The symptoms of ulcerative colitis are caused by inflammation of the digestive tract. Systemic steroids (corticosteroids) are powerful anti-inflammatory medications that doctors have used for decades as the treatment of choice for ulcerative colitis and Crohn's disease, another form of inflammatory bowel disease. However, due to serious side effects and new medical treatments, doctors are no longer as widely used to treat ulcerative colitis as widely as they used to be. Your body naturally produces steroids, which are chemicals or hormones. Systemic steroids used to treat ulcerative colitis are laboratory-synthesized versions of this hormone. The dosage of the drug is much higher than what the body naturally produces, which leads to side effects. These drugs are different from anabolic steroids that people sometimes use illegally to increase muscle mass. Steroids don't cure ulcerative colitis, but they're very effective at reducing inflammation and putting the condition into remission, which means you have no signs of disease. Due to their serious side effects, they are not a long-term solution to the symptoms of ulcerative colitis. In addition, symptoms may recur during your use of them. Steroids are very good at healing an inflamed gut but not as effective at preventing further attacks. Once severe ulcerative colitis goes into remission under the effects of steroids, your doctor will transfer you to other medications for long-term use. A doctor can prescribe a variety of steroids for your ulcerative colitis and have different ways to take it. The most common is taken orally. Doctors usually recommend that you take oral steroids in the morning to reduce the effects on sleep. Oral steroids usually improve symptoms within 1-4 weeks and are not recommended for more than 8 weeks. Your doctor may prescribe you topical steroids that act directly on the inflamed area and are suitable for mild to moderate ulcerative colitis. Most people will see symptoms start to improve within 1-2 weeks. For severe ulcerative colitis flares, you may need intravenous hydrocortisone in the hospital, which usually relieves symptoms within 4-10 days. The doctor will then switch you to oral steroids. Since systemic steroids slow down your immune system to reduce inflammation, you'll have a lower defense against bacteria while taking them, which means you're at a higher risk of infection. Side effects of steroids depend on the dosage and timing you take, and common side effects include weight gain, osteoporosis, and cataracts. Some side effects go away after you stop taking steroids, but cataracts and osteoporosis do not. Your doctor may recommend calcium and vitamin D supplements to help fight the effects of osteoporosis. Due to the serious side effects of steroids, doctors usually recommend that you only take them for a certain period of time, usually about 8 weeks. About 1 in 5 people do not respond to steroids, which is known as "steroid refractory". If steroids don't work after 3 months, doctors may add immunosuppressants such as azathioprine or methotrexate. If your ulcerative colitis is severe and these treatments don't work, your doctor may turn to biologic treatments. Since steroids slow or stop the adrenal glands from producing cortisol, you should not stop taking them abruptly. Your body needs time to restore cortisol production, and your doctor will guide you to gradually stop the medication.