Key takeaways
- Remission in ulcerative colitis means symptoms are reduced or gone. It may also mean that the colon lining has healed, biomarkers are healthy, or that cells look typical under a microscope.
- A person can achieve remission through medications that manage colon inflammation. Maintaining remission requires continuous medication use, even without symptoms, to prevent flare-ups.
- Stress management, regular exercise, and avoiding trigger foods can help maintain remission. Supplements such as vitamin D, probiotics, and curcumin may also help, but a person should discuss taking any new supplements with a doctor first.
The goal of medical treatment for ulcerative colitis (UC) is to reach and maintain remission.
This article outlines medications, lifestyle changes, and dietary adjustments that may help people maintain remission and prevent UC flare-ups.
Remission for people with UC means that medications have reduced inflammation in the colon to the point where there are no symptoms.
The length of remission can vary 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, 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 recur, leading to symptom recurrence and the development of scar tissue. A 2025 study also suggests that if an individual stops taking their medication and then tries to start again, it may not work as well the next time.
There are several types of remission for people with UC:
- Clinical remission: This usually means that the symptoms of UC are gone and bowel movements occur at a typical frequency.
- Biomarker remission: This means the inflammatory biomarkers that can indicate UC have returned to healthy levels.
- Endoscopic remission: This means the colon lining appears typical during a colonoscopy.
- Histologic remission: Histologic, or deep remission, occurs when a colonoscopy and biopsy do not show inflammation. People in this remission have a lower risk of hospitalization. A 2020 review also found that people in deep remission had a significantly lower risk of relapse than people in clinical remission.
Some doctors may refer to the completion of all these milestones as “complete remission”. However, there are no standardized definitions for each type, so doctors and researchers can use these terms slightly differently.
Treatments that may help achieve or maintain UC remission include:
Aminosalicylates
Aminosalicylates are drugs that reduce inflammation in the colon. They can treat mild to moderate UC.
Common aminosalicylates include sulfasalazine and mesalamine. However, not everyone tolerates sulfasalazine, and both can sometimes cause side effects, such as stomach pain or headaches.
Corticosteroids
Corticosteroids are fast-acting anti-inflammatories. Doctors sometimes prescribe them to treat UC flare-ups. Most people notice an improvement in symptoms within days of taking corticosteroids.
However, these drugs can have serious side effects, especially with prolonged use. Doctors should only use them as a temporary measure.
Immunomodulators
Immunomodulators are medications that modify the immune system, decreasing the body’s inflammatory response.
Unlike corticosteroids, immunomodulators can help people maintain long-term remission. Doctors may use these when other options are not suitable or do not work.
Another type of drug, known as targeted synthetic small molecules, also modifies parts of the immune system. Doctors use these for moderate to severe UC.
Biologics and biosimilars
The term “biologics” refers to drugs that the body or another organism naturally produces. Biosimilars are almost identical to these and have similar levels of effectiveness.
For people with UC, biologics can help reduce harmful gut inflammation. They can also help a person reach and maintain remission.
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.
A doctor may be able to recommend a form of talk therapy or mindfulness meditation to help relieve stress.
Exercising
A 2019 review of past research notes that exercise can help to modulate the immune system. Aerobic exercise, in particular, may increase beneficial gut bacteria that produce the compound butyrate, which strengthens the intestinal barrier.
That said, a
Confirming whether exercise can help maintain remission in colitis will require further research.
Avoiding certain pain relievers
Some over-the-counter or prescription pain medications
A safer alternative that people with UC may be able to take is acetaminophen (Tylenol).
Identifying and avoiding trigger foods
According to the Crohn’s and Colitis Foundation (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 daily to look for a pattern.
If someone suspects a particular food is worsening their UC symptoms, they can also try temporarily eliminating it from their diet and see whether symptoms improve.
However, it is vital not to restrict the diet unnecessarily, as this can lead to other health conditions. If a person reacts to lots of foods or cannot tell if they have food triggers, it may help to work with a dietitian.
Taking supplements
The following supplements may help maintain UC remission:
Vitamin D
A 2019 review of 55 observational studies found that low vitamin D levels are common among people with UC or Crohn’s disease. More than half the participants had insufficient levels.
Some scientists have speculated that vitamin D supplementation may improve UC symptoms because it helps maintain a healthy gut lining. However, there is currently a need for more high quality trials to verify this.
Nevertheless, vitamin D is important for preserving overall health and preventing osteoporosis, which
Probiotics
In a
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
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.
UC remission rates vary by drug and population. However, in a 2022 study of 180 newly diagnosed people with UC, 76.7% reached clinical remission, 62.8% reached histologic remission, and 42.2% reached complete remission after 3 months of conventional treatment.
The study included people taking 5-aminosalicylates, corticosteroids, azathioprine, or a combination of these.
There is no known cure for UC. However, with treatment, a person may not experience symptoms for months or even years.
Prescription medications and some lifestyle and dietary changes can help people with UC maintain remission. A person is likely to benefit from:
- managing stress
- exercising regularly
- taking care to avoid food triggers
Certain supplements may also help prevent UC flare-ups or reduce the risk of complications, such as vitamin D deficiency. Anyone interested should speak with a doctor about adding these supplements to their treatment plan.