Ulcerative colitis is an inflammatory bowel disease that affects the large intestine (also known as the colon). The disease has a relapsing-remitting course, which means that the patient will suffer from symptoms such as cramping and bloody diarrhea, but then have periods without symptoms. Using currently available medications, medical treatment attempts to increase the amount of time between flare-ups and make flare-ups less severe. Unfortunately, there is no medical cure for ulcerative colitis. In fact, the only known cure for ulcerative colitis is to surgically remove part or the entire colon.
Curative Surgery for Ulcerative Colitis
The symptoms typically associated with ulcerative colitis, such as cramping, bloody diarrhea, and inflammation of the bowel, can be stopped with surgery. Complete resection, i.e., removing the whole large intestine, will stop ulcerative colitis symptoms completely. However, so-called total colectomy is associated with other adverse effects. Thus sometimes a partial colectomy is performed instead, where only the diseased part of the colon is removed.
Surgery is not for everyone with ulcerative colitis. Partial or total colectomy is usually reserved for patients who have severe ulcerative colitis, in which flares are frequent and involve large areas of colon. Bowel resection surgery may be an option for patients who are dependent on corticosteroids for a long time (cannot be weaned to maintenance medication without having flares) and/or have had ulcerative colitis for at least seven years. As many as one-half to one-third of patients will require either partial or total colectomy during the course of their ulcerative colitis.1
Partial or Total Colon Resection (Colectomy)
In total resection, the entire large intestine is removed. This is the only true cure for ulcerative colitis, but it can reduce quality of life.2 In partial resection, colorectal surgeons remove the diseased region of the colon with a margin of healthy tissue on either side. When possible, the two remaining ends of the large intestine are surgically united, reconnecting the digestive system.
When this cannot be accomplished, the bowel is routed to the abdominal wall, and waste exits the body in a colostomy bag. With modern surgical techniques, it is often possible to reconnect the remaining bowel to the anus, either during the initial resection surgery or after a healing period.3
Complications Associated with Bowel Resection
Part of the bowel surgery involves creating a pouch near the anus, which collects waste prior to defecation. One of the complications of surgery is that the pouch can become inflamed, which causes diarrhea, cramps, and fever. Pouchitis, as it is called, is treated with an extended course of antibiotics.
The other main complication of bowel resection is small bowel obstruction. Small bowel obstruction is first treated with stool softeners, fluids, and bowel rest; however, severe small bowel obstruction may need to be treated with surgery.
Emergent Surgery for Ulcerative Colitis
While surgery is often delayed until the disease becomes severe, in some cases patients may require emergent bowel removal surgery because the risk of keeping the bowel is too great. People with ulcerative colitis may need emergent surgery if they experience:
- toxic megacolon (life-threatening dilation of the intestine)
- rectal bleeding
- dysplastic changes in the colon that may suggest cancer
Importantly, bowel resection that is done emergently is associated with greater risk of complications. Also, it is more likely that patients undergoing emergent surgery will need a colostomy (an opening in the abdomen for feces evacuation), at least temporarily. Therefore, it is important to maintain regular contact with a physician if you have ulcerative colitis to minimize this risk.
Surgery May Not Be a Cure
Although surgical resection of the colon cures the gastrointestinal symptoms of ulcerative colitis, it may not always cure other affected sites. Occasionally people with ulcerative colitis have inflammation of the eyes, skin, and/or joints. Unfortunately, the inflammation that is related to ulcerative colitis (e.g. arthritis) may persist even after the bowel has been totally removed.4 Fortunately, this is rather uncommon. Anyone considering bowel resection surgery should consult a pre-surgical counselor to discuss the advantages and limitations of colectomy for ulcerative colitis treatment.
A Future Medical Cure?
Basic research and clinical studies on the gut lining indicate that even during the symptom-free periods between flares, the inner gut lining is still inflamed. If gut tissue is given an appropriate time to heal in a toxin-free environment, a new lining will grow and cover the inflamed areas of the bowel. When this occurs, the normal functioning of the gut is restored. Unfortunately, most people experience flaring and relapses that are so frequent that the gut does not have time to fully heal itself. Nonetheless, if medications for ulcerative colitis advance to the point that inflammation can be stopped for a long period, the gut might be able to heal. This would mean that patients might one day be able to achieve a prolonged remission—perhaps even a cure without surgery. Until then, however, surgery is still the only known cure for ulcerative colitis.