Illustration of the Digestive System
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What Ulcerative Colitis Surgery Involves

A surgeon usually removes your colon (also called your large intestine) and rectum. Next he'll attach the lowest part of your small intestine to a hole he makes in your torso to let waste leave your body and empty into an external bag. Another procedure creates an internal waste pouch that allows stool to be passed through the anus.

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Normal Colon and Ulcerative Colon
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When Is Ulcerative Colitis Surgery Needed?

Your doctor may suggest surgery if you can't control inflammation and ulcers (right) with medication or other treatments. You may also need an operation if you get emergency complications of ulcerative colitis such as severe bleeding or tears in the colon. Some people choose to have surgery if their symptoms affect their ability to work and stay active. 

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SEM Image of Colon Cancer
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Surgery to Cure UC, Cut Colon Cancer Risk

The only way to cure ulcerative colitis is to get surgery to remove the diseased colon and rectum. You may also choose an operation if you want to cut your risk of colon cancer. Your chances of getting colon cancer go up if you have ulcerative colitis for 8 years or more or have a lot of colon damage. Your doctor may also suggest surgery if he finds abnormal growth (shown in yellow in the image) during a checkup.

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Ileoanal Anastomosis
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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 surgeon takes out your colon and rectum and fashions a new rectum, called a J-pouch, 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 2 months apart.

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proctolectomy bag
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Proctocolectomy: Removal of Colon and Rectum

In this operation, also called a permanent or Brooke Ileostomy, your surgeon removes the colon and rectum and closes off the anus. He then makes a hole in your belly, called a stoma. After surgery, waste will move from your 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.

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Illustration of Colostomy Irrigation
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Caring for an Ostomy Bag

If you need this bag after your surgery you'll get advice from your medical team about how to care for it and the stoma. You can empty or throw out the bags when you need to. Irrigating the stoma can help you control the timing of bag changes. To prevent leaks, the pouch system that connects the stoma to the bag needs to be changed every 4 to 7 days. Call your doctor if you notice a change in color, bleeding, or swelling.

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Cut Away Illustration of Kock Pouch
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Continent Ileostomy: Waste Valve vs. Bag

The least common surgery for UC is continent ileostomy, also called the Kock pouch. Your doctor might suggest it if you can't have an IPAA or want to stop using an ostomy bag. During the procedure a surgeon removes your colon and rectum. He then uses your small intestine to create a holding place (reservoir) for waste that will be drained from a valve in your abdomen.

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Doctors Looking at X-ray of Ulcerative Colitis
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Seek a Second Opinion

If your doctor recommends surgery to treat your ulcerative colitis, it's OK to get the advice of another doctor. A good first step is to seek treatment at a hospital that has experience in handling digestive disorders. Ask your doctor about:

  • Treatment options
  • What the procedure involves
  • Risks, recovery, success rates
  • Life after your surgery

 

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Man With Stomach Pain
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Ulcerative Colitis Surgery Risks, Complications

If you have any of these symptoms, get medical help right away:

  • Infection or pouch inflammation (pouchitis). Signs: Diarrhea, frequent bowel movements, stomach cramps and 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.

 

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Patient Being Rushed to Operating Room
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Scheduled and Emergency UC Surgery

Most UC surgery can be arranged at time that's convenient for you. Try scheduling it while your symptoms are calm to cut the chances of complications. 

The risks are higher when you have emergency surgery. You may need it if you get toxic megacolon -- a life-threatening condition when your colon rapidly swells and gas and bacteria build up inside. Get medical help right away if you have fever, belly pain, constipation, or swelling.

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Happy Couple after Surgery
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Life After Surgery

Ulcerative colitis surgery can help you have more control of your bowel movements and your life. But it's normal to have worries about how it will affect you and your body. Talk with your health care team before the operation so you know what to expect. And don't hesitate to join a support group or reach out to family, friends, and counselors to get the backing you need.

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Sources | Medically Reviewed on 08/14/2017 Reviewed by Minesh Khatri, MD on August 14, 2017

 

IMAGES PROVIDED BY:
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5)         Susan Gilbert for WebMD

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7)         John Todd/WebMD

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REFERENCES:

American Society of Colon & Rectal Surgeons: "Ulcerative Colitis."

National Digestive Diseases Information Clearing House: "Ulcerative Colitis."

Crohn's & Colitis Foundation of America: "Surgery for Ulcerative Colitis."

Crohn's & Colitis Foundation of America: "Living With Ulcerative Colitis."

Crohn's & Colitis Foundation of America: "Managing Flares and Other IBD Symptoms."

Crohn's & Colitis Foundation of America: "Surgery for Ulcerative Colitis."

Cohen J.L. Diseases of the Colon and Rectum, 2005; vol 48(11): pp 1997-2009.

Cima R.R. Sleisenger and Fordtran's Gastrointestinal and Liver Disease, 2006; vol 2: pp 2549-61.

Deitz, D. Nursing, 2010; vol 40 (2): pp 61-2.

Deitz, D. Nursing, 2010; vol 40 (5): pp 62-3.

US Department of Health & Human Services, National Guideline Clearinghouse: "Practice Parameters for the Surgical Treatment of Ulcerative Colitis."

Reviewed by Minesh Khatri, MD on August 14, 2017

This tool does not provide medical advice. See additional information.

THIS TOOL DOES NOT PROVIDE MEDICAL ADVICE. It is intended for general informational purposes only and does not address individual circumstances. It is not a substitute for professional medical advice, diagnosis or treatment and should not be relied on to make decisions about your health. Never ignore professional medical advice in seeking treatment because of something you have read on the WebMD Site. If you think you may have a medical emergency, immediately call your doctor or dial 911.