What I Wish I Knew: Managing Ulcerative Colitis

Ulcerative colitis (UC) is a chronic inflammatory bowel disease (IBD) that causes inflammation and ulcers in the lining of the large intestine, including the colon and rectum. UC can cause symptoms like diarrhea, cramping, and bowel movement urgency that can affect everyday life. To manage symptoms and improve quality of life, proper treatment is vital.

However, ulcerative colitis can be challenging to treat and not every person experiences the disease the same, Ariela Holmer, MD, an IBD specialist at NYU Langone Health, told Health. That’s why it’s so important for healthcare providers and patients to approach managing the condition from several angles, she said.

Some of these management angles Dr. Holmer has had to learn over the years since, she said, medical school didn’t stress a lot of important elements about managing UC. This includes how crucial it is that people with UC learn the ins and outs of their condition. “I realized in practice how much patients didn’t know about their own disease and what to look for,” she said.

Dr. Holmer said the importance of patient education was just one of the things she’s picked up in practice that weren’t addressed in medical school. The management approaches she’s learned since can make a huge difference in how her patients feel. Here’s what she wishes she had known from the start.

What do you wish you had learned in medical school about managing flares?

Ariela Holmer, MD: One of the biggest things I learned in medical school is that, as inflammatory bowel disease doctors, we have these goals that we want our patients to achieve [during a flare]. There’s a lot of research and guidelines about these goals, and the main goal generally includes wanting the lining of the intestine to heal and be free of ulcers.

But I’ve learned since that while a lot of patients care about [healing their intestines], too, the biggest thing they want is an improvement in their quality of life and resolution of their symptoms as soon as possible.

[The symptoms are] what prevent them from going on their trip, taking their exam, or walking down the aisle at their wedding. That needs to be a huge priority for you as a physician, too. You need to really listen to them.

How much did you talk about nutrition and ulcerative colitis in medical school?

Dr. Holmer: We really didn’t learn much at all about that in training, but that has changed recently. It’s typically the number one thing most patients want to know when they come to see you—how they can change their diet and what they can eliminate. Patients would like to have some control over their health and what’s happening.

I’m very fortunate that I work in a center where we have a nutritionist who is incredible and works with IBD patients. We tag team.

What do you wish you had known earlier about managing complications of ulcerative colitis?

Dr. Holmer: I’ve really learned the importance of patient education. I try to educate patients as best as I can. I always tell patients that whether you’re with me for 20 years or you move across the country, it’s important to know about your own health so you can convey that to others and be your own advocate if you end up in the emergency room.

I don’t find that handouts are so helpful, so I draw in clinic. All of my exam rooms have dry-erase boards and markers. Once you draw something out visually, you can see the change in a patient’s facial expression, and things often click. I try to do that at many visits to help.

What have you learned about making the most out of appointments?

Dr. Holmer: It can be challenging. You have all these ideas before you start practicing about what kind of physician you want to be and how much you’re going to talk to patients, but you usually only have 20 minutes or less to see someone and get all the information you need to know.

I’ve learned to pick up on cues from patients. I make sure at every visit to dedicate at least a few minutes of time to ask the patient what else in going on in their lives. How are you currently feeling? Do you have any major stressors? How is work going? I write all of that down. If they have any big events coming up, it always sparks some sort of conversation about whether they’re feeling so nervous that they won’t make it through that event and why.

When I was in medical school, we didn’t really talk about that, but it can help give you a better sense of how patients are doing and what they really need.

What do you wish you had known earlier about communicating with patients?

Dr. Holmer: I’ve learned how important it is for patients to share their symptoms with me. It can be very overwhelming to remember everything in an appointment when you’re sick and everything hurts or is bad.

I talk to them about looking out for the number of bowel movements they have a day—along with any signs of bleeding or pain—and to track it on their phone. I ask them for updates and to reach out, especially when they’re flaring. I’ll often say, “By next week, send me an update on how you’re doing,” so we can work together. Working together is so important.