9 Ways to Know Your Ulcerative Colitis Treatment Isn't Working

There are two main treatment options for ulcerative colitis (UC): medication and surgery. Your doctor will prescribe one or more medications to help calm inflammation in your colon. When there's less swelling, it gives the colon a chance to heal and eases your UC symptoms. Finding the right treatment is often a trial-and-error process. A flare may mean you need a change in your medication dose, how often you take it, or the type. If medication doesn’t work or you have serious symptoms, your doctor could suggest surgically removing all or part of your colon and rectum.

One way to know your treatment may not be working is if your symptoms stay the same. It can take from one week to three months for symptoms to improve when using a medicine for UC. Here's a closer look at how long it can take for different UC medications to start working:

• 5-aminosalicylates (5-ASAs) – One to 12 weeks
• Corticosteroids – A couple of days
• Immunomodulators – Up to 12 weeks
• Biologics – A few weeks
• JAK inhibitors – One to three days
• S1P receptor modulators – As early as two to four weeks 

If you don’t seem to be getting better within these time frames, talk to your doctor.

One sign that your treatment is working well is fewer bloody stools. Usually, someone with mild UC has around four bowel movements a day, sometimes with blood, while those with severe symptoms can have more than six bloody stools a day. Blood in your stool means that there's active inflammation in your body, even if you're not having other symptoms, like belly pain. Medication for UC eases inflammation and lessens symptoms such as diarrhea and bleeding. If you're continuing to have frequent, bloody stools, even after being on medication, contact your doctor to discuss your options.

Treating ulcerative colitis UC involves a "stepwise approach" that takes into account how severe and active your disease is. If your symptoms don't improve with the current dose of a medication, your doctor may be able to increase it, or they may have to add another medication or change the medicine entirely. One study in the U.K. analyzed clinic data to figure out how many patients reached remission and the rate of poor treatment response. Researchers found that one of the most common signs a treatment isn't working is a need to keep increasing the dose.

Diarrhea, bleeding, frequent trips to the bathroom, and a sudden and strong need to have a bowel movement are all symptoms of ulcerative colitis. On a typical (non-flare) day, you could have one to two bowel movements a day, while a flare, or a return of symptoms after treatment success, can trigger up to 10 or more trips to the bathroom a day. You may have to get up during the night to go. If your bowel symptoms haven't improved after you start a medication, or if they get worse while you're on effective medication, it might mean your treatment isn’t working.

Pain, cramping, and bloating are among the most common symptoms of UC. Some medications for UC can actually make these symptoms temporarily worse as a side effect. But if you still have these symptoms regularly while you're taking your medication, it could be a sign that the treatment isn't effective for you.

Doctors often prescribe steroids to quickly ease inflammation and help people with UC get out of a flare. But they're not meant for long-term treatment, and using them too often can cause serious side effects. If you're using steroids a lot, it may mean that other treatments aren't working well to manage your UC. Talk to your doctor about improving your treatment plan.

Fatigue is a common symptom of UC, and it's a side effect of some treatments, including steroids. It can be hard to pinpoint whether fatigue is more extreme than "normal" and a sign that your treatment isn't working. One way is to keep a symptom diary or use a fatigue scale for inflammatory bowel disease (IBD). It can help you find out whether lifestyle changes are affecting your fatigue. Also, talk to your doctor. They can help you find out whether medication, a change in your disease, or something else is causing your fatigue.

Weight loss isn't usually a symptom of UC, but it can happen in some cases. If you take medicine but still have inflammation in your colon, it can cause problems with digesting food and absorbing nutrients and water. This can eventually lead to weight loss. Some IBD medications, including steroids, sulfasalazine, and methotrexate, could also affect your ability to stay properly nourished. If you are losing weight, talk with your doctor to figure out what is causing the weight loss and how to best manage it.

Taking medication for UC can help you feel better and even go into remission. This means you'll have fewer symptoms or none at all for a while. There are two types of remission: partial, or some of your symptoms are better, and complete, meaning you’re symptom-free. Remission can last for weeks or even several years. If you've noticed a change in your remission periods, make an appointment to see your doctor. It could mean your treatment isn't working.

There are tests your doctor can order to help give more insight into whether your UC treatment is working. They include:

• C-reactive protein (CRP). This blood test tracks inflammation in people with UC. Higher CRP levels are usually a sign of a more active disease.
• Fecal calprotectin. This stool test measures how active UC is. People with active UC have higher calprotectin (protein) levels.
• Endoscopy. A colonoscope (lighted tube inserted through your anus) allows doctors to check for disease inside your colon and rectum.

Many people with UC often don't respond to treatment at first. Research shows that 75% of people with moderate to severe UC will have treatment failure within the first year.

If you think your treatment isn't working, talk to your doctor. You could:

• Switch to a different medication of the same type (for example, from one biologic to another biologic).
• Change to a completely different kind of medication.
• Add another type of medication to the one you're currently taking.
• Explore non-medication options like surgery.