Surgery is one of the many treatment options available for people with ulcerative colitis (UC). Not everyone with this condition will need surgery, however. Some people may try less invasive treatments first and then have surgery later if the disease progresses.
Keep reading to learn about the impact this type of treatment will have on your body and lifestyle.
You may be able to manage UC through medication and changes to your diet. Over time, the initial treatments your doctor prescribed may no longer work or they may become less effective.
The symptoms and side effects of UC could become so severe that you need to explore a different treatment option.
Surgery is rarely the first option. Up to of people with UC will need surgery at some point. Most people with UC will be able to treat the disease in other less invasive ways before surgery is necessary.
When surgery is needed, the colon and the rectum are removed in a procedure called a proctocolectomy.
A proctocolectomy is done in the hospital as an inpatient operation. This means you’ll stay in the hospital during the procedure and for part of your recovery. You’ll need to receive general anesthesia.
After you have a proctocolectomy. You’ll need an ileostomy or an ileal pouch-anal anastomosis (IPAA). In most cases, your doctor will conduct both surgeries on the same day so you don’t have to have general anesthesia again.
Once your colon and rectum are removed, your doctor will need to create a way for your body to eliminate waste. This procedure is called an ileostomy.
An ileostomy is an effective treatment for UC, but you’ll need a stoma as part of the procedure. A stoma is a surgically created opening that allows waste from your intestines to exit your body. A stoma is typically made in the lower abdomen, just below the waist.
You’ll also need to wear an ostomy pouch. An ostomy pouch is a bag that you wear externally to catch body waste.
What to expect
Before an ileostomy, your surgeon must perform a proctocolectomy. They’ll perform the ileostomy in the hospital, and you’ll receive general anesthesia.
Following the procedure, you’ll need to wear an ostomy pouch. This may be uncomfortable for some people. You’ll have to wear the ostomy pouch for the rest of your life. Once you’ve had this procedure, your surgeon can’t reverse it.
This second type of procedure is sometimes called a J-pouch. This surgery is also usually effective, but it hasn’t been around as long as ileostomy has. This means it may be more difficult to find a surgeon who can perform the procedure.
Unlike with an ileostomy, a pouch is constructed at the end of your ileum and attached to your anus. This eliminates the need for an external ostomy pouch.
Some people experience incontinence, or accidently pass waste, following the surgery. Medications may help control the function of the pouch. You may also experience inflammation or irritation in the pouch. This is called pouchitis. Some women may become infertile after the procedure.
What to expect
As with the ileostomy, you’ll need a proctocolectomy before an IPAA. An IPAA is done in a hospital, and you’ll receive general anesthesia.
The IPAA won’t function like a normal bowel and rectum at first. You may have bowel leakage for several weeks while you learn to control the internal pouch. Medication can help.
The pouch may become inflamed or irritated. You may have to treat this continually.
If you’re a woman and planning to have children in the future, talk to your doctor about this before the procedure. This procedure may lead to infertility in women.
Another type of ileostomy is called a continent ileostomy, or K-pouch. During this procedure, the end of your ileum is secured against the inside of your abdomen.
Unlike a traditional ileostomy, you don’t need to wear an ostomy pouch. A K-pouch is also different from a J-pouch in that the ileum isn’t connected with the anus. Instead, a continent ileostomy relies on an internal valve that collects waste and prevents it from draining out.
When the K-pouch gets full, waste is removed via a catheter. You’ll need to use a stoma cover and drain the pouch often, at least a few times per day.
A K-pouch procedure may be preferable if you’ve had issues with an ostomy bag, such as skin irritation, or if you just don’t want to mess with an external waste bag. However, due to the fact that continent ileostomy can only be performed when your bowels are healthy, this procedure is no longer common as it once was.
After the surgery, you’ll stay in the hospital three to seven days. This window of time allows your surgeon to monitor you for signs of complications.
Both sets of procedures will require a four- to six-week recovery period. During this time, you’ll meet regularly with your surgeon, doctor, and possibly an enterostomal therapist. An enterostomal therapist is a specialized therapist who works directly with people who’ve had their colon removed.
Your care team will likely cover the following points with you to help improve your recovery:
- Eat well because good nutrition can help your body heal and help you avoid post-operation health issues. Nutrition absorption can be an issue after these surgeries, so eating well will help you maintain your levels of nutrients.
- Hydration is important for your overall health but especially for your digestive health. Drink six to eight glasses per day at a minimum.
- Work with a rehab therapist or a physical therapist to slowly recover your physical capabilities, and exercise when you can. Staying active is a great way to care for your overall health as you recover, but too much activity too soon could complicate your recovery.
- Manage stress. Anxiety or emotional stress can cause stomach issues, which can increase your risk of an accident.
If you have an ostomy bag from a traditional ileostomy, you’ll need to take care of it in order to reduce the risk of gastrointestinal discomfort and other complications.
Your surgeon will advise you to take the following steps for ostomy care:
- Empty your ostomy bag whenever it’s a third of the way full. This will help prevent leakage and bulkiness.
- When you’re ready to empty the bag, hold the bottom of the bag and slowly lift up, gently unrolling it over the toilet. Clean both the inside and outside of the pouch tail with some toilet paper and roll it back up.
- Depending on the type of bag you have, you may need to change out the ostomy once per day or a few times per week. You may also need to switch out the bag more often if you sweat a lot because it won’t be able to stick to your skin as effectively as it should.
- When changing the ostomy bag out, you’ll want to carefully clean any discharge around the stoma and clean your skin with soap and water. Make sure your skin is completely dry before placing a new patch and bag against it.
Changing out your ostomy bag also provides you with an opportunity to look for any possible skin irritation.
Call your doctor if your skin is excessively red or irritated, as this could indicate an allergic reaction to your ostomy materials. This is usually fixed by using different adhesives and patches.
Surgery is usually a last-resort option for UC, partly due to the fact that any surgery can pose risks and complications. Some of these risks for UC surgery include:
- itching or irritation of the stoma
- organ damage
- blocked intestines from scar tissue build-up
- excessive gas
- rectal discharge
- nutritional deficiencies, especially vitamin B-12
- electrolyte imbalances
Bowel surgery may also pose the risk of developing phantom rectum. A phantom rectum refers to the feeling of having to pass a bowel movement even though you no longer have a rectum. This can occur for several years post-surgery.
Meditation, antidepressants, and OTC pain relievers may help with phantom rectum.
For most people with UC, surgery is the last option after other treatment options have either failed or not provided the necessary relief. Surgery options fall into two main categories. The key difference is where the waste pouch is placed following surgery.
Both surgeries are intensive and require a lengthy recovery period. Before you make a decision, consult a variety of healthcare professionals, including your doctor, a surgeon, and an enterostomal therapist.
UC isn’t curable but removing your colon and rectum does treat the symptoms of UC. You may still live with many of the side effects of these surgeries long after the incisions have healed. That’s why it’s important that you feel prepared and informed about your options before going into the hospital.
If you’re considering surgery as a UC treatment, talk to your doctor about your options and the risks. Write down a list of questions before the appointment. Bring along a spouse, family member, or a friend to help you remember answers and ask questions.
Here are some questions you may want to ask:
- Am I a candidate for surgery?
- How will this surgery affect my UC symptoms?
- What are the risks of this surgery?
- What are the possible short- and long-term complications?
- Which type of surgery is best for me?
- Have you worked with a surgeon who has performed this procedure before?
- What will recovery be like?
- Will I need to make any lifestyle changes?
- How will this surgery affect my day-to-day life?