two different options for surgery to manage severe UC. Both options have pros and cons that you can discuss with your doctor.

Proctocolectomy with end ileostomy

Also known as a full proctocolectomy, this surgery requires the removal of the entire colon, rectum, and anus.

A surgeon then creates a stoma using the end of the small intestine to remove waste from the body.

Proctocolectomy with J-pouch formation

J-pouch surgery requires the removal of your entire colon and rectum.

During this surgery, a pouch constructed from the end of your small intestine is attached to your anus. This allows for relatively usual waste elimination to occur without the need to wear an external bag.

Some people try alternative treatments such as acupuncture or supplements like creatine to see if they help manage their UC pain.

Another alternative therapy, moxibustion, is a heat therapy that has been studied as a combination treatment with acupuncture to ease UC symptoms. It uses dried plant materials burned in a tube to warm the skin, often in the same areas targeted by acupuncture. However, research so far on acupuncture and moxibustion therapy is not robust.

Speak with your doctor before trying alternative remedies or supplements. And it may be worth discussing new or off-label medications with your doctor to help better manage your symptoms.

UC pain can range from mild to severe, depending on your particular circumstances. You may experience long periods of symptom remission, followed by flare-ups in which symptoms return or worsen.

Medication can help reduce flare-up symptoms and lengthen the duration of remission. Diet, exercise, stress management, and other alternative therapies may help.

If you’re experiencing pain due to UC, talk with a doctor about new medications or medication changes, as well as other potential options to help manage your pain.