WHAT IS ULCERATIVE COLITIS?
Ulcerative colitis (UC) is an inflammatory condition that impacts the large intestine (colon and rectum). In UC, the inflammation is limited to the internal lining of the intestinal wall (mucosa). The initial treatment option typically involves medical management to keep the inflammation in remission. If surgery is needed for UC, it often provides a cure.
WHAT ARE THE RISK FACTORS FOR ULCERATIVE COLITIS?
UC equally affects all ages and can develop in both men and women. A family history of UC slightly increases the risk of developing the disease.
WHAT CAUSES ULCERATIVE COLITIS?
The exact cause of UC remains unknown, but it is not contagious. Possible factors include abnormalities in the immune system and bacterial infection.
WHAT ARE THE SYMPTOMS OF ULCERATIVE COLITIS?
Most patients start showing symptoms of UC in their 30s. Some may first experience symptoms later in life, between ages 60 and 70. UC only affects the colon and rectum, but has similar symptoms to another inflammatory bowel disease, Crohn’s disease. The most common symptoms of UC include:
- Abdominal cramping
- Pain
- Diarrhea
- Bleeding with bowel movements
- Fever
- Fatigue
- Weight loss
HOW IS ULCERATIVE COLITIS DIAGNOSED?
Ulcerative colitis needs to be diagnosed by your doctor. Usually, a colonoscopy is performed to diagnose UC. During a colonoscopy, your doctor looks inside your colon and rectum to find and biopsy ulcers and inflammation that are signs of UC. This evaluation helps determine how much of the colon is affected and how severe it is. It also helps rule out other diseases such as Crohn’s disease, and guides how your doctor will treat it. Other tests might include blood tests, stool samples, or imaging such as CT scans or X-rays.
WHAT ARE THE MEDICAL TREATMENT OPTIONS FOR UC?
Medical treatment is the first and most effective option for most patients with ulcerative colitis. The goal of medical therapy is to reduce inflammation and improve a patient's quality of life by minimizing diarrhea, bleeding, and pain. Initial treatment with steroids is used to induce remission during a flare-up. Long-term medications are used as maintenance therapy to prevent recurrent attacks. These medications include immunomodulators such as azothiprine, anti-inflammatory medications such as sulfasalazine, and biologic medications such as infliximab. Depending on how much of the colon is affected and how severe the inflammation is, medications may be prescribed by injection or infusion, by mouth, or by suppository inserted into the rectum.
WHAT ARE THE SURGICAL TREATMENT OPTIONS FOR UC?
Surgery is an option for patients when medical management is no longer helping to control the disease. Surgery also may be necessary if cancer or pre-cancerous tissue is found during a colonoscopy.
UC affects only the colon and rectum, and completely removing both may cure the disease. After removing the colon and/or rectum, patients will require an ileostomy, or stoma.
Some patients may qualify for a procedure called an ileal pouch. This procedure involves creation of a new rectum using the small intestine. The new rectum is also referred to as a “pouch” often created in the shape of the letter J. This surgery is often called a J-pouch surgery. Patients who qualify for a J-pouch surgery will need a temporary ileostomy while the J-pouch heals. Once the J pouch heals, the ileostomy can be reversed.
Even patients with a J pouch may exhibit “pouch failure” over time, so the risk of a permanent ileostomy remains.
Planned and emergency surgeries for UC can be performed using traditional “open” procedures or minimally invasive (laparoscopic or robotic) techniques depending on the situation. The safest and most effective approach is determined based on the patient’s specific needs.
WHAT IS EMERGENCY SURGERY FOR UC?
In some cases, surgery is necessary if a complication of the disease occurs such as a perforated bowel (hole in the colon), severe bleeding, or serious infection (toxic colitis). Emergency surgery for UC is necessary in life-threatening situations and may require a large incision. During this surgery, the colon is removed, while the rectum and anus are left in place temporarily. The end of the small intestine (ileum) is brought through the abdominal wall to the skin to create a stoma, where stool empties into a bag attached to the skin.
After recovery from the initial surgery, a second procedure can be performed. During this procedure, the diseased rectum is removed. Some patients qualify for a J-pouch creation at the time of the second procedure. A new rectum (ileal pouch) made from the small intestine is created and connected to the anal opening. A loop ileostomy is made temporarily to protect the area while it heals.
Once healing is complete, a third procedure is performed to close the ileostomy. This three-stage UC procedure allows patients to eventually live without needing an ileostomy.
WHAT IS AN ELECTIVE SURGERY FOR UC?
In elective surgery, the first and second stages described above are combined into a two-stage procedure for UC. This can be done through a minimally invasive or open procedure. Both the colon and rectum are removed during this procedure. A new rectum or J-pouch is created from the small intestine and connected to the anal opening. To protect the area while it heals, a diverting loop ileostomy is often created temporarily.
After the patient recovers from the initial surgery, a second procedure is performed to close the ileostomy and reconnect the small intestine.
WHAT CAN BE EXPECTED POST-OPERATION?
After J-pouch surgery, patients can expect to have six to eight bowel movements per day including one at night. Medications can be used to decrease this frequency. Some patients may experience leakage or difficulty controlling bowel movements (incontinence). Infections or inflammation can develop in the pouch but can usually be treated effectively with antibiotics or steroids. In some cases, complications may arise, and about 10% of pouches may need to be removed, leading to the creation of a permanent ileostomy.
WHAT FOLLOW-UP IS NEEDED AFTER TREATMENT?
Regular follow-up medical appointments are scheduled after surgery. During these periodic visits, your physician will evaluate how well the pouch is working and its overall health.
ABOUT COLON AND RECTAL SPECIALISTS
Colon and Rectal Specialists was founded in 1913. We are a group of dedicated fellowship-trained colorectal surgeons. We are experts in the surgical and non-surgical treatment of diseases of the colon, rectum, and anus. Our surgeons have all completed advanced surgical training in the treatment of these diseases in addition to full general surgical training. We are well-versed in the treatment of both benign and malignant diseases of the colon, rectum, and anus and are able to perform routine screening examinations and surgically treat conditions when indicated.
ABOUT C.A.R.E.S. CENTER
Colon and Rectal Endoscopy and Surgery (CARES) Center is our state-of-the-art Ambulatory Surgery Center. Our center has been accredited by the Accreditation Association for Ambulatory Health Care (AAAHC) and has been given Medicare Deemed Status by CMS. We perform a variety of services including: screening colonoscopies, hemorrhoidectomy, abscess and fistula surgery, fissure surgery, pilonidal surgery, and surgery to treat fecal incontinence. Learn more about us at www.crspecialists.com.
