Life After Ulcerative Colitis Surgery: What to Know About Diet, Exercise, and More

There are a few different types of common procedures, and your specific situation will determine which is right for you, says Dana Lukin, MD, a gastroenterologist at Weill Cornell Medicine and NewYork-Presbyterian in New York City.

But no matter which option you and your health team choose, recovery after surgery tends to be similar in terms of ongoing monitoring, lifestyle shifts like diet and physical activity, and the risk of complications. Here’s what you may experience in the weeks and months after the operation.

“The type of surgery performed will depend on several factors, including the presence of [co-occurring conditions], patient age, and other[s],” says Dr. Lukin. “[It] should be determined using a shared decision-making approach.”

End Ileostomy

“The major issues will revolve around learning how to place and change the ileostomy appliance, manage ileostomy output, and care for skin around the pouch site,” he says. “In most cases, this surgery results in an excellent quality of life, and inflammatory complications are rare.”

J-Pouch Surgery

“For patients undergoing [J-]pouch surgery, this results in the ability to defecate [through the anus],” he says. One of the colon’s main functions is to absorb water from waste, which solidifies fecal matter, slowing its transit down. This means bowel movements post-colon removal will be more frequent and range from liquid to solid, Lukin says.

“The typical output for [J-]pouch patients ranges from 4 to 10 [bowel] movements per day,” he says.

In the months just after the procedure, there is an adjustment to return to normal bowel function, and the frequency and consistency often improves during this time, Lukin says.

“In terms of outcome, usually [J-]pouch function is excellent, but depending on [bowel movements’] frequency, consistency, and level of urgency, this may take some adjustment, or may require the use of antidiarrheal medications, fiber supplements, or other medications to decrease output,” he says.

“The goal with diet will be to achieve normal digestive function as soon as feasible, and this may involve keeping fiber intake low during recovery from surgery,” he says. “For many, being on a liquid diet for at least a few days may be necessary.”

From there, you’ll transition to soft, bland foods, as those tend to be gentle on the digestive tract, Dr. Polman says. Over time, it’s often possible to transition to foods that are higher in fiber.

“Higher-fiber foods, sometimes called high-residue foods, may produce symptoms in the earlier part of the post-operative period, which is why they’re not recommended in the weeks right after the procedure,” says Lukin.

In the long term, most people will be able to consume a diet with few restrictions, he says. If you experience surgical complications such as strictures (narrowing of the intestines) or adhesions (scar tissue that makes the intestine stick to the abdominal wall), however, that may affect your diet.

Once you’ve healed, you may still have food triggers — the most common tend to be spicy foods, dairy, and fatty foods, Lukin says. Keeping a food diary or using a symptom-tracking app after UC surgery is helpful to identify specific foods that may be causing issues.

“If there are no hernias or other physiologic issues, light activity can be resumed in the early months followed by a return to usual activities, including exercise,” he says. “In most cases, patients may return to [their] previous level of activity.”

Your doctor will advise you on when specifically to resume physical activity, based on your recovery.

“For patients with ileostomy, this may require some adjustment to the new anatomy, but there are no specific restrictions on sexual activity,” Lukin says.

• Fecal incontinence or other disorders related to bowel movements
• Strictures
• Fistula
• Sepsis
• Internal leakage of fecal matter at the surgical site where the intestines were connected
• Pouch failure

• High-volume bowel movements, leading to dehydration and electrolyte imbalances
• Skin irritation or other dermatological issues
• Infection of the stoma (surgically created opening)
• Stoma obstruction, retraction, or prolapse (protrusion)
• Internal leakage of fecal matter at the surgical connection site
• Sepsis

Regular checkups after either type of surgery are important to ensure that there’s no infection or other complications. You’ll likely see your doctor at least a few times within the first couple months after surgery; after that, an annual check is recommended to make sure you’re still on track with UC management, says Lukin.

• New or worsening abdominal or pelvic pain
• Fever that is recurring or sustained despite use of medication
• Increase or decrease in bowel movement frequency
• Bowel urgency
• Blood in stool
• Worsening diarrhea
• Feeling of incomplete evacuation of bowels

“If you’re feeling abdominal cramping and pain that’s not controlled with pain meds, you should talk to your doctor,” says Polman. “If that’s accompanied by other issues like fever and excessive bleeding, you need to get evaluated.”

• When ulcerative colitis treatment with medications and lifestyle changes doesn’t adequately manage inflammation and other symptoms, or you have a complication, surgery to remove the colon may be an option.
• After surgery, you’ll need to adjust your diet temporarily, and possibly in the long term as well.
• Other lifestyle shifts may need to happen after surgery, such as adjusting your physical activity levels.