Treatment plan for ulcerative colitis
disease is more often than not treated with appropriate medications –
surgery is usually reserved for more severe cases, or if complications
arise. If you are not needing to have surgery, don’t worry about the
sections about the different types of surgery, preparing for your
surgery, and the questionnaire
Surgery as a treatment option
Usually, treatment with medication is the first option for people with
ulcerative colitis. Surgery may be needed, however, if there are serious
complications (eg, perforation of the colon; severe bleeding; or toxic
megacolon) or to achieve remission (no symptoms) in people with
inflammation who have not had good results from medication. For best
results, surgery is performed in patients who are less than 65 years of
Approximately 25–40% of people with ulcerative colitis will ultimately
need surgery at some point. The main benefit of surgery is that once the
colon and/or rectum are removed, people with ulcerative colitis are
considered to be ‘cured’ as the diseased tissue is completely removed.
As a result, there is no need for maintenance medication.
on a number of factors – extent of the disease and age and health – one
of two surgical procedures may be recommended as described below.
Common types of surgery for ulcerative colitis
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Proctocolectomy with ileostomy:
This surgery has been done for many years. The surgeon takes out the
colon, rectum and anus. Then, an ileostomy is done, in which the
lowest part of the small intestine (called the ileum) is put through
a small hole (known as a stoma) in the belly wall. This allows waste
to be drained from the body. A waste collection bag is worn over the
opening (called an ostomy) to collect the waste.
(also called an ileoanal pouch anal anastomasis or IPAA): This is a
much newer surgery that is done in two steps. In the first step, the
colon is removed, and care is taken to keep both the anus and anal
muscles (referred to as anal sphincters) in place. In the second
step, the ileum (end of the small intestine) is turned into a pouch
and connected to the anus after removal of the rectum. In some
cases, to allow the pouch to heal after surgery, an ileostomy (as
described above) is created, and closed 10–12 weeks later. The
internal pouch is used to collect waste. Stools can then pass
through the anus normally.
Preparing for your surgical consultation
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the decision to have surgery can be difficult. If you are feeling
frightened or anxious at the thought of having surgery, it may help to
have a good understanding of what to expect, both before and after.
Sometimes it is helpful to meet other patients who have already had the
same surgical procedure as they will be able to allay your concerns.
Your surgical consultation will give you an opportunity to ask any
questions that may be on your mind. In this appointment you will have a
chance to meet your surgeon and discuss the procedure that is to be
performed, including what you should do to prepare for it.
people fear surgery so much that they put if off for years or even tell
their doctor they are feeling well when they really aren’t. This can
lead to unnecessary pain and could prevent you from getting in control
of your ulcerative colitis more quickly. Surgery can give relief from
symptoms and may even mean that you do not need to take any more
medication. Also, remember that surgery may be your best chance of
taking control of your disease and help get you back to doing the things
you used to do as soon as possible and give you the best quality of
The following list of questions is provided to help you prepare for your
consultation with your surgeon.
Questions to ask your surgeon
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are a few example questions you might want to ask your surgeon during
1. What are the benefits and risks involved with this procedure?
what to expect both before and after the surgery will help you prepare
and plan ahead.
2. If we decide together that surgery is the best option at this time
how long will I have to wait?
Once you understand the potential benefits of surgery, you may want to
get it done as quickly as possible. However, there may be reasons to
wait a while – or have it very soon – so it is best to discuss timings
with your doctor and set your expectations.
3. How long will it take before I start feeling better?
This is important to consider so you can plan time off work and line up
help from family and friends. It may take a few weeks before you are
able to get entirely back on your feet and start moving around again as
you used to.
4. When can I have sex again?
Do not be afraid to ask this question of your surgeon. Even if your
surgeon says you are well enough, you might not feel ready, so just take
your time and communicate with your partner as well.
5. Will I have to make any lifestyle changes as a result of my surgery?
If you have any concerns about whether you will be able to continue some
of your existing activities (eg, sporting hobbies) then raise these
questions with your surgeon and they will be able to give you lots of
useful tips and advice.
Before and after surgery
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are some general considerations to help you prepare for and recover from
Before the surgery, your doctor may tell you that you need to build
up your nutrition. He or she should give you instructions for how to
Allow others to help you, even with the simplest of tasks. If you
need help carrying the groceries or lifting something heavy, ask for
help. Most likely, family and friends will want to help but may not
always know what you need them to do and would appreciate your
Once you get the clear signal from your doctor, try to start moving
around again. This will help to get your bowels active again, and
also help you feel better. Start gradually and don’t push yourself
to do too much too soon.
may have some other points to discuss concerning your return home
may wish also to discuss various aspects of your current lifestyle.