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decision pointShould I have surgery to cure ulcerative colitis?

Key points about surgery for ulcerative colitis

Your decision about whether to have surgery will involve several issues, including the severity of your illness, concern about the risk of further disease, and the risks of having surgery. Consider the following when making your decision:

  • Surgery is rarely done for mild ulcerative colitis. Many people who have mild colitis have only occasional symptoms that they can control with antidiarrheal medication.
  • The only cure for ulcerative colitis is surgery to remove the colon and the lining of the rectum. This surgery removes any tissue in which ulcerative colitis could return. But this surgery may not cure complications from the disease. In many cases, it also requires that you have an ostomy (an opening in the abdominal wall).
  • Removal of the colon and rectal lining eliminates the risk of colon cancer. The risk of colon cancer is higher than average for people who have had ulcerative colitis for 8 years or longer.
  • Surgery carries a significant risk of complications, including obstruction of the small intestine and leakage of stool from the area where the small intestine is attached to the rectum or anus during surgery. If stool leaks into your body from this connection, it can cause a severe infection.
  • Surgery may be needed if abnormal cells are found during biopsy.

What is ulcerative colitis?

Inflammatory bowel disease (IBD) is a group of disorders that cause inflammation or ulceration of the digestive tract . The most common forms are ulcerative colitis and Crohn's disease.

Ulcerative colitis affects the colon and the rectum. It can cause abdominal pain, diarrhea or constipation, and bleeding. In some cases, symptoms may develop in other areas of the body, such as the joints, the eyes, and the skin.

How is ulcerative colitis treated?

In many mild cases, medicines can reduce the inflammation and manage the symptoms. But medicines sometimes do not work. Surgery to remove the colon (total colectomy) is the only cure.

What are the long-term risks of having ulcerative colitis?

Ulcerative colitis can drastically lower your quality of life, particularly if the disease is severe. Frequent diarrhea and abdominal pain may force you to limit work or social activities. Some people feel isolated or depressed.

Ulcerative colitis is not life-threatening for most people. But it does increase your risk of colon cancer over time. Most doctors recommend screening for colon cancer if you have had ulcerative colitis for 8 years.

The risk of developing colon cancer is higher in people who have ulcerative colitis throughout the colon (pancolitis) than in those who have the condition in one area. The risk of colon cancer is especially high in people who developed ulcerative colitis as children because the risk increases the longer you have ulcerative colitis.

What surgeries are done to cure ulcerative colitis?

Two surgeries are commonly done. One allows you to have nearly normal bowel movements after surgery. The other requires that after surgery you wear an ostomy bag to collect stools.

  • Ileoanal anastomosis. The surgeon removes the colon and the lining of the rectum. The lower end of the small intestine (ileum) is made into a pouch that connects to the anus. The anal sphincter muscles are left intact, allowing for nearly normal bowel movements. This surgery has become standard because it cures ulcerative colitis and allows nearly normal bowel movements.1
  • Proctocolectomy and ileostomy. The large intestine, the rectum, and sometimes the anus are removed (proctocolectomy). The surgeon sews the anus closed and makes a small opening (stoma) in the skin of the lower abdomen. The ileum attaches to the opening in the abdomen. Stool empties into an ostomy bag that attaches to the stoma.

Ileoanal anastomosis is the surgery that is most often done. This surgery is successful in 95% of people who have it.1 Most young people with ulcerative colitis have ileoanal surgery. Proctocolectomy is done for people with ulcerative colitis who cannot be under anesthesia for long periods of time because of illness or age.

Your treatment choices are:

  • Continue taking medicines to see if your symptoms improve.
  • Have surgery to remove your colon, curing ulcerative colitis.

The decision about whether to have surgery takes into account your personal feelings and the medical facts.

Deciding about surgery for ulcerative colitis
Reasons to have surgery Reasons not to have surgery
  • Medicines are not controlling your symptoms. Your activities continue to be interrupted by frequent urgency, pain, and diarrhea.
  • Medicines such as corticosteroids are causing side effects such as cataracts or osteoporosis.
  • You have complications outside the colon, such as problems with your joints, eyes, or liver. But some complications may not go away if you have surgery.
  • Your quality of life is suffering from symptoms and limitation of activities.
  • You have precancerous changes (dysplasia) in the colon or you have concern about your risk of colon cancer.

Are there other reasons why you might want to have surgery?

 

 

  • Surgeries to remove the colon have a significant risk of complications, including:
    • Blockage (obstruction) of the small intestine.
    • Inflammation in the pouch (pouchitis) created from the small intestine.
    • Leakage of stool.
    • Fertility problems.2
  • Depending on the type of surgery, you may need to wear an ostomy bag to remove waste.
  • You may not need surgery now. Screening for colon cancer usually doesn't begin until you have had ulcerative colitis for 8 years.

Are there other reasons why you might not want to have surgery?

 

 

The following personal stories may be helpful in making your decision.

Use this worksheet to help you make your decision. After completing it, you should have a better idea of how you feel about having surgery for ulcerative colitis. Discuss the worksheet with your doctor.

Circle the answer that best applies to you.

Medicines are not controlling my symptoms. Yes No Unsure
I have troublesome side effects from my medicines. Yes No Unsure
My quality of life is poor with my current treatment. Yes No Unsure
I have complications from IBD. Yes No Unsure
I have to severely limit my activities because of my condition. Yes No Unsure
I have had signs of precancerous changes (dysplasia) in my colon. Yes No Unsure
I don't have dysplasia, but I am worried I will develop cancer. Yes No Unsure
I am concerned about how my body will look if I have an ileostomy. Yes No Unsure
I am a woman and I am worried that having surgery will make it harder for me to get pregnant. Yes No Unsure
I know complications sometimes occur with surgery, but curing my disease is worth the risk. Yes No Unsure

Use the following space to list any other important concerns you have about surgery or ulcerative colitis.

 

 

 

 

What is your overall impression?

Your answers in the above worksheet are meant to give you a general idea of where you stand on this decision. You may have one overriding reason to have or not have surgery.

Check the box below that represents your overall impression about your decision.

Leaning toward having surgery

 

Leaning toward NOT having surgery

         

Citations

  1. Change GJ, et al. (2006). Colitis section of Large intestine. In GM Doherty, LW Way, eds., Current Surgical Diagnosis and Treatment, 12th ed., pp. 722–729. New York: McGraw-Hill.

  2. Waljee A, et al. (2006). Threefold increased risk of infertility: A meta-analysis of infertility after ileal pouch anal anastomosis in ulcerative colitis. Gut, 55(11): 1575–1580.

Author Monica Rhodes
Editor Kathleen M. Ariss, MS
Associate Editor Pat Truman, MATC
Primary Medical Reviewer Kathleen Romito, MD - Family Medicine
Specialist Medical Reviewer Arvydas D. Vanagunas, MD - Gastroenterology
Last Updated November 3, 2008

WebMD Medical Reference from Healthwise

Last Updated: November 03, 2008
This information is not intended to replace the advice of a doctor. Healthwise disclaims any liability for the decisions you make based on this information.

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