Life Stages With Ulcerative Colitis

What Ulcerative Colitis Surgery Involves

About 25% to 40% of people with ulcerative colitis (UC) may eventually need surgery.  Surgery usually removes the colon (large intestine) and rectum. The lowest part of the small intestine can then be attached to a hole made in the abdominal wall to let waste leave the body and empty into an external bag. Another procedure can be done to create an internal waste pouch that allows stool to be passed through the anus.

When Is Ulcerative Colitis Surgery Needed?

Most often, surgery is recommended if ulcerative colitis inflammation and ulcers (right) can't be controlled with medication or other treatments. Surgery also may be needed if you're having emergency complications of UC such as severe bleeding or tears in the colon. Some people choose to have surgery if UC is affecting their ability to work and stay active. 

Surgery to Cure UC, Cut Colon Cancer Risk

Removing the diseased colon and rectum lining is the only way to cure ulcerative colitis. Some people also choose surgery to cut their risk of colon cancer. Having ulcerative colitis for eight years or more, or having a lot of colon damage, can increase your risk. If abnormal growth (above, yellow) is found during a checkup, surgery may be recommended.

Ileal Pouch Anal Anastomosis: No Bags or Valves

The most common procedure for ulcerative colitis is pelvic pouch or ileal pouch anal anastomosis (IPAA). Your colon and rectum will be removed. A new rectum, called a J-pouch, will be fashioned out of your small intestine. This type of surgery allows you to have bowel movements and use the bathroom. You won't need an ostomy bag. The procedure takes two separate surgeries about two months apart.

Proctocolectomy: Removal of Colon and Rectum

Also called a permanent or Brooke Ileostomy, this surgery removes the colon and rectum and closes off the anus.  Then a hole in abdomen, called a stoma, is made.  Waste will move from the small intestine, out the stoma, and into a plastic ostomy bag. While wearing a bag you'll still be able to work, be intimate, and play sports. This surgery is often used for older or other people who can't undergo longer surgeries.

Caring for an Ostomy Bag

If your surgery requires a bag, you'll be taught how to care for it and your stoma. Bags are emptied or thrown out as needed. Irrigating your stoma can help you control the timing of bag changes. To prevent leaks, the pouch system that connects your stoma to the bag needs to be changed every four to seven days. Also watch for stoma irritation. A change in color, bleeding, or swelling are signs to call your doctor.

Continent Ileostomy: Waste Valve vs. Bag

The least common surgery for UC is continent ileostomy. Also called the Kock pouch, it's a very technical surgery. It's sometimes done if you can't have an IPAA or want to stop using an ostomy bag. During the procedure your colon and rectum are removed. Your small intestine is used to create a holding place (reservoir) for waste that will be drained from a valve in your abdomen.

Seek a Second Opinion

If your doctor recommends surgery to treat your ulcerative colitis, it's OK to seek a second opinion. Seeking treatment at a hospital with experience in treating digestive orders is a good first step. Ask your doctor about:

• treatment options
• what the procedure involves
• risks, recovery, success rates
• life after your surgery

Ulcerative Colitis Surgery Risks, Complications

After surgery watch for complications. If you have any of  these symptoms, seek immediate medical treatment:

• Infection or pouch inflammation or Pouchitis. Signs:Diarrhea, stool frequency, crampy stomach pain, fever, joint pain. Treatment: Antibiotics.
• Blockage or bowel obstruction. Signs: Cramping, nausea, vomiting. Treatment: IV fluids and fasting, sometimes surgery.
• Pouch failure. Signs: Fever, swelling, pain. Treatment: Surgery and permanent ileostomy.

Scheduled and Emergency UC Surgery

Most UC surgery can be scheduled when you like. Try scheduling it while your symptoms are calm to cut the risk of complications. Risks are higher if it's done in an emergency situation. One cause for emergency surgery is toxic megacolon. This life-threatening condition happens when your colon rapidly swells and gas and bacteria build up inside. Seek medical attention immediately for fever, abdominal pain, constipation, or swelling.

Life After Surgery

Ulcerative Colitis surgery can help you have more control of your bowel movements and your life. But worries about how it will affect you and your body are normal. If you have concerns, seek support. Talk with your health care team beforehand. And plan ahead for post-surgery support. Consider leaning on family and friends, or trying counseling. Connecting with others who have had UC surgery can be informative and comforting.