What is ulcerative colitis?

Ulcerative colitis is a chronic inflammation of the inner lining of the large intestine (colon) and rectum. People with ulcerative colitis have small ulcers and abscesses (swollen areas filled with pus) in their colon and rectum that periodically flare up. The symptoms include bloody stools, diarrhea, abdominal pain and anemia (low levels of red blood cells).

Reasons for surgery with ulcerative colitis

Better medical treatments in recent years have resulted in fewer people with ulcerative colitis needing surgery. About 20-30% of people with the disease will require surgery and it may be recommended for a number of reasons:

  • Surgery becomes an option if symptoms are not adequately controlled with medication or the side effects of treatment are severe enough to be dangerous to the patient’s health. If the colon begins showing signs of abnormal cell growth (dysplasia), surgery might be an option to reduce the risk of cancer. Some people also choose to have surgery if the symptoms of ulcerative colitis are significantly affecting their quality of life.
  • Surgery becomes necessary when emergency complications arise, such as tears in the colon, significant bleeding, a severe flare that does not subside within 3-4 days or when the muscles of the colon become dilated and are at risk of rupture (called toxic megacolon).

Surgical procedure to treat ulcerative colitis

Surgery can cure a person of ulcerative colitis but usually involves a number of surgical procedures. The first step is usually the removal of the entire colon (called a subtotal colectomy) up to and including most of the sigmoid colon (the last part of the large intestine) but leaving the rectum in place. The surgeon then creates an opening in the ileum (the last section of the small intestine) called an end ileostomy and may connect the ileum to the rectum. If the rectum is too diseased, the end ileostomy will extend out of the abdomen for the passage of mucous drainage.

The second step typically occurs a few months later when the remaining sigmoid colon and rectum are removed, leaving the anus and pelvic muscles in place so that voluntary control of bowel movements may still be possible. A pelvic pouch (also called a J-pouch) is constructed and connected to the anus. A temporary ileostomy is created (called a loop ileostomy) that allows the pelvic pouch to heal.

After a few weeks have passed to insure healing, the third, smaller procedure is performed to close or reverse the loop ileostomy. The procedure will then most likely allow you to have bowel movements without the need for an external ostomy bag.

All of these surgical procedures can be performed using standard (open) procedures or using minimally invasive (laparoscopic) procedures.

Possible complications

In general, surgery for ulcerative colitis is considered safe. But you do need to watch for the following acute and delayed complications, which could include:

  • Infection
  • Pelvic abscess
  • A painful obstruction of the ileum
  • Urinary incontinence
  • Impotence
  • Infertility
  • Pouchitis (inflammation of the ileal pouch)
  • Small bowel obstructions

Surgery for ulcerative colitis is an important decision. There are risks involved and not every person will be able to restore continuity. Those who are severely ill prior to surgery are more at risk for the above complications. Your need and desire for surgery must always be balanced with the possible complications you might encounter. The benefits and risks along with the best approach for you will be a decision you and your surgeon and other members of your healthcare team make together.