What is Ulcerative Colitis?

Ulcerative colitis is an inflammation of the lining of the large bowel (colon and rectum). It is one of the diseases which is included and classed as IBD( Inflammatory Bowel Disease).

Symptoms include bleeding from the rectum, diarrhea, abdominal cramps/ pain, weight loss, and fever.

In addition, patients who have had extensive ulcerative colitis for many years are at an increased risk to develop large bowel cancer. The cause of ulcerative colitis remains unknown, although environmental and viral infection have been blamed.

 How do you treat Ulcerative colitis ?

Initial treatment of ulcerative colitis is medical, using antibiotics and anti-inflammatory medications such as aminosalicylates. Most of the times the Medical Gastroenterologist will treat these symptoms. If these fail, prednisolone ( steroids) can be used for a short period of time but long-term use can be associated with significant side effects. If prednisolone is ineffective or cannot be discontinued, immunomodulators such as 6-mercaptopurine or azathioprine can be used to control active disease that does not merit hospitalization.

In order to maintain control of the disease, aminosalicylates or immunomodulators are used on a long-term basis.”Flare-ups” of the disease can often be treated by increasing the dosage of medications or adding new medications. Hospitalization may be necessary to put the bowel to rest and deliver steriods directly into the blood stream. There are also some newer medications which can be tried but please get in touch with your Gastroenterologist for further details.

 When is surgery necessary?

Surgery is indicated only for patients who have life-threatening complications of inflammatory bowel diseases, such as massive bleeding, perforation, or infection. It may also be necessary for those who have the chronic form of the disease, which fails to improve with medical therapy.

It is important the patient be comfortable that all reasonable medical therapy has been attempted prior to considering surgical therapy. In addition, patients who have long-standing ulcerative colitis may be candidates for removal of the large bowel, because of the increased risk of developing cancer. More often, these patients are followed carefully with repeated colonoscopy and biopsy, and surgery is recommended only if precancerous signs are identified.

It is important to note that surgery sometimes provides the option of complete cure in Ulcerative colitis.

What operations are available?

Historically, the standard operation for ulcerative colitis has been removal of the entire colon, rectum, and anus. This operation is called a proctocolectomy and may be performed in one or more stages. It eliminates the disease and removes all risk of developing cancer in the colon or rectum. However, this operation requires creation of a ileostomy (bringing the end of the remaining bowel through the abdomen wall) and long-term use of an appliance on the abdominal wall to collect waste ( faeces) from the bowel.

Some patients may be treated by removal of the colon, with preservation of the rectum and anus. The small bowel can then be reconnected to the rectum and continence preserved. This avoids an ileostomy, but the risks of ongoing active colitis, increased stool frequency, urgency, and cancer in the retained rectum remain. Patient motivation remains the key element in choosing this type of procedure.

Are there any other surgical alternatives?

The ileoanal pouch procedure is the most common surgical treatment for the management of ulcerative colitis. 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.

Usually, a temporary ileostomy is created, but this is closed several 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. This operation all but eliminates the risk of recurrent ulcerative colitis and allows the patient to have a normal route of evacuation. Patients can develop inflammation of the pouch (pouchitis), which usually responds to antibiotic treatment. In a small percentage of patients, the pouch fails to function properly and may have to be removed. If the pouch is removed, a permanent ileostomy is likely to be necessary. It is important to recognize that none of these alternatives/ choices makes a patient with ulcerative colitis normal. Each alternative/choice has perceivable advantages and disadvantages, which must be carefully understood by the patient prior to selecting the alternative which will allow the patient to pursue the highest quality of life.

To get more details please contact your Colorectal Surgeon who would be happy to help.

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