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What Is Ulcerative Colitis?
Ulcerative colitis is a chronic (long-term) inflammatory disease. It affects the lining of the large intestine, or colon, and rectum. The rectum is the last section of the colon and is located just above the anus. People with ulcerative colitis have tiny ulcers and abscesses in their colon and rectum. These flare up periodically and cause bloody stools and diarrhea. Ulcerative colitis may also cause severe abdominal pain and anemia. Anemia is marked by low levels of healthy red blood cells.
Ulcerative colitis has alternating periods of flare-ups and remission. During remission the disease seems to have disappeared. The periods of remission can last from weeks to years.
The inflammation usually begins in the rectum. It then spreads to other segments of the colon. How much of the colon is affected varies from person to person. If the inflammation is limited to the rectum, the disease is called ulcerative proctitis.
How Is Ulcerative Colitis Diagnosed?
Ulcerative colitis closely resembles Crohn's disease. Crohn's is another inflammatory bowel disease. Often the only thing that distinguishes ulcerative colitis is that it affects only the colon. Crohn's may affect any part of the digestive system, including the mouth. Crohn's disease also is particularly destructive to the small intestine, known as the ileum.
A doctor may order several different types of tests when considering ulcerative colitis as a diagnosis. These include:
How Common Is Surgery for Ulcerative Colitis?
About 25% to 40% of people with ulcerative colitis will have to have surgery to remove their colons. The reasons that surgery becomes necessary include:
- Medical treatment -- for instance, drug therapy -- fails to provide results.
- There may be a risk of cancer without surgery.
- The colon has ruptured.
- The patient experiences a severe, sudden onset of the disease.
- There is extensive bleeding.
- Treatment causes side effects severe enough to compromise the patient's health.
- Toxic megacolon has set in. In this dangerous condition, the muscles of the large intestine are dilated, and the colon can rupture.
In some cases, surgery to remove the colon is recommended if other treatments do not work or if the side effects of medications are harming the patient.
What Types of Surgery Can Treat Ulcerative Colitis?
Surgery to remove the entire colon is called a colectomy. Surgery to remove both the colon and rectum is a proctocolectomy. Both can be used to treat ulcerative colitis. These surgeries are also performed to eliminate the threat of colon cancer. Colon cancer is common in people with ulcerative colitis. Proctocolectomy is considered the standard treatment when surgery for ulcerative colitis is needed.
If the entire colon is removed, the surgeon may create an opening, or stoma, in the abdominal wall. The tip of the lower small intestine is brought through the stoma. An external bag, or pouch, is attached to the stoma. This is called a permanent ileostomy. Stools pass through this opening and collect in the pouch. The pouch must be worn at all times.
Another procedure is the pelvic pouch or ileal pouch anal anastomosis (IPAA). This is a procedure that does not require a permanent stoma. This surgery is also called a restorative proctocolectomy. The patient is still able to eliminate stool through the anus. In this procedure, the colon and rectum are removed. Then the small intestine is used to form an internal pouch or reservoir -- called a J-pouch -- that will serve as a new rectum. This pouch is connected to the anus. This procedure is frequently done in two operations. In between the operations the patient needs a temporary ileostomy.
The continent ileostomy, or Kock pouch, is an option for people who would like their ileostomy converted to an internal pouch. It's also an option for people who do not qualify for the IPAA procedure. In this procedure, there is a stoma but no bag. The colon and rectum are removed, and an internal reservoir is created from the small intestine. An opening is made in the abdominal wall, and the reservoir is then joined to the skin with a nipple valve. To drain the pouch, the patient inserts a catheter through the valve into the internal reservoir. This procedure, however, is not the preferred surgical treatment for ulcerative patients. That's because of its uncertain results and the potential need for additional surgery.
What Are the Benefits of Ulcerative Colitis Surgeries?
If the entire colon is removed, ulcerative colitis is cured. This should put an end to the diarrhea, abdominal pains, anemia, and other symptoms.
In addition, the surgical procedures prevent colon cancer. Overall, an estimated 5% of ulcerative colitis patients will develop cancer. The elimination of the colon cancer threat is especially significant for people who have ulcerative colitis that affects the entire colon. In these cases, as opposed to cases of ulcerative colitis that affects only the lower colon and the rectum, the cancer risk without surgery could be up to 32 times the normal rate.
What Are the Complications of Ulcerative Colitis Surgeries?
Complications from ileoanal anastomosis may include:
- More frequent and more watery bowel movements
- Inflammation of the pouch (pouchitis)
- Blockage of the intestine (bowel obstruction) from internal scar tissue, called adhesions, caused by surgery
- Pouch failure, which happens in about 8% to 10% of patients with IPAA
- If the pouch fails, the patient will need to have a permanent ileostomy.
WebMD Medical Reference
Health Solutions From Our Sponsors
National Digestive Diseases Information Clearing House: "Ulcerative Colitis."
Crohn's & Colitis Foundation of America: "Surgery for Ulcerative Colitis."
American Society of Colon & Rectal Surgeons: "Ulcerative Colitis."
Reviewed by Kimball Johnson, MD on August 03, 2012
Top Ulcerative Colitis Surgery Related Articles
7 Reasons You are Tired after SurgeryPostsurgical fatigue is normal and is due to a variety of factors. Depression, stress, and anxiety may produce fatigue. Sleep deficits, certain medications, anemia, blood loss, fasting, and loss of electrolytes and minerals associated with surgery can also produce fatigue. Exercise, physical exertion, aging, and the overall health status of a patient are additional factors that play a role in postsurgical fatigue.
Abdominal Adhesions (Scar Tissue)Abdominal adhesions (scar tissue) bands of scar tissue that form between abdominal organs and tissues. Symptoms of abdominal adhesions are pelvic or abdominal pain. Abdominal adhesions on the intestines can cause bowel obstruction, which is a medical emergency. Treatment for abdominal adhesions is generally surgery to cut the adhesions away from the internal tissues and organs. There is no way to prevent abdominal adhesions.
Abdominal Pain (Causes, Remedies, Treatment)
Abdominal pain can have many causes that range from mild to severe. Some of these causes include bloating, gas, colitis, endometriosis, food poisoning, GERD, IBS (irritable bowel syndrome), ovarian cysts, abdominal adhesions, diverticulitis, Crohn's disease, ulcerative colitis, gallbladder disease, liver disease, and cancers.
Signs and symptoms of the more serious causes include dehydration, bloody or black tarry stools, severe abdominal pain, pain with no urination or painful urination.
Treatment for abdominal pain depends upon the cause.
Anemia is the condition of having less than the normal number of red blood cells or less than the normal quantity of hemoglobin in the blood. The oxygen-carrying capacity of the blood is, therefore, decreased. There are several types of anemia such as iron deficiency anemia (the most common type), sickle cell anemia, vitamin B12 anemia, pernicious anemia, and aplastic anemia. Symptoms of anemia may include
- hair loss,
- menstruation, and
Treatment for anemia includes treating the underlying cause for the condition. Iron supplements, vitamin B12 injections, and certain medications may also be necessary.
balsalazide disodiumbalsalazide disodium (Colazal, Giazo) is a drug prescribed for the treatment of the signs and symptoms of mild to moderately ulcerative colitis. Side effects, drug interactions, and warnings and precautions should be reviewed prior to taking any medicication.
Capsule EndoscopyCapsule endoscopy is a video capsule that is swallowed and takes photographs of the small intestine. Preparation for capsule endoscopy is similar to that of colonoscopy. There are limitations to capsule endoscopy, however capsule endoscopy is generally able to diagnose:
- small intestinal tumors,
- and Crohn's disease.
CAT ScanA CT scan is an X-ray procedure that combines many X-ray images with the aid of a computer to generate cross-sectional and three-dimensional images of internal organs and structures of the body. A CT scan is a low-risk procedure. Contrast material may be injected into a vein or the spinal fluid to enhance the scan.
Colon CancerColon cancer is a malignancy that arises from the inner lining of the colon. Most, if not all, of these cancers develop from colonic polyps. Removal of these precancerous polyps can prevent colon cancer.
Colon Cancer PreventionColo-rectal cancer is both curable and preventable if it is detected early and completely removed before the cancerous cells metastasize to other parts of the body. Colonoscopy and flexible sigmoidoscopy (along with digital rectal examination and stool occult blood testing) are both effective at preventing colo-rectal cancers and detecting early colo-rectal cancers.
ColonoscopyA colonoscopy is a procedure whereby a docotor inserts a viewing tube (colonoscope) into the rectum for the purpose of inspecting the colon. Colonoscopy is the best method currently available to diagnose, detect, and treat abnormalities within the colon.
DiarrheaDiarrhea is a change is the frequency and looseness of bowel movements. Symptoms associated with diarrhea are cramping, abdominal pain, and the sensation of rectal urgency. Causes of diarrhea include viral, bacterial, or parasite infection, gastroenteritis, food poisoning, and drugs. Absorbents and anti-motility medications are used to treat diarrhea.
Inflammatory Bowel Disease: Intestinal ProblemsThe inflammatory bowel diseases (IBD) are Crohn's disease (CD) and ulcerative colitis (UC). The intestinal complications of Crohn's disease and ulcerative colitis differ because of the characteristically dissimilar behaviors of the intestinal inflammation in these two diseases.
Stool Color ChangesStool color changes can very from green, red, maroon, yellow, white, or black. Causes of changes of stool color can range from foods a person eats, medication, diseases or conditions, pregnancy, cancer, or tumors. Stool can also have texture changes such as greasy or floating stools. Stool that has a uncharacteristically foul odor may be caused by infections such as giardiasis or medical conditions.
Ulcerative ColitisUlcerative colitis is a chronic inflammation of the colon. Symptoms include abdominal pain, diarrhea, and rectal bleeding. Ulcerative colitis is closely related to Crohn's disease, and together they are referred to as inflammatory bowel disease. Treatment depends upon the type of ulcerative colitis diagnosed.
Ulcerative Colitis Diet
An ulcerative colitis diet plan can help a person with the disease avoid foods and drinks that trigger flares. There also are foods that can soothe ulcerative colitis symptoms during a flare. Types of ulcerative colitis plans include
- a high-calorie diet,
- a lactose-free diet,
- a low-fat diet,
- a low-fiber diet (low-residue diet), or
- a low-salt diet.
Self-management of ulcerative colitis using healthy lifestyle habits and a nutrient rich diet can be effective in management of the disease. Learn what foods to avoid that aggravate, and what foods help symptoms of the disease and increase bowel inflammation.