The Crohn’s and Colitis Foundation say 25 to 40 percent of people with ulcerative colitis eventually require surgery.
Today, there are two different surgical techniques for ulcerative colitis. The type of surgery a person has will depend on their symptoms, age, other health conditions, and personal preference.
After surgery, most people with ulcerative colitis can lead healthy, active lives. Learn more about the procedures and what to expect in this article.
What is ulcerative colitis surgery?
A person may need ulcerative colitis surgery if other treatments, such as medication, do not control their symptoms.
A person may also need surgery if they have colon cancer or precancerous changes in the colon.
Having ulcerative colitis raises a person’s risk of developing colon cancer, especially if they have had ulcerative colitis for 8 years or more.
Sometimes, people with ulcerative colitis need emergency surgery if they have a perforation (hole) in the colon or bleeding that will not stop.
There are two types of ulcerative colitis surgery:
Proctocolectomy with ileostomy
Proctocolectomy with ileostomy involves the following steps:
The stool that comes out of the small intestine is not solid, and so it can flow into the pouch without the individual noticing.
The stoma does not have a muscle, and people cannot control when the pouch fills up. Ostomy bags available today are flat, discreet, and odor-free.
People wear an ostomy bag under their clothes, where it is not noticeable. Special garments are also available that conceal the ostomy bag for intimacy.
After a person has a proctocolectomy with ileostomy, they will need to learn to care for their stoma and the ostomy pouch. As well as regularly draining the pouch, they must learn to clean the stoma area to avoid infections.
Some pouches are washable and reusable, while others are disposable. The type of pouch will depend upon a person’s preference.
Proctocolectomy and ileoanal pouch-anal anastomosis (IPAA) is a newer procedure that allows a person to have bowel movements out of their natural anal opening. This procedure is sometimes called ileoanal pouch reservoir surgery or J-pouch surgery.
IPAA preserves the anus, rather than removing it. This procedure involves the following steps:
Stool gradually collects in the internal pouch and exits the body via the anus, making it more like a standard bowel movement.
If a person’s anal muscles are in good condition, they will be able to feel stool coming out and will be able to use the toilet for bowel movements, as usual.
Although a surgeon preserves the anus with this procedure, the bowel movements are often more frequent and may be very soft or watery because the colon is missing.
Fecal incontinence (having an accident) may occur in some people, but medications are available that can help control bowel movements. A person should have good functioning of the anal muscles to help reduce the risk of incontinence.
Sometimes, surgeons perform IPAA in stages. The first stage involves making the pouch and connecting it to the anus. Then, the surgeon will leave the pouch alone to heal for several weeks.
The surgeon creates a temporary stoma and ostomy bag for use until the second procedure takes place.
After 2–3 months, they will close the temporary stoma in the abdomen and re-route the waste to the internal pouch and out via the anus.
The most common issue for people who have an ileostomy is a blockage in the small intestine. Symptoms of a blockage include:
- severe abdominal pain
- thin, clear, foul-smelling liquid in the pouch
- dark-colored urine
- vomiting
- lack of liquid in the pouch
- swelling around the stoma
A person should call a doctor immediately or go to the emergency room if they are experiencing symptoms of a blockage.
People who have IPAA surgery will need to watch for symptoms of pouchitis. This is an infection of the internal pouch that requires antibiotics.
About half of all people who have IPAA surgery get pouchitis at least once. Symptoms of pouchitis include:
- diarrhea
- frequent bowel movements
- abdominal pain
- fever
- joint pain
Sometimes the small intestine can get blocked after IPAA surgery, but this problem is less common. Most of the time, a person can recover from a blockage following an IPAA surgery with a short stay in the hospital and intravenous fluids.
Dietary changes after surgery
After ulcerative colitis surgery, a person may need to change their diet. Without a colon, the body digests food differently.
Some people may need to take vitamins or supplements to ensure they get enough nutrients. A doctor or dietitian can help a person make an individualized meal plan after they have had surgery.
People may find that certain foods cause diarrhea or digestive problems following surgery. When trying new foods, it is wise if they introduce only a little at a time to minimize any possible issues.
While problematic foods vary from person-to-people, many find it best to avoid the following foods to minimize discomfort and diarrhea:
- dried fruit, such as prunes, figs, and raisins
- raw fruits and vegetables
- nuts and seeds
- spicy foods
- high-sugar foods, such as candy
- carbonated drinks or drinks with caffeine
Eating small meals more frequently can also help avoid gas and pressure from an empty stomach.
Foods that are “binding,” such as bananas, potatoes, and rice may also be helpful. Drinking plenty of water can help offset dehydration from loose stools. Staying hydrated also helps keep the intestines working well.
Outlook
While ulcerative colitis surgery is a significant life change, the outcome is often positive overall, as surgery may permanently relieve some symptoms.
Deciding upon the type of surgery and when to have it can be difficult, but a doctor can discuss all the options.
In addition, support groups and forums for people with ulcerative colitis can be helpful, not only for deciding about surgery but also for receiving ongoing emotional support.
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