Is Your Ulcerative Colitis Treatment Effective?
First, you should know what effective treatment looks like. “Your treatment is successful if you are able to form stools without bleeding, cramping, or urgency,” says Sunanda V. Kane, MD, a gastroenterologist and professor of medicine at the Mayo Clinic in Rochester, Minnesota, and a member of the Crohn’s and Colitis Foundation’s education committee. There are two components of effective treatment: controlling symptoms and maintaining that control. Both are important parts of truly successful treatment. “The goals of therapy include to induce clinical remission, to alleviate or greatly reduce symptoms, and to prevent damage from untreated disease over time,” says Jessica Philpott, MD, PhD, a gastroenterologist at the Cleveland Clinic in Ohio. “Basically, the goal is to minimize the impact of the disease on you in a way that works best for you and to help you live the life you want to live.” There are five classes of medications used to treat ulcerative colitis:
Signs Your Ulcerative Colitis Treatment Isn’t Working
After a while on one treatment plan, you may find that your medication doesn’t work as well as it used to. Dr. Philpott says that an increase in your bowel movements, trouble or pain passing stool, weight loss, fevers, blood in stool, and fatigue could be signs that it’s time to discuss a change with your doctor. But she cautions, “It is important to be aware that sometimes these symptoms can occur for a different reason. That is why your healthcare provider should do some tests when this occurs, to identify what is causing the problem.” According to Kane, “If you are feeling worse on the medication than off it, it is time to have a discussion with your doctor.” Don’t be afraid to speak up. “Your doctor assumes everything is okay unless you say something,” she says. Her recommendation is to start by saying something like, “I’m not sure that my medicine is doing what it’s supposed to,” and then going into detail about your symptoms. Your doctor will appreciate your honesty, she adds. Philpott says it’s also important to be prepared going into your appointment. “Things to discuss with your healthcare provider would be what the specific symptoms are, when they started, and if [you] notice a fluctuation over time.” For example, she says, if you’re taking an injection and notice that symptoms start recurring before you’re due for the next injection, that’s important to note. Tell your doctor about any new medications you may be taking, including those that are over-the-counter, as well as any other new symptoms you’re experiencing. Finally, “being able to report how many bowel movements [you have] a day and at night, and how this has changed from your baseline, will be important,” Philpott says.
How Your Doctor Will Assess Your Current Treatment Plan
Your doctor will likely want to rule out other possible causes of your symptoms. At your appointment, you’ll be assessed to see if the symptoms are the result of a UC flare, an infection, or another condition like irritable bowel syndrome, explains David P. Hudesman, MD, a gastroenterologist and the codirector of the inflammatory bowel disease center at NYU Langone Health in New York City. Tests you may undergo include blood tests, stool studies, and a colonoscopy, he says. One possible reason for worsening symptoms is that you’re not taking your medication exactly as prescribed. A study published in March 2019 in the journal PLoS One found that about 50 percent of patients with UC did not take their medications correctly. Those who were under 40, smoked, and drank alcohol were more likely not to adhere to their treatment plan properly. Research published in the journal Inflammatory Bowel Diseases found that more than 60 percent of patients admitted to not taking their medication as directed. Reasons included too many pills, too frequent dosing intervals, not wanting to use rectal applications, and simply forgetting. If none of these are factors, your doctor will need to determine why your symptoms flared. Sometimes, a patient may experience a loss of response to a medication, having built up a resistance to it, Dr. Hudesman explains. Once your doctor figures out what’s going on, any changes to your ulcerative colitis treatment plan will be discussed.
Options for Adjusting Treatment
If your doctor feels it’s appropriate to adjust your treatment plan, they may increase the dose of your medication, change the interval between treatments, or try a different drug. Your doctor may also suggest a short course of steroids to control your flares. “But there has to be an exit strategy [from steroids],” Kane says. That strategy could be getting you back on the medicine you were taking previously or starting a new one. Steroids aren’t a long-term solution. RELATED: The Pros and Cons of Taking Steroids for Ulcerative Colitis If none of the drugs control your inflammation and keep you in remission, surgery to remove your colon may be the next step. Surgery for UC is often curative. “The important thing to understand is that nowadays we have many medical and surgical options, so do not give up hope if your UC is difficult to control. And contact your healthcare team to discuss treatment options,” Philpott says.
It’s Important to Stay the Course
Never stop your ulcerative colitis medication unless directed by your doctor. Adhering to the treatment that was prescribed to you decreases your chances of a flare and reduces your risk of colon cancer. If you’re in remission and have been doing well for a long time, then you might talk to your doctor about reducing your medication dosage and changing your dosing schedule.
