People with ulcerative colitis (UC) may experience periods of remission. Remission is when the symptoms of UC are reduced or disappear, and the disease does not interfere with a person’s daily life.

The goal of medical treatment for UC is to achieve and maintain remission.

UC is a long-term inflammatory bowel disease (IBD) that affects the large intestine, or colon. In people with UC, the colon becomes inflamed and develops small, pus-producing ulcers.

The symptoms of UC include:

  • abdominal discomfort
  • diarrhea
  • a frequent need to have a bowel movement

This article outlines the medications, lifestyle changes, and dietary adjustments that may help people maintain remission and prevent flare-ups of UC.

woman walking down steps with blue umbrellaShare on Pinterest
Willie B. Thomas/Getty Images

Remission occurs when UC medications manage or resolve inflammation of the colon, leading to improved symptoms.

The length of remission varies from weeks or months to years. If the medications are working and no other factors trigger a flare-up, the disease can remain in remission for a long time.

Even if UC stays in remission for years, it is essential to keep using the medications to help prevent future flare-ups.

If a person stops taking their UC medication, there can be negative consequences. For example, inflammation may return and cause symptoms to reappear, as well as scar tissue to develop. If an individual stops taking their medication and then tries to start again, it may not work as well or at all the next time.

Treatments that may help achieve or maintain UC remission include:

Aminosalicylates

Aminosalicylates are drugs that reduce inflammation in the lining of the colon. They can treat mild to moderate UC.

The two most common aminosalicylates are:

  • sulfasalazine
  • mesalamine

According to the Crohn’s & Colitis Foundation (CCF), around 90% of people who cannot take sulfasalazine can take mesalamine (mesalazine), which has fewer side effects.

Mesalamine is available as:

  • an oral medication
  • a suppository
  • an enema formulation

Current guidelines recommend prescribing one of the following for people with extensive mild to moderate UC:

  • standard-dose mesalamine (2–3 grams per day (g/d))
  • diazo-bonded 5-ASA, such as the prodrugs balsalazide and olsalazine, which convert into mesalamine in the gut

The guidelines recommend these rather than low dose mesalamine (less than 2 g/d), sulfasalazine, or nothing.

However, a doctor might recommend 2–4 g/d of sulfasalazine for the following people, if alternatives are too expensive:

  • those who are already taking sulfasalazine and who are in remission
  • those with prominent symptoms of arthritis

However, sulfasalazine can lead to adverse effects, and not everyone tolerates them well.

Suppositories and enema formulations can target specific parts of the colon and rectum. They may provide extra symptom relief for people who use them alongside oral medications.

Corticosteroids

Corticosteroids are powerful and fast-acting anti-inflammatories. Doctors may prescribe them to temporarily treat UC flare-ups. Most people notice an improvement in symptoms within days of taking corticosteroids.

However, these drugs can have serious side effects, so doctors warn against long-term use.

Immunomodulators

Immunomodulators are medications that modify the immune system, decreasing the body’s inflammatory response.

Unlike corticosteroids, people can use immunomodulators to maintain long-term remission. This may reduce the need for repeated corticosteroid treatments.

Biologics

The term “biologics” refers to any drug that the body or another organism naturally produces.

For people with UC, biologics can help reduce harmful inflammation in the gut. They can also help a person achieve and maintain remission.

Clinical remission

This means that the symptoms, or the majority of the symptoms, of UC are gone.

Endoscopic remission

A person is considered in endoscopic remission if their colonoscopy looks routine.

This type of remission means that a person has a lower risk of recurrent symptoms. However, a colon biopsy may show microscopic disease activity. A person in this type of remission should continue to take the medication their doctor has prescribed.

Histologic remission

Histologic, or deep remission, occurs when a colonoscopy and biopsy do not show inflammation. People in this remission have a low risk of needing surgery or having colon cancer in the future.

People experiencing remission should continue taking medications as recommended by a doctor.

Even if a person has no symptoms, the medications can prevent flare-ups.

The following lifestyle and dietary changes can also help maintain remission:

Managing stress

Many people with UC report that stress causes their symptoms to flare up.

A 2022 study found that people with UC who reported high levels of stress had a 3.6 times higher risk of experiencing a flare-up than those who reported low stress levels.

Similarly, an older 2013 study found that short-term stress may increase the risk of UC relapse among people in remission.

A doctor may be able to recommend a form of talk therapy or mindfulness meditation to help relieve stress.

Exercising

According to a 2018 meta-analysis, regular exercise may have a protective effect against the development of UC. However, the protective effect is not as strong as it is for Crohn’s disease.

The study also found that exercise can have a positive effect on the course of UC. People with UC who engage in regular exercise may experience fewer disease exacerbations and have a better quality of life. Higher levels of physical activity also appear to be associated with a reduced risk of UC relapse.

However, a more recent 2021 study did not find a clear connection between physical activity and the severity of UC symptoms.

Confirming whether exercise can help maintain colitis remission will require more research.

Avoiding certain pain relievers

Some over-the-counter or prescription pain relievers can cause intestinal ulcers. This includes nonsteroidal anti-inflammatory (NSAIDs) drugs, such as ibuprofen and aspirin. This is also the case for COX-2 inhibitors, including the brand Celebrex.

An alternative pain reliever generally recommended to people with IBD is acetaminophen (Tylenol).

Identifying and avoiding trigger foods

According to the CCF, some people with UC experience increased cramping, bloating, and diarrhea after eating certain foods.

Although trigger foods vary from person to person, some common examples include:

  • fatty foods
  • spicy foods
  • sugary foods
  • sugar substitutes
  • alcohol
  • caffeinated drinks
  • foods containing lactose
  • insoluble fibers, which are in raw green vegetables, grains, and most fruits

If UC symptoms seem to worsen after eating certain foods, a person can keep a food diary and record symptoms every day to check for a pattern.

If someone suspects a type of food is worsening their UC symptoms, they can also try eliminating it from their diet and check whether symptoms improve.

Taking supplements

The following supplements may help maintain UC remission:

Vitamin D

Vitamin D may reduce inflammation in the colon. Some researchers estimate that 60–70% of people with IBD have insufficient vitamin D levels.

Participants with low vitamin D also needed more:

  • medications
  • emergency department visits
  • hospital admissions
  • surgeries

The authors also found that participants accessed health services less often after receiving vitamin D supplements.

Probiotics

Research from 2018 suggests that an imbalance in intestinal bacteria may cause the inflammation that occurs in people with UC.

In a systematic review from 2022, researchers found an improvement in disease activity when people with UC received probiotics alongside their standard medication.

Probiotics may help reduce UC symptoms by:

  • preventing the growth of harmful gut bacteria
  • regulating the immune system
  • reducing inflammation in the colon
  • improving the function of the intestinal barrier, which prevents toxins and harmful bacteria from entering the bloodstream

Curcumin

Some plants in the ginger family produce the chemical curcumin.

In a 2020 review, researchers suggest curcumin may be a potentially effective therapy for maintaining or inducing remission in people with UC.

However, they also conclude that results may vary depending on the dose and formulation of curcumin used, as well as the method of administration.

Ultimately, the benefits of curcumin for UC remission require more research.

Below are some commonly asked questions about UC remission.

What is the remission rate for ulcerative colitis?

According to the CCF, in a given year:

  • 48% of people with ulcerative colitis are in remission
  • 30% have mild disease activity
  • 20% have moderate disease activity
  • 1–2% have severe disease

The longer a person with UC remains in remission, the less likely they are going to experience a flare-up in the following year.

Can ulcerative colitis go away completely?

There is no known cure for UC. However, with treatment, it is possible for a person to not experience any symptoms for months, or even years, at a time. This is known as remission.

Prescription medications and some lifestyle and dietary changes can help people with UC maintain remission. A person is likely to benefit from:

  • managing stress when possible
  • exercising regularly
  • taking care to avoid food triggers

Certain supplements may also help prevent UC flare-ups. Anyone interested should speak with a doctor about adding these supplements to their treatment plan.