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Ulcerative colitis is an inflammation of the mucosa (inner lining) of the large bowel and the rectum which can result in rectal bleeding, diarrhea, abdominal cramps, weight loss, fevers, and increased risk of cancer. The cause of ulcerative colitis is not known.
Antibiotics and anti-inflammatory medications such as aminosalicylates are first line treatment. In more severe instances steroids are used; however, long-term use of steroids can result in significant side effects. If the medication prednisone is given but proves to be ineffective then immunomodulators such as 6-mercaptopurine or azathioprine can be used to control active disease that does not merit hospitalization.
In situations such as massive bleeding, perforation, infection, cancer, dysplasia (precancerous changes) or failure of medical therapy, surgery may be necessary.
The ileoanal pouch procedure is the procedure of choice. This procedure removes all of the colon and rectum, but preserves the anus. A pouch reservoir is created out of the small bowel and replaces the rectum both functionally and structurally. A temporary ileostomy is created that is closed several months later. Patients usually experience five to ten bowel movements per day. Patients can develop inflammation of the pouch (pouchitis), which usually responds to antibiotic treatment. In a small percentage of patients, the pouch fails and it must be removed making a permanent ileostomy necessary.
Historically, the recommended procedure for ulcerative colitis has been removal of the entire colon, rectum, and anus (proctocolectomy). It eliminates the disease and removes all risk of developing cancer in the colon or rectum but requires creation of a permanent ileostomy. Rarely a continent ileostomy is performed which requires wearing a disposable pouch on the abdomen; an external pouch is not necessary because the bowel is emptied with a tube several times a day. Sometimes the rectum can be preserved and the small bowel can be connected to it thus avoiding the need for a pouch; however, the risks of ongoing active colitis, increased stool frequency, urgency, and cancer in the retained rectum persist.
For more information on ileostomy please go to the About Ostomy section.