Ulcerative Colitis

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What is ulcerative colitis? 

Ulcerative colitis (UC) is an inflammatory bowel disease. The inflammation usually occurs in the innermost lining of the large bowel and rectum. Males and females are affected equally and may present particularly between the second and forth decades. Ulcerative colitis will increase your risk of developing colorectal cancer. Removal of the diseased bowel implies cure without the need for long term immunosuppressant / medication and removes the risk of cancer

Causes of ulcerative colitis 

The cause of Ulcerative Colitis is unknown but there are a few things that appear to trigger it. It may follow an acute diarrhoea illness where an abnormal immune response is incited against the gastrointestinal microorganisms. This overwhelming immune response results in a concurrent attack of your own colonic wall, giving rise to colonic inflammation. Genetics may also play a part as a causative factor.

Symptoms of ulcerative colitis 

  • Rectal bleeding 

  • Bloody diarrhoea 

  • Abdominal pain 

  • Extra-intestinal symptoms include: liver disease, eye inflammation, arthritis and skin lesions 

What is the management for ulcerative colitis?

  • A consultation with your GP and subsequent referral to a colorectal surgeon will ensure that your symptoms are appropriately assessed and treated 

  • Diagnosis of UC is based on the clinical picture and the appearance of large bowel inflammation at colonoscopy. Biopsies are taken.

When is surgery indicated for ulcerative colitis?

  • Medical treatment fails to control the symptoms / persistent chronic disease state

  • Presence of complications e.g. severe haemorrhage, toxic colon, colonic perforation

  • Cancer or large area of high grade dysplasia 

Who should be performing your surgery for ulcerative colitis?

The decision to operate is always made by the patients physician and surgeon in consultation. It is very important that the surgeon is familiar with all aspects of UC and is skilled in the full range of available surgical techniques. Members of CSSANZ have these skills, and they are trained in the long term support and follow-up of patients who have surgery for UC.

What surgical options are available?

The aim of surgery is to remove all your colon and rectum (collectively called the large bowel) and this can be done in one of more stages. 

There are 2 options following this 

  • Permanent ileostomy: Ileostomy (stoma) is formed using the end of small bowel where it passes through a hole made in the abdominal wall. A stoma bag is attached to this to allow stool emptying. 

  • Pouch surgery: Small bowel is used to form a pouch which is later connected to the anus. This removes the need for a permanent stoma. This operation is not suitable for all patients and is more complex than the former option. It may result in an increased number of loose but well-controlled bowel actions per day.

If cancer has complicated UC, the surgical treatment may be modified.

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