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While most patients with ulcerative colitis (UC) get adequate symptom relief with drug therapy and lifestyle modifications, a minority do not -- either because the medications don't work, or they do for a while but then symptoms return. In other cases, the drugs' side effects may be more unpleasant than the UC symptoms.

Fortunately, however, there is an alternative that is the closest thing there is to a "cure" for UC. That option is surgery to remove the colon ("colectomy"). While it may seem an extreme option, it is an excellent option for some patients, especially those who have not had good control of UC symptoms with medications. Many patients fear surgery because of the need for a "bag" or ostomy, but for most patients who need colectomy, the ostomy is only temporary and a bowel reconstruction.

The most common type of reconstructive surgery for UC is called the J-pouch procedure (formally, "proctocolectomy with ileal pouch-anal anastomosis"), which involves removing the colon and rectum while forming a pouch resembling the letter J at the end of the small intestine. The pouch is then connected to the anus, allowing fecal matter to be discharged the usual way.

If for some reason the J-pouch is impractical, the main alternative is to remove the entire lower bowel (colon, rectum, and anus); the surgeon creates a hole ("stoma") through the skin and abdominal wall to which the lower intestine is attached. Waste then flows into a colostomy bag worn externally.

Surgery can be the solution when other options have failed; surgery could also be something to consider early on, depending on how you feel about taking drugs indefinitely and living with their side effects. UC patients are also at increased risk for colorectal cancer, which colectomy can definitively prevent.

Colectomy eliminates the immediate cause of your UC symptoms. Once your body has healed, you should find your condition vastly improved. Surgery does, however, come with substantial tradeoffs and some risks:

• You will most likely have to wear a colostomy bag for a few months (or permanently, if the J-pouch is not feasible), which you will need to empty several times daily

• Even with the J-pouch, you can still expect to have bowel movements more frequently than before you developed UC (i.e., 6-8 per day including at least one at night)

• It may take up to a year for you to adjust to the changes in your digestive system

• Surgery can damage nerves or other tissues in the pelvic region, leading to sexual dysfunction, fertility loss, and/or urinary incontinence or retention

• Infections from the surgery or the stoma can occur

In a recent multinational survey, some 80% of UC patients who had colectomies said they had experienced one or more problems, yet the same percentage also said they were satisfied overall with the results. Thus, surgery for UC should not be taken lightly -- but neither should it be rejected out of hand before weighing the pros and cons. Your doctor can discuss these with you in detail.

Read previous installments in this series:

What Is Ulcerative Colitis?

I've Had Diarrhea That Won't Go Away -- What Should I Do?

UC -- Why Me?

Starting Drug Therapy for Ulcerative Colitis

Diet and Lifestyle Considerations

My Ulcerative Colitis Treatment Isn't Working. Now What?

Living With Ulcerative Colitis

"Medical Journeys" is a set of clinical resources reviewed by physicians, meant for the medical team as well as the patients they serve. Each episode of this 12-part journey through a disease state contains both a physician guide and a downloadable/printable patient resource. "Medical Journeys" chart a path each step of the way for physicians and patients and provide continual resources and support, as the caregiver team navigates the course of a disease.