Ulcerative Colitis Surgery Options

Quincy AdamUC Treatments

For as many as 700,000 Americans currently living with ulcerative colitis (UC), even eating can be a painful prospect.

Long-term management of UC is possible thanks to many treatment options. However, many patients with the condition choose some form of ulcerative colitis surgery in order to improve their quality of life.

Reasons for Surgery

Doctors are not quick to recommend ulcerative colitis surgery except in dire cases where a patient’s life is at risk, such as in the development of toxic megacolon, a dangerous condition which can lead to bowel perforation and death. In more benign cases, however, drug therapy can keep symptoms under control.

Sometimes, conventional treatments fail and it becomes clear that the disease is putting a patient’s life in danger. This is the time to discuss surgery as an option.

Ulcerative colitis surgery can be considered a preventative measure for patients wishing to avoid future complications. However, the decision to have surgery should not be made lightly. Surgery involves the removal of organ tissue and the rerouting of normal biological function. This is why such procedures are considered a last resort.

If you or a loved one is facing such a decision, here’s a list of the various types of surgical options that might be considered:

Colectomy and proctocolectomy

The removal of the colon is referred to as colectomy, while the removal of both colon and rectum is called proctocolectomy. There are options as to how the patient can then live without their colon following surgery.


In this procedure, a small opening is created in the abdomen and the end of the small intestine is brought through to the surface and stitched into place. This is called a stoma. Stool passes through this opening into an external pouch or bag which the patient must wear constantly. The biggest drawback for many when it comes to this surgery is stigma, as the idea of wearing a colostomy bag is unpleasant. However, many patients find that the benefits of living a fuller life greatly outweigh the drawbacks. The most common problem associated with this is parastomal hernia, which occurs as a result of weakened abdominal muscles surrounding the stoma opening.


Restorative proctocolectomy with ileal pouch-anal anastomosisis is known by many. The most common (and easiest to say) is “J-pouch” surgery. The result of this surgery is that a pouch is created out of a section of small intestine which allows stool to collect internally. The pouch is connected to the anus. This allows stool to pass as it normally would, without the presence of a stoma and external bag. This surgery is typically completed in two parts, since the pouch needs time after creation to heal. Because of this, a temporary ileostomy is created and the colostomy bag worn until the J-pouch is able to handle stool collection. Then “takedown” surgery (where the small intestine is connected to the internal pouch) is performed. While this surgery is the most popular since it leaves all workings internal, the pouch can become inflamed as the colon once did (known as pouchitis), and other complications such as infection, bleeding and pouch failure can occur.

Continent ileostomy

Also known as Kock pouch, this surgery is performed on patients for whom J-pouch is not an option. A pouch is created along with the ileostomy, and is drained via a catheter. Further surgery is a potential outcome, so this procedure is not as common as the others.

Though all surgery comes with its own potential setbacks, the idea of a life lived free of ulcerative colitis and its complications should be reason enough for a patient to consider surgical remediation. Talk to your doctor about all the options that are available. Once you have a plan of action, your doctor will most likely connect you with support and assistance in getting accustomed to the “new normal” of post-surgical life.