When is surgery needed?
About 2 to 4 people out of 10 (20% to 40%) who have ulcerative colitis eventually must have surgery to remove their colons. Surgery is called a "cure" for ulcerative colitis because it removes the irritated tissue so the disease cannot return.
Some people decide to have surgery to get rid of frequent severe symptoms that even medication can't relieve. Surgery may be required suddenly if there is an emergency, such as a hole or tear (perforation) in the colon; massive bleeding in the colon; a sudden, severe attack of ulcerative colitis; or toxic megacolon, which means the muscle wall of the colon stretches (dilates), allowing bacteria and gases to build up inside the colon.
What are the surgical procedures?
Proctocolectomy (pronounced "prahk-to-ko-leck-toh-mee")
The surgery that is usually done for ulcerative colitis is a proctocolectomy. In this operation, the surgeon removes the entire colon and rectum. Then, the surgeon performs a second procedure to allow waste to exit the body. There are 2 kinds of procedures, described below, that the surgeon can recommend based on how severe the person's disease is, their lifestyle, needs, and expectations.
Ileostomy (pronounced "ill-ee-osto-mee")
The surgeon creates a small hole (stoma) in the abdomen and attaches the end of the small intestine (the ileum) to it. The stoma, which is about the size of a quarter, is covered by a plastic pouch, which a person wears outside the body, just below the beltline. Waste travels through the small intestine, through the stoma, and into the pouch. The pouch is emptied into the toilet when needed, usually a few times a day.
Ileoanal anastomosis (pronounced "ill-ee-oh-ay-nuhl uh-nasto-mo-sis")
In this procedure, the surgeon creates a small pouch from the small intestine inside the body and attaches it to the anus. Stool collects in this pouch and is released like a normal bowel movement. Most people who have an ileoanal anastomosis have about 6 soft bowel movements a day.
What are the complications of surgery?
The 2 most common complications of surgery for ulcerative colitis are small bowel obstruction and inflammation of the ileal pouch (pouchitis). When the bowel is obstructed, something is blocking the stools from passing through. When this happens, a person may experience cramping, stomach pain, nausea, and vomiting. Usually the obstruction can be fixed with fluids sent through an intravenous (IV) line, often in a hospital's outpatient clinic, and by letting the bowel rest. Sometimes, though, only surgery can remove the obstruction.
Next: Does ulcerative colitis cause colon cancer?