Ulcerative colitis (UC) is a chronic (long-term) medical condition. It’s a type of inflammatory bowel disease (IBD). UC can cause inflammation and ulcers in the lining of your colon (large intestine) and rectum. You can choose surgery if your:
- Symptoms persist and other medical treatments (such as medication) don’t help
- Risk for cancer is higher because you have polyps or a long history of UC
- Treatment causes side effects serious enough to weaken your health
- UC symptoms aren’t going away
You may need surgery sooner if you get certain UC problems. These can include acute fulminant colitis. It’s a sudden, serious onset of UC symptoms. If medication doesn’t help, your doctor may suggest surgery if you:
- Get more than 10 stools in a day
- Have constant bleeding
- Get pain in your belly
- Bloat
- Can’t eat or you get toxic symptoms such as a high temperature (fever)
You may need emergency surgery if:
- Your colon has ruptured
- You have a lot of bleeding
- Get a life-threatening dilation of your colon (toxic megacolon)
A toxic megacolon is a serious medical condition. Get medical help right away. It can put you at risk for colon rupture.
How Common Is Surgery for Ulcerative Colitis?
About 7 out of every 100 people get major surgery within the first five years of their ulcerative colitis diagnosis. And a third need surgery after having this lifelong condition for 30 years.
Common surgical options for UC include ileostomy and J-pouch surgery. People typically consider surgery when other treatments aren’t working. Or they may get it right away if serious problems arise, such as:
Acute fulminant colitis. It’s a sudden, serious inflammation causing serious symptoms such as frequent stools, bleeding, and belly (abdominal) pain.
Toxic megacolon. It’s a serious, life-threatening condition where your colon gets bigger (enlarges). Toxic megacolon can also burst (rupture) your colon.
Dysplasia. Sometimes, abnormal tissue can grow in your colon. It can potentially be cancer or precancer.
Ulcerative colitis surgery is a useful treatment. It’s important to know that surgery isn’t a sign that other treatments failed.
Surgery for UC is simply another tool. It can help you manage your health. Whether you need it can depend on the complications and your symptoms.
Types of Ulcerative Colitis Surgery
There are different types of surgeries that can help you. Your symptoms and health issues matter, but you’ll help your doctor decide. Talk with your surgeon about which one they suggest.
Proctocolectomy with ileal pouch-anal anastomosis (IPAA) or J-pouch
There are usually two steps for this surgery. But if your surgeon decides to complete it, you won’t have a stoma (opening through your belly). Instead, they’ll sew or staple your ileal pouch and anus together.
If your surgeon decides to make a stoma, they’ll likely do an IPAA. First, they’ll make your pelvic pouch. It uses a temporary hole in your small intestine and belly (abdomen), called a stoma.
You may still be able to pass stool through your anus if your stoma is reversed. The reversal surgery is done later. You’ll get this second surgery after a few months. You’ll first need to complete your treatment and fully heal.
A proctocolectomy takes out your colon and rectum. It’s sometimes called a restorative proctocolectomy. Keeping your anal sphincter can also help you keep stool (poop) in and not have fecal incontinence (leak poop).
Next, the IPAA (J-pouch) is made. It connects to your anus to serve as your new rectum. Your surgeon will protect the healing anastomosis and make a temporary ileostomy loop. This will have your stoma where a bag can catch your stools.
But after the area heals, your surgeon will do the reversal surgery after two to three months. Then, you’ll pass stool through your anus.
Total colectomy
A total colectomy is a surgery to remove your entire colon. But it leaves your rectum intact. Together, the colon and rectum make up your large bowel. During the surgery, your surgeon may also do an ileostomy.
They’ll connect a small section of your small intestine through an opening. They do this at the top of your stomach. The stoma allows stool to exit through the opening into a stoma bag.
But this surgery isn’t done very often for UC because it leaves behind the rectum. The rectum can still get inflamed and cause UC symptoms.
Permanent ileostomy
If a restorative proctocolectomy with an IPAA is not a good option, your doctor may suggest a permanent ileostomy.
The tip of your lower small intestine is brought through the stoma. An external bag, or pouch, is attached to it. This is called a permanent ileostomy. Stools pass through this opening to collect in the pouch. The pouch must be worn at all times.
Continent ileostomy
The continent ileostomy, or Kock pouch, is another option. It’s a good option if you’d like to get your ileostomy made into an internal pouch. It’s also an option if an IPAA isn’t possible.
This surgery makes a stoma but doesn’t need a bag. The colon and rectum are removed first. Next, an internal storage pouch is created from your small intestine.
A small hole is made in your belly (abdominal wall). Then, a storage pouch is joined to the skin with a nipple valve. When you need to drain your pouch, you’ll insert a catheter through the valve into the internal reservoir.
It’s not the preferred surgery for UC. That’s because it can have uncertain results. And you may need more surgeries later.
Hemicolectomy
This surgery only removes part of your colon. It’s not preferred for UC because the other part of your colon can still get inflamed. But it may be a good option if only part of your colon has UC. There are two types done. It can depend on where your problem area is:
Right hemicolectomy. Removes the right, or ascending, part of your colon. Your surgeon may also take out some other areas. They may take out your appendix. Your surgeon may also take out the middle part of your large intestine. Then, they’ll connect what’s left of your colon to your small intestine.
Left hemicolectomy. Removes the left, or descending, part of your colon. Your surgeon will attach the right and middle parts to your rectum. This is the last place your bowel movements pass through on the way out.
How to Prepare for Ulcerative Colitis Surgery
It’s become common for people to get ulcerative colitis surgery in the early stages of the disease. But whether you’re in the early or late stages or somewhere in between, you’re likely wondering how to prepare. Here’s what you need to know.
Prepare mentally
It’s easier to feel ready for what’s ahead when your day-to-day responsibilities are taken care of. Before your surgery, figure out how work and family duties will be handled. Be sure to request enough time off from work for your recovery (your doctor can tell you how much time you’ll need). If you have kids, try to schedule your surgery when school is out. If that’s not possible, get help with childcare.
Connect with a wound-ostomy nurse if you’re getting an ostomy. That’s an operation that changes how urine and stool leave your body. This type of specialist will visit you in the hospital and tell you what type of treatment is needed to help you heal.
Prepare emotionally
It’s natural to feel different emotions both before and after the surgery. Talking with other people who’ve gone through the same thing can help. Join an online or in-person support group for people with IBD. You can also reach out to a therapist.
Surround yourself with family and friends who can support you. Rely on them to get you to and from the hospital. They can also help prepare meals and handle household chores while you get well.
Prepare physically
Any surgery is a strain on your body. So, your body needs to be as strong and healthy as possible. It’s important to have a healthy diet high in protein and lots of water in the days and weeks before surgery. This builds up your immune system. Talk to your doctor about vitamins or minerals to take in preparation. Poor nutrition is a risk for people with irritable bowel disease. It puts you at a higher chance of infection from surgery.
Don’t drink alcohol the day before surgery. If you smoke, try to stop. Smoking slows down your ability to heal. This raises your chances for an infection.
What to bring
Pack a travel bag to bring to the hospital. Include comfortable clothes that are easy to move in. Bring a family member or friend who can offer support. Compression socks can help with blood flow in your legs and avoid blood clots.
What to consider
There are risks with any surgery. They may include bleeding, infection, and issues from your general anesthesia. Your surgeon can talk to you about possible risks and what you can do to avoid them.
Pre-operative appointment
For this, you’ll go to the hospital about a week before your surgery. Your nurse will take your vitals and go over your medical history. You’ll also find out which of your medications to take or not take before surgery. You’ll talk about your colitis symptoms. Tests such as a chest X-ray or an EKG may be ordered to see your heart strength. Your blood is drawn for the anesthesiologist to look at. This doctor prescribes your general anesthesia. It’s the medicine that puts you to sleep during the surgery and keeps you from feeling pain.
Talk to your surgeon
You’ll talk about the operation and the risks that come with it. Your surgeon will also talk about the benefits you can expect from it. This is when you should ask any questions you have.
Ulcerative Colitis Surgery Recovery
Expect to stay in the hospital for at least a few days. But you may stay up to a week after surgery. It can depend on your healing time and other medical conditions. You’ll likely get IV fluids to keep you hydrated as you adjust.
You’ll be on a liquid diet for the first few days. How long can depend on your surgery and how your body adjusts. Don’t push yourself, listen to your body, and go slowly.
You’ll need up to a year to fully heal. Allow your body time to get used to the new changes. It’s learning to digest your nutrients differently.
You’ll slowly go from liquids to soft, mushy foods in the hospital. If you do well on mushy foods for a few days, you’ll get bland, soft foods next. After your body digests soft foods, try to chew solid foods slowly.
Drink lots of water, and keep hydrated. To stay hydrated, you may find oral rehydration solutions helpful. You can also try to eat and drink foods high in electrolytes.
Medicine will help with pain, but you probably won’t do normal activities for a couple of weeks. If you have open surgery, it might take longer. Your doctor will probably tell you not to lift any heavy objects for at least six weeks.
“Both the American Society of Colon and Rectal Surgeons and the Society of American Gastrointestinal and Endoscopic Surgeons advocate for preoperative education and stoma training for patients undergoing ileostomy creation,” says Nikhil Kadle, MD, a gastroenterologist at Digestive Healthcare of Georgia in Newnan, Georgia. “These measures can improve recovery and minimize complications.”
Stoma training can teach you how your surgery is done. Some can teach you how to care for your stoma and where to buy equipment. Classes also help you learn how to live with your stoma. They can give you ideas about how to talk with your partner about the stoma, too.
You should be able to eat and go to the bathroom normally after you get better. But if you have a stoma bag, you may still get an urge to go to the bathroom. That’s normal, too — it’s called a phantom rectum. Be patient — the urge will go away after your body adjusts.
Everyone heals at their own pace, so take it easy until you feel better. Ask your doctor what to expect.
Call your doctor if you:
- Have a fever of 100.4 F or higher
- Have cuts that swell or leak blood, fluid, or pus
- Get pain that worsens
- Can’t stop throwing up
- Still haven’t pooped three days after surgery
- Have blood in your stool
And if you have a hard time breathing, call 911 and get medical help at once.
What to Eat After Ulcerative Colitis Surgery
Ask your surgeon when it’s safe to eat solid meals. It will take some time for your intestines and gut to digest normally. While you recover, your colon may also have trouble taking in water.
You might have:
- Diarrhea or more bowel movements
- Dehydration
- Smelly or frequent gas
Here are some things you can do after surgery to help:
Talk to a dietitian. It’s important to discuss what’s safe to eat while your bowels heal. Ask your doctor about seeing a dietitian. They’ll help you create a personalized diet for your health.
It’s common to have problems with certain foods at first. Talk to your doctor or dietitian about it. They can help you adjust or offer advice. It’s likely temporary while your intestines heal. They’ll slowly help you eat certain foods again safely.
Rest your gut. To give your gut a rest, your doctor may also ask you to follow a low-residue diet. You may need to stay on it for about four to six weeks.
This can make your bowel movements smaller. Or you may go less often. It can also cut out most of your fiber. The diet may restrict some dairy, too. Some “low-residue” foods you can eat include:
- Applesauce
- Bananas
- Bread or toast
- Peanut butter
- Yogurt
- Potatoes
- White rice
- Cheese
- Pasta
- Tofu or easy-to-eat meat
Some foods you may need to avoid include:
- Processed meat, such as hot dogs or sausage
- Nuts
- Beans, peas, lentils, or legumes
- Fruits with skins, such as apples, pineapple, or coconut
- Popcorn
Stay hydrated. Make sure you drink 8-10 glasses of water or other fluids a day. This can help keep you hydrated. That means keeping the right balance of electrolytes and water in your body.
Notice the weather, too. Drink more if it’s hot or you’re more active. If you feel dehydrated or your stool is thicker, try to drink more liquids. You can add more broth, soups, or vegetable juice during the day.
You can also drink oral hydration solutions, electrolyte beverages, or pediatric electrolyte solutions, too. Ask your doctor or dietitian what they suggest for your health.
Vitamins and minerals. There are three main things you may keep an eye on after surgery: vitamin D, vitamin B12, and iron. Vitamin D helps your bones stay healthy. Vitamin B12 is key for oxygen and your nerves. Iron helps with your oxygen levels. If you have a J-pouch surgery, your doctor may check your iron.
“Nutritional status plays a pivotal role in recovery, with malnutrition and hypoalbuminemia linked to longer hospital stays,” says Kadle. “And [poor nutrition] can increase risk of complications.”
Hypoalbuminemia (low levels of a protein called albumin) can happen due to inflammation. Try to eat a balanced diet during your recovery. Ask your doctor or dietitian about nutritious foods to include in your diet.
What Are the Benefits of Ulcerative Colitis Surgeries?
Removing the entire colon and rectum can cure ulcerative colitis. This can put an end to the diarrhea, abdominal pain, anemia, or other symptoms. Surgery can also help avoid colon cancer.
About 4.5 in 100 people get colon cancer after having ulcerative colitis for 20 years. But colon cancer screening or surgery to cure UC can keep this from happening.
Your doctor may suggest surgery if you’re at higher risk for colon cancer. For example, if your ulcerative colitis affects your entire colon, you may have a higher cancer risk.
What Are the Complications of Ulcerative Colitis Surgeries?
Complications from ileoanal anastomosis may include:
- More frequent and more watery bowel movements
- Inflammation of the pouch (pouchitis)
- Blockage of your intestine (bowel obstruction) from internal scar tissue (adhesions)
- Pouch failure, which happens within five years in about 4 out of every 100 people with IPAA
If your pouch fails, you’ll need a permanent ileostomy. A hemicolectomy also has some of the same risks as other surgeries.
It’s safe for most people, but you could have a reaction that makes you feel sick for a few days. It’s rare, but some people may feel confused for a week or so.
You could also get blood clots in your legs or lungs. To lessen the chances of clots, you’ll walk around every hour or so in your hospital room. Other possible problems include:
- Infection
- Scar tissue blocking your intestines
- Leakage where your intestines reconnect
- Hernia
- Injury to nearby organs
- Internal bleeding
Life After Ulcerative Colitis Surgery
Your doctor will want to see how you’re doing after surgery. Talk to them about when you should follow up. They may want you to visit within a couple of weeks. But your checkup schedule could be different, depending on why you needed the procedure.
You may have mixed feelings about your stoma after surgery. You may be uncertain about living with it. But often, you’ll be able to return to activities such as swimming, travel, and work.
If your stoma is temporary or permanent, it’s normal to wonder about the bag. It lays pretty flat against your skin. But there are other pouch systems you can choose from.
Also, talk to your doctor about any feelings of anxiety or depression. Your emotional and mental health and well-being are important, too.
You can get support at the United Ostomy Associations of America . And you can ask your doctor or talk to your therapist about local support groups, too.
Takeaways
Ulcerative colitis surgery can help ease the symptoms and avoid your risk of colorectal cancer. Proctocolectomy with an ileal pouch-anal anastomosis (IPAA) or J-pouch is the most common one. You’ll get better in a hospital and may have some diet changes. Some risks include pouchitis or blockages, but you’ll slowly get back to your usual routine.
FAQs for Ulcerative Colitis Surgery
How successful is surgery for ulcerative colitis?
Proctocolectomy with an ileal pouch-anal anastomosis (IPAA) or J-pouch is the most common UC surgery. It’s highly successful, and more than 90 in 100 people report positive long-term results. Although usually successful, you’ll need follow-up care if you have any problems later.
What is the life expectancy of someone with ulcerative colitis?
Life expectancy with UC can depend on factors such as age, seriousness of the disease, and other medical problems. Most people who have UC live a normal lifespan. Repeated surgeries, colorectal cancer, or toxic megacolon can slightly lower your life expectancy, though.
Can you still poop if your colon is removed?
Yes. But you may not be able to do it the traditional way. That depends on the type of surgery you have.
