Does Surgery Really ‘Cure’ Ulcerative Colitis?

If medication hasn’t eased ulcerative colitis (UC) symptoms, you may be considering surgery.

Here’s what you need to know, plus what to expect after the procedure.

Surgery for ulcerative colitis typically involves removing the colon and the rectum and creating a new passage in the body for bowel movements. Because the condition is marked by chronic inflammation in the colon and rectum, removing these two things can effectively eliminate symptoms for many people.

End Ileostomy

This surgery removes the colon, rectum, and anus to change the way stool leaves the body. During the procedure, your surgeon will create a quarter-sized opening in your lower abdomen, called a stoma, and connect it to the end of your small intestine. This connection reroutes stool into an external pouch or bag (called an ostomy bag) that’s worn at all times.

For end ileostomies, which are performed under general anesthesia, you’ll spend a few days in the hospital and continue recovering at home for six to eight weeks. During that time, you’ll be on a limited diet (liquids only and then soft foods) and gradually transition back to eating normally.

J-Pouch Surgery

The most common type of ulcerative colitis surgery, J-pouch surgery involves removing the colon and rectum and replacing it with a pouch made from the end of the small intestine. The pouch, which connects to the anus, acts as a new “rectum” that holds stool internally until you’re ready to have a bowel movement. That allows you to poop like you would if you had a colon and a rectum.

J-pouch surgery usually happens in multiple stages. Initially, your surgeon will create the pouch using tissue from your small intestine and give you a temporary ileostomy. You’ll have bowel movements through the ileostomy for 8 to 12 weeks, while the J-pouch heals.

That said, living with an end ileostomy or a J-pouch comes with some unique considerations — and, in some cases, new challenges. When the J-pouch is new, you may experience urgency and loose, frequent bowel movements (up to 12 per day). This improves over time. As the J-pouch stretches and anal muscles get stronger, you’ll have firmer bowel movements and be able to hold it longer.

If you have an ileostomy, you’ll need to learn how to change the bag and prevent it from leaking. You may also have to adjust your diet if certain foods (such as beans or cruciferous veggies) tend to cause loose or smelly output in the bag.

Keep in mind, too, that you may still experience symptoms after either procedure. J-pouches can develop pouchitis, which can cause symptoms similar to an ulcerative colitis flare, such as watery diarrhea, urgency, fevers, and abdominal pain. And while pouchitis usually can be treated with antibiotics, it can be stubborn. “More chronic versions of pouchitis may need a course of rotating medications, such as antibiotics typically used to treat inflammatory bowel disease,” says Dr. Hernandez.

• It’s possible for surgery to eliminate the symptoms of ulcerative colitis, which can translate to a major improvement in quality of life for many people.
• J-pouch surgery, which preserves your ability to poop normally, is the most common type of ulcerative colitis surgery. Some people may undergo an end ileostomy, where stool is diverted out of an opening in the abdomen and into a bag.
• Both procedures come with a learning curve. And you may still experience some gastrointestinal or inflammation-related symptoms elsewhere in your body.