The therapeutic options for the treatment of mildly to moderately active distal colitis or distal flare up of total colitis have increased over the last decade. Many reports have documented the effectiveness of various compounds, such as 5-aminosalicylic acid, steroids, cytoprotective agents, lidocaine gel, short chain fatty acid, and cyclosporine when they are applied topically to the inflamed distal colon in patients with ulcerative colitis. These treatments have considerably attracted our attention because of their possible anti-inflammatory effects on ulcerative colitis with lower toxicity. Larger, controlled studies will be necessary to establish the roles of enema therapy in patients with distal colitis.