Ulcerative Colitis, an Inflammatory Bowel Disease, has many treatment options. The goal of all treatment methods is to achieve and maintain remission, which means avoiding inflammation flares and UC symptoms.
Multiple factors help determine the best approach to treating Ulcerative Colitis. The severity of the disease, location of the disease, response to past treatments, and other medical conditions all influence future treatment approaches.
Medications, both prescription and non-prescription, are treatment options for Ulcerative Colitis and often the first line of defense. If medications fail to improve the condition, your doctor may recommend surgery.
Surgery is used as a treatment for between one-quarter and one-third of Ulcerative Colitis patients. It is generally selected as a treatment method when patient quality of life suffers. Your doctor may suggest surgery if you suffer from frequent flares and if medication proves ineffective. Your doctor may also perform surgery if you develop:
- Perforations in your intestine
- Severe bleeding requiring blood transfusions
- Colon cancer, or
- Narrowing of the intestine that appears like colon cancer.
Types of Ulcerative Colitis Surgery
Surgery for UC is called a proctocolectomy, which involves the removal of the colon and rectum. The type of surgery for each patient is based on many factors including:
- Your condition’s severity
- Patient’s age
- Patient’s overall health condition.
There are two variations of colectomies:
Proctocolectomy with ileal pouch-anal anastomosis (IPAA)
This surgery removes the colon and rectum. In this procedure, the ileum, a part of the small intestine, is turned into a pouch and attached directly to the anal sphincter muscle. With this option, individuals can still empty their bowels normally and there is no need to wear a permanent external bag for waste.
IPAA is the most common surgery performed in Ulcerative Colitis patients. In some cases, this procedure can be completed laparoscopically, which is minimally invasive and requires a shorter stay in the hospital post-op.
IPAA can be completed in multiple stages. If completed in two stages, a temporary ileostomy will be created while the pouch your doctor formed begins to heal. An external ostomy pouch is temporarily required for waste during this time. If you are in poor physical health, on high-dose steroids, or need emergency surgery, IPAA may be completed in three stages.
Immediately after IPAA, it is common for stool to be soft or liquid. You may experience up to twelve bowel movements daily and have a sense of urgency and some stool leakage. As your new ileal pouch heals and your anal sphincter muscle gets stronger, your stool will become thicker, and the frequency will decrease. Within a few months of surgery, most individuals will reduce output to six to eight bowel movements daily, which are soft, but no longer liquid.
One potentially serious complication after IPAA is pouchitis. Pouchitis is a condition in which the new ileal pouch becomes inflamed and requires antibiotics for treatment. Diarrhea, cramping, increased stool frequency, fever, dehydration, and joint pain are all symptoms of pouchitis. Contact your doctor if you experience these symptoms after surgery.
Total proctocolectomy with end ileostomy
This surgery removes the colon, rectum, and anus. An ileostomy is created, which places a hole in the abdominal wall. After surgery, solid waste leaves the body through the hole, known as a stoma.
The stoma will be about the size of a quarter and appear pink, moist, shiny, and slightly raised. It is generally located on the lower abdomen, to the right of the belly button. An external ostomy pouch will be connected to the stoma to collect waste. The pouch will need to be emptied several times each day.
After this procedure, you should contact your doctor if you develop an infection in the stoma or notice the stoma sticking out further or pulling back into the body. Additionally, if you are not collecting waste in the ostomy pouch, there may be a blockage and you should alert your doctor immediately.
Most individuals who undergo these surgeries for UC can return to normal life after recovery. It is important to set your expectations appropriately for life post-surgery. Generally, it takes about a year to get used to the changes in your body post-op.
Immediately after surgery, your doctor will likely recommend a liquid or soft diet. You will be able to slowly add more solid foods and work your way back to a normal diet from there, though we always recommend avoiding foods that cause gas or diarrhea and drink plenty of water. Per your doctor’s recommendations, you should be able to return to physical activity a few weeks after surgery.
Although surgery can significantly improve and even cure Ulcerative Colitis, it is still important to take care of your body after surgery.
Continuing to work with your doctor and dietitian will allow you to maintain a healthy life.
Kaitlyn Willwerth is a Registered Dietitian at OnPoint Nutrition. Kaitlyn's work focuses on providing individualized health and lifestyle coaching and, most importantly, support. She is a Certified LEAP Therapist and has also completed the Monash University 'Low FODMAP Diet for IBS' online training course for health professionals.