Ulcerative colitis (UC) is a chronic inflammatory disease that affects the colon, causing symptoms such as bloody diarrhea and fatigue. If you live with UC, your healthcare provider may prescribe steroids, also called corticosteroids, to treat inflammation in the digestive tract. The goal of treatment is to resolve symptoms and maintain remission, or a period of no symptoms.

Steroids typically treat short-term flare-ups of UC effectively. However, long-term use of steroids can have negative side effects. This article discusses how to use steroids for UC, and lifestyle changes that can help relieve symptoms.

Why Take Steroids for Ulcerative Colitis? 

Taking steroids for ulcerative colitis is an effective way to reduce symptoms in the short term. They are 80% effective at achieving a reduction in symptoms and 50% effective at putting the disease into remission.

However, due to the risks of long-term steroid use, they’re most effective for short-term flare-ups when symptoms are at their worst.

Steroids for Ulcerative Colitis Treatment 

Steroid use is often one part of the treatment plan for ulcerative colitis.

Most healthcare providers will prescribe steroids to treat a flare-up of symptoms, then work to lower the dose as early as possible. This helps avoid negative side effects such as dependence, weight gain, and effects on blood sugar regulation.

How Do Steroids Work?

Steroids work by stopping the production of certain chemicals in the body that produce inflammation.

The body naturally produces steroid hormones in the adrenal cortex. The adrenal cortex produces certain hormones to regulate a variety of bodily functions, such as the fight-or-flight response and the inflammation response.

Corticosteroids mimic these natural hormones to produce anti-inflammatory effects.

Taking Steroids for Ulcerative Colitis

The two most common ways to take steroids for ulcerative colitis are orally and rectally. For some hospitalized patients, intravenous (IV) steroids might be prescribed.

Corticosteroids vs. Anabolic Steroids

Though corticosteroids are referred to as steroids, they are not the same as the steroids some athletes use for performance enhancement. These steroids, known as anabolic steroids, are human-made versions of testosterone. Taking corticosteroids for UC does not have any testosterone-producing effects on the body.

The most commonly used oral steroids are prednisone and budesonide.

Prednisone

Prednisone works by changing the way the immune system functions and by reducing inflammation.

The main side effects of prednisone include, but aren’t limited to:

  • Weight gain
  • Increased appetite
  • Mood swings
  • Depression
  • Fatigue
  • A puffy face caused by more fat, known as “moon face”
  • Difficulty sleeping

Though these side effects can be experienced by both men and women, women tend to feel these negative effects more often than men.

Budesonide

Budesonide is another oral corticosteroid that is used for mild to moderate UC. Budesonide has less widespread effects on the body and is more focused on the GI tract.

Both prednisone and budesonide are effective in treating UC, but since there are fewer side effects associated with budesonide, it may be preferred.

Side effects of budesonide include, but aren’t limited to:

  • HeadacheDizzinessRunny nose, sneezing, coughingNauseaIndigestionBack painFatigue

These side effects can be experienced by both men and women.

Rectal Steroids

Rectal steroids are used when the affected part of the colon is closer to the anus. In this case, the steroids can be administered rectally so that they can work on the affected areas directly. This topical approach reduces the risk of full-body side effects that are common with oral steroids.

Rectal steroids come in suppository, enema, and rectal foam preparations.

Common rectal steroids include, but aren’t limited to:

  • Hydrocortisone in suppository, enema, and rectal foam formCortenema and methylprednisolone in enema form onlyUceris (budesonide foam) and Proctofoam-HC in rectal foam form

Managing Ulcerative Colitis Long Term

While corticosteroid use is a common treatment for UC, it is best used for controlling acute flare-ups and bringing UC into remission. Long-term use of prednisone can be dangerous and may not help to control UC over time.

To manage UC long term, there are other options.

What Is Considered Long-Term Prednisone Use?

Long-term prednisone use is the use of the medication for more than a month.

Using prednisone long term can have adverse effects. The longer the treatment time, the more negative side effects can be expected.

Long-term use of corticosteroids can cause other conditions, such as diabetes, cataracts, high blood pressure, and osteoporosis.

To manage UC long term, talk to your healthcare provider about other options for controlling your disease.

Alternatives to Prednisone

Though corticosteroids are an effective treatment option in the short term, it’s important to know alternative options.

Several medications can be used to treat UC long term. These include, but are not limited to:

  • 5-aminosalicylates (5-ASA) such as sulfasalazine, mesalamine, and olsalazineImmune system suppressors or immunomodulators such as azathioprine, cyclosporine, and tacrolimusBiologics such as adalimumab, golimumab, and infliximab

In some cases, surgery to treat UC may be necessary. Approximately 20% of people with UC will need surgery to treat the disease at some point.

Surgery main be needed for those who have stopped responding to treatment, have developed cancer, or have an emergency situation such as severe bleeding or toxic megacolon.

The most common type of surgery is a restorative proctocolectomy with ileal pouch-anal anastomosis (IPAA), which involves removing all or part of the colon and restoring bodily function.

Lifestyle Changes for Ulcerative Colitis 

While medical treatment can help control UC and keep it in remission, changing certain lifestyle factors can also help you live well with the disease.

These changes can help lessen the severity of UC. If your UC does worsen, being continuously monitored by your healthcare team can boost chances of early detection and improve colon cancer survival rates.

Lifestyle changes you can consider making include:

  • Having regular cancer screening via colonoscopySeeing your gastroenterologist annually, or more often as neededEating a diet that is high in vegetables, fruits, and whole grainsLimiting dairy product intakeReducing your intake of red meat and processed meats, which are connected to risk of colorectal cancerLimiting alcohol intake or avoiding it altogetherDrinking a lot of liquids, all day longEating smaller meals throughout the dayExercising regularlyReducing stress

Summary

Corticosteroids are a common type of medication used to treat ulcerative colitis. However, they can have negative side effects when used on a long-term basis. There are alternative treatment options for UC, including other types of medications, surgery, and lifestyle modifications.

A Word From Verywell

Living with UC requires work to manage the disease. While steroids can be an important part of your treatment plan to help you reach and maintain remission, it’s important to talk to your healthcare provider about other treatment options and lifestyle changes you can make. These can improve your quality of life while living with the disease, as the negative effects of long-term steroid use can be consequential.

Frequently Asked Questions

  • Is prednisone a corticosteroid?
  • Prednisone is a corticosteroid that lowers inflammation in the body.
  • How long can you take steroids for ulcerative colitis?
  • Though steroids can be used long term, it’s not advisable as negative side effects become more common. Most healthcare providers will work to keep steroid treatment to the minimum time necessary to achieve results.
  • What is the most effective medication for ulcerative colitis?
  • Each person with UC has a different course of disease, and it’s important to talk to your healthcare provider to find the most effective medication for you.
  • Are there any new treatments for ulcerative colitis?
  • Although treatment for UC used to be limited to steroids, over the last two decades more medications have been developed to treat the disease.

Prednisone is a corticosteroid that lowers inflammation in the body.

Though steroids can be used long term, it’s not advisable as negative side effects become more common. Most healthcare providers will work to keep steroid treatment to the minimum time necessary to achieve results.

Each person with UC has a different course of disease, and it’s important to talk to your healthcare provider to find the most effective medication for you.

Although treatment for UC used to be limited to steroids, over the last two decades more medications have been developed to treat the disease.