Surgery

Ulcerative colitis affects only the large intestine. So surgery that removes the entire large intestine can cure the disease. Some people who have the disease in the entire colon eventually need surgery to remove the colon. Surgery also can often cure the rare problems that the disease causes outside of the colon, such as skin and eye problems. But it may not cure liver problems and some joint problems.

People may need surgery for ulcerative colitis in several situations, such as when other treatment fails to manage symptoms, when holes form in the large intestine, or if dysplasia is found during colonoscopy or biopsy.

Ulcerative Colitis: Should I Have Surgery?

Surgery choices

Removal of the colon to cure ulcerative colitis involves one of these surgeries:

• In ileoanal anastomosis, the surgeon removes some or all of the large intestine (colon) and the diseased lining of the rectum. Then the end of the small intestine (the ileum) is connected to the anal canal. This allows you to have bowel movements without an ostomy.
• In proctocolectomy and ileostomy, the large intestine and rectum are removed, leaving the lower end of the small intestine (the ileum). The surgeon sews the anus closed and makes a small opening called a stoma in the skin of the lower belly. The ileum is connected to the stoma, creating an opening to the outside of the body.

What to think about

Ileoanal anastomosis is performed most often. Proctocolectomy with ileostomy is preferred for people who cannot tolerate anesthesia for a long period of time because of illness or age.

In most cases, surgery can be scheduled at your convenience. Emergency surgery usually isn't needed unless an acute attack causes toxic megacolon, severe uncontrolled bleeding, or a rupture in the intestine. The risk of problems after surgery can be high if surgery is done during a severe or rapidly worsening attack or if emergency surgery is needed.