If left untreated, the pain associated with ulcerative colitis can make it hard to work, exercise, or enjoy daily activities. Managing the disease with medication, stress reduction, and diet can help to manage and reduce pain.
Ulcerative colitis (UC) is a type of inflammatory bowel disease that can cause varying levels of pain.
UC is caused by chronic, long-term inflammation that leads to open sores known as ulcers in the innermost lining of your colon, or large intestine, and rectum. Having a higher level of pain can be a sign that the disease is flaring up or even getting worse.
How much inflammation you have in your colon and where it’s located can determine where you’re likely to feel pain. This pain may include abdominal cramping and mild to severe pain in the abdomen and rectum. The pain may be long-lasting or it may fade when the inflammation recedes.
Long periods of remission between flare-ups are common. During remission, your symptoms may decrease or disappear completely.
People with mild UC may experience pressure and cramping. As the disease progresses, as inflammation and ulcers in your colon increase, the pain may manifest as feelings of gripping or extreme pressure that tightens and releases over and over again.
Gas pain and bloating may also occur, which can make the sensation feel worse.
If you have a type of UC known as left-sided ulcerative colitis, your left side may also feel tender to the touch.
The pain associated with UC can diminish your overall quality of life. If you have chronic, unmanageable pain at any level, consider discussing the following treatment options with a doctor so that you can feel better.
Treatment can also get you back into the swing of your day-to-day activities. A doctor may recommend a combination of medications, dietary changes, and other complementary therapies to help manage your UC pain.
If you have mild pain, over-the-counter (OTC) medications such as acetaminophen (Tylenol) may be enough to help you feel relief.
If you have ulcerative colitis, avoid nonsteroidal anti-inflammatory drugs (NSAIDs). These OTC drugs shouldn’t be taken for UC pain, as they can cause flare-ups and make other symptoms, such as diarrhea, worse.
Medications to avoid can include:
- ibuprofen (Motrin IB, Advil)
- aspirin (Bufferin)
- naproxen (Aleve, Naprosyn)
Inflammation is the root cause of most UC-related pain. Certain medications can help reduce inflammation in your colon. A doctor can help you decide which kind is right for you based on which part of your colon is affected and your pain level.
Anti-inflammatory medications that may help can include corticosteroids, such as prednisone and hydrocortisone.
Amino salicylates are another class of anti-inflammatory medication. These are sometimes prescribed for UC pain. There are many kinds, including:
- mesalamine (Asacol, Lialda, Canasa)
- sulfasalazine (Azulfidine)
- balsalazide (Colazal, Giazo)
- olsalazine (Dipentum)
Anti-inflammatory drugs can be taken orally as tablets or capsules or be administered through suppositories or enemas. They can also be given intravenously. Most anti-inflammatory medications can cause side effects of varying kinds.
You may need to try more than one type of anti-inflammatory drug before you find one that is the best fit for your symptoms. Each medication is sold under a number of brand names.
Immunosuppressant drugs may be prescribed alone or in addition to anti-inflammatory medications. They reduce pain by working to stop your immune system from triggering inflammation. There are a number of different types, including:
- azathioprine (Azasan, Imuran)
- mercaptopurine (Purixan)
- cyclosporine (Sandimmune)
Immunosuppressant medications are typically used in people who don’t respond well to other types of drugs and are meant for short-term use. They can be damaging to the liver and pancreas.
They may cause serious side effects, including a lowered ability to fight off serious infections, and some cancers, such as skin cancer. Cyclosporine has been linked to fatal infections, seizures, and kidney damage.
Biologics are another type of immunosuppressant medication. One type of biologic is tumor necrosis factor alpha inhibitors (TNF-alpha).
Anti-TNF alpha medications are now first-line treatments for people with moderate to severe UC. They’re typically reserved for people who haven’t had success with other therapies. They help stop pain by nullifying a protein produced by the immune system. One type of anti-TNF alpha medication is infliximab (Remicade).
Integrin receptor antagonists are another form of biologics. These include vedolizumab (Entyvio), which has been approved to treat UC in adults.
Biologics have been linked to serious forms of infection and tuberculosis.
Janus kinase (JAK) inhibitors
JAK inhibitors are oral medications that block a specific enzyme involved in inflammation. They can be effective in treating moderate-to-severe UC in instances where biologics are not effective. JAK inhibitors can include tofacitinib (Xeljanz) and Rinvoq (upadacitinib).
What you eat won’t cause UC, but certain foods may exacerbate your symptoms and can cause additional cramping and pain. Keeping a food diary can help you identify any food triggers you may have.
Common foods that people with UC typically avoid can 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 help to eat several small meals a day rather than three large ones. You should also try drinking lots of water — at least eight 8-ounce glasses a day. This may put less strain on your digestive system, produce less gas, and help bowel movements move through your system smoothly.
Once thought to cause UC, stress may be a trigger for UC flare-ups in some people. Managing and reducing stress may help alleviate UC symptoms, such as inflammation, and pain.
Different stress-management techniques work for different people, and you might find that a simple walk in the woods and deep breathing are what benefit you the most. Yoga, mindfulness meditation, and exercise may also help reduce stress in some people with UC.
A 2019 review of research found that mindfulness interventions can be effective in relieving stress and depression and improving the quality of life in people with inflammatory bowel disease (IBD). However, it didn’t lead to significant symptom relief. More research specific to UC is needed.
In extreme cases, surgery may be the best way to eliminate UC and its pain. There are two different options for surgery to manage severe UC. Both options have pros and cons so it is best to discuss them with a 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 forms a stoma using the end of the small intestine so that waste can be removed from your body.
Proctocolectomy with J-pouch formation
This surgery requires the removal of your entire colon and rectum.
During surgery, a pouch constructed from the end of your small intestine is attached to your anus. This allows for relatively normal waste elimination to occur, meaning you won’t have to wear an external bag.
Alternative treatments such as acupuncture may help reduce and regulate bowel inflammation, reducing UC pain.
Another form of alternative treatment called moxibustion may also have a positive effect on UC symptoms. Moxibustion is a type of heat therapy. It uses dried plant materials burned in a tube to warm the skin, often in the same areas targeted by acupuncture.
Depending on the severity of UC symptoms, pain can range from mild to severe. You may experience long periods of remission from these symptoms followed by flare-ups where the symptoms return or worsen.
These symptoms can make it hard to perform your daily activities.
Medication can help reduce the symptoms of flare-ups and lengthen the time of remission. Diet, exercise, stress management, and other alternative therapies may also help.
If you’re experiencing pain due to UC, talk with a doctor about your treatment options to manage the condition and reduce pain.