Ulcerative Colitis Treatment in 2026: A Nurse’s Guide to Your Options

By Anna Curran, RN, BSN, PHN · Last reviewed October 2026

Ulcerative colitis treatment aims to calm inflammation in the colon, ease symptoms and keep you in remission for the long term. Mild to moderate UC is often treated with mesalamine or a similar medicine, while moderate to severe UC may need biologics or newer pills that target the immune system. Some people choose or need surgery, which removes the colon and rectum.

In 2026, there are more choices than ever. Here is a plain-language look at each one so you can have a better talk with your gastroenterologist.

The Goals of Ulcerative Colitis Treatment

Your care team is usually working toward a few goals:

Bring a flare under control (called “induction”)
Keep you in remission (called “maintenance”)
Heal the lining of the colon
Prevent complications and hospital stays
Help you stay off steroids over the long run

The right plan depends on how much of your colon is involved, how active your UC is and how you have done on past medicines. If you are new to UC, start with our guide to what ulcerative colitis is.

Aminosalicylates (5-ASAs): A Mainstay for Mild to Moderate UC

Aminosalicylates are often the first medicine for mild to moderate UC. NIDDK notes they are used both to treat flares and to keep you in remission. Mayo Clinic lists these examples:

Mesalamine (Apriso, Lialda and others)
Sulfasalazine (Azulfidine)
Balsalazide (Colazal)

MedlinePlus explains that some forms are taken by mouth and others are placed in the rectum. Rectal forms, such as suppositories or enemas, put the medicine right where the inflammation is when UC affects the lower colon. Your doctor may suggest one or both.

Unlike in Crohn’s disease, where these medicines play a smaller role, 5-ASAs are a key part of UC care. Take them every day as prescribed, even when you feel well.

Corticosteroids (Steroids)

Steroids such as prednisone and budesonide calm inflammation quickly. NIDDK says they are used for moderate to severe UC, or for mild to moderate UC that does not get better with a 5-ASA. Some steroids come in rectal forms too.

Steroids are for short-term use only. Mayo Clinic notes they are not safe for long-term use. NIDDK notes that long-term use can cause serious side effects, and steroids are linked to bone loss.

Never stop a steroid suddenly. Your doctor will give you a plan to lower the dose slowly.

Immunomodulators

These medicines calm the overactive immune system. Mayo Clinic lists:

Azathioprine (Azasan, Imuran)
Mercaptopurine (Purinethol, Purixan)

They can take a few months to work. Doctors may use them to help you stay in remission and off steroids, sometimes together with a biologic. You will need regular blood tests to check your blood counts, liver and pancreas.

Biologics

Biologics are medicines made from living cells that block specific proteins driving inflammation. NIDDK notes they are used for moderate to severe UC. They are given as an IV infusion, a shot under the skin, or both. Biosimilars, which are close copies of some biologics, are also available.

Anti-TNF medicines

Infliximab (Remicade and biosimilars)
Adalimumab (Humira and biosimilars)
Golimumab (Simponi)

Anti-integrin medicine

Vedolizumab (Entyvio) blocks certain immune cells from moving into the gut lining.

IL-12/23 and IL-23 blockers

These block interleukins, signals that fuel inflammation:

Ustekinumab (Stelara and biosimilars) blocks IL-12 and IL-23. In August 2026, the FDA expanded its approval to children ages 2 and older with moderate to severe UC.
Mirikizumab (Omvoh) blocks IL-23. It was approved for adults with UC in October 2023. In October 2025, the FDA approved a single monthly maintenance shot in place of the earlier two-shot dose.
Risankizumab (Skyrizi) blocks IL-23. It was approved for UC in June 2024.
Guselkumab (Tremfya) blocks IL-23. It was approved for UC in September 2024. In September 2025, the FDA approved starting doses given as shots under the skin, so you can begin treatment without an IV.

Safety with biologics

Because biologics calm the immune system, they can raise your risk of infection. Before you start, your doctor will usually check for tuberculosis (TB) and may test for hepatitis B. It is a good time to review your vaccines too.

Call your doctor if you get a fever, chills, a cough that will not go away or other signs of infection.

JAK Inhibitors

JAK inhibitors are pills. They are small molecule medicines that block signals inside immune cells. Mayo Clinic lists two for UC:

Tofacitinib (Xeljanz)
Upadacitinib (Rinvoq)

In October 2025, the FDA updated the label for upadacitinib. It is for adults with moderate to severe UC who have tried a TNF blocker, or who have tried another approved systemic medicine when a TNF blocker is not a good choice.

JAK inhibitors carry serious warnings. According to the upadacitinib safety information, risks include serious infections, certain cancers, heart attack, stroke, blood clots and death. These risks are higher in people 50 and older with heart risk factors and in current or past smokers. Your doctor will weigh the benefits and risks with you.

S1P Receptor Modulators

S1P receptor modulators are a newer class of once-daily pills for moderate to severe UC. They work by keeping certain white blood cells in the lymph nodes, so fewer reach the colon. Mayo Clinic lists:

Ozanimod (Zeposia)
Etrasimod (Velsipity), approved in October 2023

A 2025 research review in PubMed Central notes these key safety points:

They can slow your heart rate, especially when you first start. You will need a heart tracing (ECG) before treatment.
They can rarely cause swelling in the back of the eye (macular edema). You may need an eye exam.
They can affect liver tests and lower white blood cell counts, raising infection risk.
They should not be used during pregnancy. Talk with your doctor about birth control and family planning.

Your doctor will also review your other medicines and vaccines before you start.

Other Medicines and Care

Your doctor may also suggest:

Acetaminophen for mild pain
Iron if you have iron-deficiency anemia
Calcium and vitamin D to protect your bones
Anti-diarrhea medicine only if your doctor says it is safe

NIDDK and Mayo Clinic advise avoiding NSAIDs such as ibuprofen and naproxen, because they can make UC worse. Mayo Clinic also warns that anti-diarrhea medicines may raise the risk of toxic megacolon. Check with your doctor before taking any over-the-counter medicine.

During a severe flare, you may need hospital care. MedlinePlus notes this can include IV steroids and IV nutrition. NIDDK adds that some people need IV fluids, antibiotics or a blood transfusion.

Surgery for Ulcerative Colitis

Because UC only affects the colon and rectum, removing them is considered a cure. MedlinePlus notes that surgery may be needed when medicines do not work, when there are precancerous changes or when complications such as heavy bleeding, toxic megacolon or a hole in the colon occur.

The main surgery is a proctocolectomy, which removes the colon and rectum. Then the surgeon creates a new way for stool to leave the body:

J-pouch (ileoanal anastomosis): A pouch made from the end of the small intestine is attached to the anus, so you can pass stool in the usual way. NIDDK notes this most often takes two or three operations.
Ileostomy: The small intestine is brought through an opening on the belly called a stoma. Stool collects in a bag you wear.
Continent ileostomy (Kock pouch): An internal pouch with a one-way valve, emptied with a tube.

Ask your surgeon which option fits your health and lifestyle. Many people feel much better after surgery.

Frequently Asked Questions

What is the newest ulcerative colitis treatment?

Recent changes include under-the-skin starting doses for guselkumab in 2025, a simpler monthly mirikizumab shot in 2025, and ustekinumab approval for children with UC in August 2026. Ask your doctor which option fits your needs.

Can I stop my UC medicine when I feel better?

No, not on your own. Missing doses is a common cause of flares, and maintenance medicine is what keeps many people well. Talk with your doctor before making any change.

Is mesalamine safe to take long term?

Many people take mesalamine for years to stay in remission. Your doctor will check on you over time. Report any new symptoms or side effects, and ask what tests you need.

Does surgery cure ulcerative colitis?

Yes. Removing the colon and rectum is considered a cure for UC, because the disease only affects those parts. Surgery is a big decision, so talk through the benefits and changes with your care team.

The Bottom Line

Ulcerative colitis treatment in 2026 includes 5-ASAs like mesalamine for mild to moderate UC, short courses of steroids, immunomodulators, many biologics, JAK inhibitors, S1P pills and surgery. Newer IL-23 blockers and easier dosing options have added more choices. The best plan depends on your type of UC, how active it is and your health history. Work closely with your gastroenterologist, and never start, stop or change a medicine on your own.