Initial treatment of ulcerative colitis is medical, using antibiotics and anti-inflammatory medications. Steroids may also be needed. Hospitalization may be necessary to put the bowel to rest.
Surgery is needed for life-threatening complications. This include massive bleeding, perforation, or severe infection. It may also be necessary for those who have the chronic form of the disease, where medication fails to work or when the side-effects of medication are intolerable. In addition, patients who have long-standing ulcerative colitis and have a high risk of developing cancer may be offered surgery.
Historically, the standard operation for ulcerative colitis has been removal of the entire colon, rectum, and anus. This operation is called a proctocolectomy. It cures the disease and removes all risk of developing cancer in the colon or rectum. However, this operation requires a permanent ileostomy.
Some patients may be treated by removal of the colon, while leaving behind the rectum and anus. The small bowel can then be re-connected to the rectum and patients can pass motion normally. However, there is an increased risk of ongoing disease in the rectum, increased stool frequency, and cancer in the retained rectum.
Ileoanal pouch procedure
The currently preferred operation by colorectal surgeons is an ileoanal pouch procedure. This is the newest alternative. This procedure removes all of the colon and rectum, but preserves the anal canal. The rectum is replaced with small bowel, which is refashioned to form a small pouch. A temporary ileostomy is created while the pouch is allowed to heal, but this is closed in a few months later. The pouch acts as a reservoir to help decrease the stool frequency. This maintains a normal route of defecation, but most patients experience five to ten bowel movements per day. Patients can develop inflammation of the pouch, which requires antibiotic treatment. In a small percentage of patient, the pouch fails to function properly and may have to be removed. If the pouch is removed, a permanent ileostomy will be necessary.
It is important to recognise that none of these alternatives makes a patient with ulcerative colitis normal. Each alternative has perceivable advantages and disadvantages, which must be carefully understood by the patient prior to selecting the operation which will allow the patient to pursue the highest quality of life.