Conventional Treatment:

The main stay of conventional treatment is medicines for the patients. In severe cases, a patient may need surgery to remove the diseased colon.

Medicines:

1. 5-AS or aminosalicylates: Most patients with mild or moderate disease are first treated with 5-ASA agents such as sulfonamide, sulfapyridine, salicylate, mesalamine, etc. These medicines help control inflammation. Sulfasalazine is the most commonly used of these drugs.

a. Possible side effects of 5-ASA preparations include nausea, vomiting, heartburn, diarrhea, and headache.

b. Sulfasalazine interferes with the absorption of folic acid, a water-soluble vitamin. This may be a vital point in terms of risk for colon cancer.

c. Sulfa medications used to treat UC can affect sperm count or motility and lead to temporary infertility. This is especially important if you are trying to begin or broaden your family.

d. Skin problems may be side effects of some drugs used to treat IBD. Sulfasalazine (Azulfidine®), used in the treatment of both ulcerative colitis and Crohn's disease, may cause an allergic-type skin rash.

2. Steroids: People with severe disease and those who do not respond to mesalamine preparations may be treated with corticosteroids. Prednisone, hydrocortisone, Budesonide are the corticosteroids used to reduce inflammation.

Corticosteroids can cause side effects such as:

a. Weight gain, acne, facial hair, hypertension, mood swings, and increased risk of infection

b. Corticosteroids, when taken daily in high doses, can decrease intestinal absorption of calcium and phosphorus, increase urinary losses of vitamin C, calcium, potassium, zinc, and nitrogen, and cause excessive breakdown of protein. They also can cause fluid retention, an effect that can be counteracted by a low-salt diet.

c. People who suffer from inflammatory bowel disease (IBD) may incur an additional risk for osteoporosis if they use corticosteroids (e.g., prednisone) for a prolonged period.

Please click here to read more about the adverse effects of Cortisone.

3. Immune System Suppressors: An overactive immune system is probably important in causing ulcerative colitis. Certain drugs such as azathioprine (Imuran), 6-MP (Purinethol), cyclosporine (Neoral, Sandimmune), and methotrexate (Rheumatrex) suppress the immune system and at times are effective.

However these drugs are not short of side effects:

Cholestyramine may cause poor absorption of the fat-soluble vitamins (A, D, E, and K), as well as folic acid, vitamin B-12, calcium, and iron. This is of particular concern since folic acid helps regenerate tissue and prevents transformation of chronically inflamed tissue to cancer. Other drugs may be given to relax the patient or to relieve pain, diarrhea, or infection.

Surgery:
For patients with longstanding disease that is difficult or impossible to control with medicine, surgery is the option. About 25 percent to 40 percent of ulcerative colitis patients must eventually have their colons removed. This procedure is called a colectomy. If the colon is removed, the small intestine leads to a stoma (opening on the abdomen or ‘tummy area’) for emptying of liquid stool (feces). This is curative but leaves the patient with an ileostomy- an abdominal opening with a disposable bag for stool collection. Alternatively, a replacement colon (ileo-anal pouch) is created by the surgeon reshaping the end of the small intestine.

One of several surgeries that may be done:

1. The most common surgery is a proctocolectomy with ileostomy, which is done in two stages. In the proctocolectomy, the surgeon removes the colon and rectum. In the ileostomy, the surgeon creates a small opening in the abdomen, called a stoma, and attaches the end of the small intestine, called the ileum, to it. This type of ileostomy is called a Brooke ileostomy. Waste will travel through the small intestine and exit the body through the stoma. The stoma is about the size of a quarter and is usually located in the lower right part of the abdomen near the beltline. A pouch is worn over the opening to collect waste, and the patient empties the pouch as needed.

2. An alternative to the Brooke ileostomy is the continent ileostomy. In this operation, the surgeon uses the ileum to create a pouch inside the lower abdomen. Waste empties into this pouch, and the patient drains the pouch by inserting a tube into it through a small, leakproof opening in his or her side. The patient must wear an external pouch for only the first few months after the operation. Possible complications of the continent ileostomy include malfunction of the leakproof opening, which requires surgical repair, and inflammation of the pouch (pouchitis), which is treated with antibiotics.

The point to ponder is that surgery may not be appropriate for every person. Which surgery has to be done depends on the severity of the disease and the patient's needs, expectations and lifestyle.