Proctocolectomy: What You Should Know

Medically Reviewed by Sabrina Felson, MD on June 09, 2024
3 min read

If medication doesn’t help ease severe symptoms of ulcerative colitis (UC), your doctor might recommend a proctocolectomy, which is surgery to remove the colon and rectum.

The ulcerative colitis symptoms that might prompt your doctor to suggest this operation include toxic megacolon, holes or tears (called perforations) in the colon, and uncontrolled severe colorectal bleeding.

Doctors might recommend it for people with hereditary nonpolyposis colorectal cancer or synchronouscolon cancers, life-threatening injuries to the colon, or people with severe Crohn’s disease.

Most proctocolectomies are done laparoscopically, which means that your surgeon works through several small cuts in your abdomen. Recovery is faster and less painful than with open surgery. But sometimes, doctors do an open proctocolectomy, which involves a longer cut in the abdomen.

In addition to removing the colon and rectum, there are two variations of this procedure:

  • A proctocolectomy with end ileostomy. The surgeon connects the end of the small intestine to a small hole in the abdomen and then to an external bag, or ostomy, to dispose of waste.
  • A proctocolectomy with ilial pouch anal anastomosis, which attaches the end of the small intestine directly to the rectum.

The major benefit of this procedure is to get your symptoms under control, which can help improve your quality of life.

A proctocolectomy is considered a safe procedure, but like any surgery, there are risks. These include:

  • Wounds that heal slowly
  • Bleeding
  • Infection
  • Injury to other internal organs
  • Electrolyte problems
  • Kidney stones and gallstones
  • Problems with peeing or with sex

Tell your doctor what medications and supplements you take. You might have to stop taking some of them prior to the surgery, especially the ones that make it harder for the blood to clot, such as aspirin and ibuprofen.

If you smoke, consider quitting. It may help you heal faster after the surgery.

The day before the surgery, your doctor will ask you to not eat anything and only drink clear liquids, such as water, some juices, or broth, at certain times.

Your doctor will also ask you to take a laxative or use an enema to clear your intestines. Sometimes, your doctor might ask you to take antibiotics. Be sure you follow all of the instructions your doctor gives you.

You will stay at the hospital from 2 to 7 days after the operation. That will depend on how quickly the wounds heal, how you handle food, and how quickly your bowels start working again. You will be able to drink water and other liquids a day after the surgery. Depending on how well your intestines recover, you will be able to slowly start eating solid foods again.

Your recovery at home could take up to 6 weeks. During that time, you may need to limit some physical activities at first, as well as certain foods, until you are fully recovered.

Depending on the type of the surgery, you might need to learn how to use an ostomy bag. With an ostomy, you will have a bag that requires emptying.

After you are fully recovered, you will be able to do most activities you did before the surgery. But keep in mind that you will most likely have incontinence and frequent bowel movements, at least four to six per day, if you got an anastomosis.

You will also need to schedule follow-up visits with your doctor to check on your symptoms.

If you got an ileostomy, living with an ostomy bag takes some practice, but you should be able to enjoy all activities. The bag is easy to hide, and people live normal lives with few complications.