Surgery for Ulcerative Colitis

Ulcerative colitis surgery removes your large intestine (colon) and usually your rectum. Your healthcare provider may recommend surgery if medication no longer controls your symptoms. Surgery may also be an option if ulcerative colitis (UC) causes serious complications.

For many people, surgery can relieve symptoms and improve quality of life. In some cases, it can be lifesaving. The type of surgery you need depends on your symptoms and overall health. It also depends on whether the procedure is planned or an emergency. Your surgeon will discuss your options with you and explain their recommendation.

When might I need surgery for ulcerative colitis?

Most people with UC manage the condition with medication. But you may consider surgery if medication isn’t working anymore. You may also get surgery if you:

• Can’t handle medication side effects
• Have ongoing inflammation that doesn’t improve with treatment
• Develop cancer or precancerous changes
• Have heavy bleeding, a hole in your colon or toxic megacolon

About 3 out of 10 people with advanced UC eventually need surgery.

What are the risks of ulcerative colitis surgery?

The risks depend on the type of surgery you have. Potential risks include:

• Infection
• Bleeding
• Blood clots
• Bowel blockage, which is usually reduced when having keyhole surgery
• Leakage around a surgical bowel connection that doesn’t heal properly
• Possible dehydration in the case of a (temporary) stoma

Your surgeon will talk to you about your risks based on your health and the procedure you’re having.

How should I prepare for ulcerative colitis surgery?

Before surgery, your healthcare provider may:

• Review your medications
• Discuss possible ostomy care
• Mark a location on your belly for a stoma
• Explain potential risks
• Go over what to expect with recovery

You may also work with specialists in different areas, like a gastroenterologist and an ostomy care nurse.

What are the types of surgery for ulcerative colitis?

There are several types of ulcerative colitis surgery. Healthcare providers choose which procedure to use based on your health, symptoms and treatment goals.

J-pouch surgery

J-pouch surgery is the most common operation for ulcerative colitis. Providers also call it restorative proctocolectomy with ileal pouch-anal anastomosis (IPAA).

During this type of surgery, your surgeon removes your colon and rectum. Then, they use part of your small intestine to create an internal pouch (J-pouch) that connects to your anus. The pouch stores poop and allows you to poop without a permanent ostomy.

Your surgeon may do J-pouch surgery in one, two or three stages. Staging it may be safer if you’re taking certain medications or have malnutrition. They may also stage it if you have severe inflammation or need emergency surgery.

The stages may include:

1. Removing your colon and creating a temporary ileostomy
2. Creating a J-pouch and connecting it to your anus
3. Closing the temporary ileostomy after you’ve healed

Your surgeon will explain which approach is safest for you.

People who have J-pouch surgery may develop specific complications, including:

• Pouchitis 
• Inability to hold in poop
• Pelvic infection
• Pouch failure

Total proctocolectomy with end ileostomy

This surgery removes your colon, rectum and anus. Poop leaves your body through a permanent ileostomy.

Your provider may recommend this option if you aren’t a good candidate for J-pouch surgery.

Total abdominal colectomy with end ileostomy

In this type of colectomy, your surgeon removes your colon and creates an ileostomy. An ileostomy brings the end of your small intestine through an opening in your belly. Poop leaves your body and collects in an ostomy pouch.

In most cases, providers will do this type of surgery first. They’ll definitely do it if you’re very sick from UC.

Total abdominal colectomy with ileorectal anastomosis (TAC-IRA)

This procedure removes your colon but leaves your rectum in place. Your surgeon connects your small intestine to your rectum.

Providers don’t do this type very often. Because your rectum remains, ongoing inflammation can still occur. You’ll need regular monitoring for cancer and precancerous changes.

Proctocolectomy with continent stoma or Kock pouch

In some cases, your surgeon can create a continent stoma, or Kock pouch. Instead of having a stoma with a bag, you’ll have a pouch inside your body to hold poop.

The pouch attaches to the stoma. Several times a day, you’ll need to empty the pouch by inserting a tube into the stoma.

How long does ulcerative colitis surgery take?

It depends on which procedure you have. Providers typically do J-pouch surgery in stages. Each surgery can take several hours.

Ulcerative colitis surgery recovery

Your recovery depends on the type of operation. It also depends on whether the surgery was planned or done urgently. Many healthcare systems use enhanced recovery measures that encourage:

• Early movement after surgery
• A gradual return to eating
• Good pain control with less reliance on opioids
• Early removal of IV fluids and urinary catheters, when appropriate

If you have a temporary ileostomy, you’ll get instructions on caring for it until it’s reversed.

Life after ulcerative colitis surgery

Many people have major symptom relief after surgery. J-pouch surgery allows most people to poop through their anus and avoid a permanent ostomy. But bowel habits are usually different than they were before surgery. Some people poop more often.

If you have a permanent ileostomy, an ostomy nurse can help you learn how to manage it. They’ll show you how you can return to your daily activities.

Surgery can remove your diseased colon and rectum. But you’ll still need ongoing follow-up care. Your provider will want to track your long-term health. They can address any complications that may develop.

When should I call my healthcare provider?

Contact your provider if you have:

• Fever
• Severe belly pain
• Heavy rectal bleeding
• Signs of infection around a stoma
• Ongoing nausea or vomiting
• Problems with the ileostomy
• Sudden changes in bowel function

Is ulcerative colitis cured by surgery?

Removing your colon and rectum gets rid of the disease in those organs. But some people may still have issues related to the surgery itself, like pouchitis.

Can ulcerative colitis come back after surgery?

UC doesn’t return if you have your colon removed. But some people may develop inflammation in a J-pouch. You may also continue to have symptoms related to your remaining rectal tissue.