Surgery for Ulcerative Colitis

B.S. Dietetics, Dietitian, Health Professional

Ulcerative Colitis is a form of Inflammatory Bowel Disease that affects the colon and rectum. For most patients the first line of treatment involves medications to treat symptoms and slow the disease process. According to the Crohn's and Colitis Foundation of America (CCFA) between 25-43 percent of people with Ulcerative Colitis will end up needing some kind of surgery to manage their disease. For some the surgery will be optional to treat symptoms but can be necessary to others depending on the severity of the disease or the addition of complications.

When should you consider surgery for UC?
There are several reasons why someone would consider or need surgery for UC. Some of the main indications for surgery include:

  • Severe attack of colitis that can't be controlled by medications.
  • Toxic Megacolon that is severe or does not respond to treatment within 24-48 hours.
  • Ulcerative colitis that no longer responds to medications.
  • Signs of dysplasia or cancers.
  • Growth issues or Failure to Thrive in children.
  • Severe symptoms of UC that extend beyond the colon or rectum.

What is the most common surgery for UC? The most common surgery for UC is called a proctocolectomy with ileal pouch-anal anastomosis. During this procedure the colon and rectum are removed while still preserving the nerves and muscles needed for continence—allowing stool to continue to pass through the anus. Often this type of surgery is done in two different procedures.** Once both of these organs are removed the UC is considered cured.** Check out this wonderful HealthCentral Explainer for more information on types of surgery for UC.

What to expect before and after surgery
Your gastroenterologist should provide you with all of the information regarding what to expect during surgery, whether there will be multiple surgeries and recovery times based on the procedure they have chosen for you. If you have additional questions be sure to ask them so you will be better prepared. You will likely need time off work and help while recovering from surgery. Check out the information on IBD and Disability as well as FMLA for IBD Caregivers.

For additional information and things your doctor might not tell you please check out Jackie Zimmerman's four part series here:

Part 1: 5 Things They Don't Tell Women About Colorectal Surgery

Part 2: Long Term Complications They Don't Tell You About With Colorectal Surgery

Part 3: Your Surgeon's Priorities Through Your Colorectal Surgery

Part 4: Keep Your Opinion to Yourself About MY Colorectal Surgery

Nutritional changes post surgery
You may need to make some temporary changes to your diet while you recover from surgery. Some of those changes include:

  • Limiting gas causing foods like cauliflower, broccoli, or asparagus.
  • Limit foods that may irritate the anus or pouch like: coconut, dried or raw fruits, raw vegetables, spicy foods, seeds and nuts.
  • Eat smaller more frequent meals and don't skip meals.
  • Add in potassium rich foods to prevent a deficiency caused by diarrhea.
  • Add new foods slowly.
  • Chew food thoroughly to aid digestion.
  • Keep hydrated to prevent dehydration from diarrhea.

Surgery can be a scary thing to go through. Obtaining the most information, asking questions of your health care provider and getting support from others who have been there can help you get through your surgery as smoothly as possible. Contact the CCFA's Information Resource Center at 888.MY.GUT.PAIN (888.694.8872) for more information or to join a support group.

See more helpful articles:

Six Ways to Prepare for an Ulcerative Colitis Flare

Doctor Q&A: How to Manage Ulcerative Colitis

Different Types of Colitis

Sleep and Diet Changes May Help IBD Patients