Overview

Ulcerative colitis (UC) is an inflammatory bowel disease that affects the large intestine or colon. The disease has a relapsing-remitting course, which means that  periods of flare-ups are followed by periods of remission.

Right now, there’s no medical cure for UC. Current medical treatments aim to increase the amount of time between flare-ups and to make flare-ups less severe.

Curative surgery

The symptoms typically associated with UC, such as cramping, bloody diarrhea, and inflammation of the bowel, can be stopped with surgery. Complete resection, or removing the whole large intestine, will stop symptoms completely. However, a total colectomy is associated with other adverse effects. Because of this, a partial colectomy is sometimes performed instead, where only the diseased part of the colon is removed.  

Of course, surgery isn’t for everyone. A partial or total colectomy is usually reserved for those who have severe forms of UC.  Bowel resection surgery may be an option for those who need corticosteroids for a long time or have had the condition for at least seven years.

Partial or total colon resection

In total resection, the entire large intestine is removed. This is the only true cure for UC, but it can reduce quality of life. 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 done, the bowel is routed to the abdominal wall and waste exits the body in a colostomy bag. With modern surgical techniques, it’s often possible to reconnect the remaining bowel to the anus, either during the initial resection surgery or after a healing period.

Possible complications

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. This is called pouchitis, and can be 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

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 UC 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

Having emergent surgery poses a greater number of risks and complications. It’s also more likely that patients undergoing emergent surgery will temporarily need a colostomy.

Takeaway

Although surgery may cure the gastrointestinal symptoms of UC, it may not always cure other affected sites. Occasionally, people with UC have inflammation of the eyes, skin, or joints. These types of inflammation may persist even after the bowel has been totally removed. This is uncommon, but is something to consider before getting surgery.