Do You Actually Need to Avoid NSAIDs if You Have Ulcerative Colitis?

Why Are People With Ulcerative Colitis Told to Avoid NSAIDs?

“NSAIDs work by blocking enzymes called COX-1 and COX-2,” says Adam Mayer, MD, a rheumatologist and the codirector of the Hackensack University Medical Center inflammatory bowel disease–related spondyloarthritis clinic in Hackensack, New Jersey.

What Are the Risks of NSAIDs for People With Ulcerative Colitis?

• Intestinal ulcers
• Rectal bleeding
• Narrowed intestines (strictures)
• Openings in your bowel wall (perforations)

“People with ulcerative colitis can also have flares after taking NSAIDs, especially if their disease is active, but how sensitive someone is can vary,” says Tauseef Ali, MD, the medical executive director at SSM Health St. Anthony Digestive Care and the director of the Crohn’s and Colitis Center of Excellence in Oklahoma City, Oklahoma.

Do People With Ulcerative Colitis Actually Need to Avoid NSAIDs?

Sometimes, though, the benefits of NSAIDs may outweigh the risks, says Dr. Ali. “For example, someone with severe pain after surgery, a sudden muscle or joint injury, kidney stones, headaches, menstrual cramps, or inflammatory arthritis might need NSAIDs for a short time,” says Ali.

The decision should be tailored to each person, says Ali. Consider the following factors:

• How active your disease is
• How you have responded to NSAIDs before
• What other treatment options are available
• Why pain control is needed

How to Manage Pain With Ulcerative Colitis

NSAID Alternatives

“For more severe pain, there are several prescription medications we can consider that are safer for the gut than NSAIDs,” says Mayer. Some options, he says, include:

• Antispasmodics for cramping
• Antidepressants for chronic pain
• Gabapentin and pregabalin for nerve-related pain

Your provider may prescribe opioid pain medications for severe short-term pain or injury, says Mayer. “[But] they are generally avoided for long-term use due to the risk of dependence and other side effects.”

Lifestyle Changes for Pain Management

• Dietary changes: Identify and avoid trigger foods to help manage symptoms.
• Stress management: Techniques like yoga, meditation, and regular exercise can help reduce stress, a known IBD trigger. This in turn may reduce IBD flares.

Precautions While Taking NSAIDs

For his patients taking NSAIDs, Ali watches for any GI-related side effects, like:

• More frequent diarrhea
• Rectal bleeding
• Stomach pain

Ali also recommends these precautions while taking NSAIDs with UC:

• Use the lowest dose that works.
• Keep the treatment as short as possible.
• Try to avoid taking NSAIDs every day for a long time.
• Work closely with your gastroenterologist, especially if your UC has been active recently.

“Do not ignore ongoing pain,” says Ali. “If you have pain that does not go away, talk to your gastroenterologist instead of treating yourself with NSAIDs over and over.”