Overview

Ulcerative colitis (UC) is an inflammatory bowel disease that mainly affects the lining of the large intestine (colon). This autoimmune 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. The removal of the entire large intestine (total colectomy) will stop the UC colon 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 UC. Bowel resection surgery may be an option for those who have not responded well to medical therapy for UC, typically after years of medical therapy, in which side effects or decreased ability of the medications to control the disease have led to a poor quality of life.

Partial or total colon resection

In a total resection, the entire large intestine is removed. While this is the only true cure for UC, it can reduce quality of life. In a 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 an ileostomy or colostomy bag. With modern surgical techniques, it’s potentially 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. A small bowel obstruction is first treated with intravenous fluid and bowel rest (and possibly nasogastric tube suction for decompression). However, a severe small bowel obstruction may need to be treated with surgery.

Emergent surgery

While surgery is often delayed until the disease becomes severe or dysplastic changes trending to the point of cancer have occurred, in some cases patients may require emergent large bowel removal surgery because the risk of keeping the diseased bowel is too great. People with UC may need emergent surgery if they experience:

  • toxic megacolon (life-threatening dilation of the large intestine)
  • uncontrolled bleeding within the large intestine
  • colon perforation

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

The 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. While this is uncommon, it is something to consider before getting surgery.