Ulcerative Colitis (UC) and Surgery: What to Know

If you have ulcerative colitis (UC), your first line of treatment will likely be medication. But even with medication, sometimes symptoms continue to flare, tanking your quality of life along the way.

If that happens, a surgery called proctocolectomy may be considered to better control pain and inflammation, says Tracey Childs, MD, a colorectal surgeon and chief of surgery at Providence Saint John's Health Center in Santa Monica, California.

"Medications now compared to even 10 years ago are much more effective at controlling ulcerative colitis," Dr. Childs says. "That means we're doing fewer surgeries overall.” Medication doesn’t always work for everyone, so surgery can be a necessary option for preventing UC complications as well as alleviating symptoms, she says.

There are two types of proctocolectomy considered when treating UC, and what differentiates them is how stool will be collected after surgery.

Proctocolectomy With Ileal Pouch-Anal Anastomosis

Proctocolectomy With End Ileostomy

"To some degree, which procedure you have can come down to patient preference," says Childs. "Some people hate the idea of having an ostomy, but others appreciate the convenience of not having to find a bathroom 6 to 10 times per day."

"In an emergency situation, someone would be very sick, with toxic colitis," he says. "This is a serious complication with inflammatory bowel disease that involves rapid, severe inflammation and it can be life-threatening. In that situation, surgery is needed not just for the UC, but often to save the life of the patient."

The type of care necessary after a procedure depends on what's done, says Parul Shukla, MD, regional chief of colon and rectal surgery at Northwell Health in New York City. For example, if you have an ostomy bag, care will involve making sure your stoma is not infected, and that you're not experiencing issues with emptying the ostomy efficiently. If you have a J-pouch, follow-up will include ensuring that there's no inflammation happening with the internal reservoir, he says.

"For both surgeries, your health team will talk about nutritional changes you may need to keep inflammation controlled, and do postoperative bloodwork to detect any inflammation or infections in an early stage," Dr. Shukla says. With a proctocolectomy, there should not be a need for further UC medications, but it's still important to track any symptoms and do regular surveillance visits with your doctor, he says.

The Takeaway

• Medications have come a long way in the last decade for treating UC, but they don't work for everyone, or you may have complications that warrant an emergency proctocolectomy.
• The surgery removes both your colon and rectum, and you'll have either an internal pouch or an external ostomy to handle the body's stool.

• Which type of pouch you have will depend on factors related to how your anus is affected by UC. Patient preference is also considered when deciding on a surgical option.
• Surgery can often significantly improve quality of life because it can lead to far fewer flares, less pain, and less urgency.