Should You Undergo a Colectomy for Ulcerative Colitis?

Social Support After Surgery Has An Important Effect On Well-Being

Patient And Physician
Ulcerative colitis might be treated with a colectomy, especially when medication fails to treat the symptoms, or when colon cancer is a concern. Image © Image Source / Getty

For some people with ulcerative colitis, the choice to undergo a colectomy for their disease is a difficult one. Sometimes, the choice is made easy -- the beginnings of colon cancer are found, a perforation occurs, or medical therapy fails. But in most cases, undergoing a colectomy is an option, rather than a necessity.

What Is a Colectomy?

A colectomy is, simply put, the removal of the large intestine (colon).

After the large intestine is removed, an ileostomy is created, with a stoma on the abdomen that is used for the elimination of waste. Now, that being said, there are many finer points to colectomy surgery. A colectomy may be done for several reasons, including to treat inflammatory bowel disease (IBD), colon cancer, or familial adenomatous polyposis (FAP). The reason for the colectomy will dictate a lot of the decisions in how the surgery is done and 

A colectomy means removing the intestine, but in some cases the rectum, or at least part of the rectum, is left in places. This allows for the potential of a reconnection. With ulcerative colitis and FAP, most people have the option of having j-pouch surgery after the colectomy. In this surgery, the last part of the small intestine is sewn into the shape of a "j" so that it can hold stool. It's then connected to the rectum or the anus, so the patient can eliminate waste without the need for an ostomy appliance.

In some cases of IBD, and especially in Crohn's disease, a reconnection might not work very well, and so a stoma and a permanent ileostomy is created.

Some people with ulcerative colitis may also choose not to have a reconnection, but to have a permanent ileostomy. The reasons for this choice are personal, but they can include the desire to have children (in women), concerns over complications with a j-pouch, or to avoid more surgery.

Who Chooses a Colectomy?

What would cause one person with ulcerative colitis to choose a colectomy, while another does not? A study published in The American Journal of Gastroenterology takes aim at understanding more about people with ulcerative colitis who choose colectomy versus those who don't.

The research looked at three groups: people who didn't have ulcerative colitis, people who had ulcerative colitis and did not have a colectomy, and people who had ulcerative colitis who did have a colectomy. Those who had ulcerative colitis and not a colectomy felt that having a colectomy was similar to living with the ulcerative colitis. Those who had a colectomy preferred their current health status to that of living with the ulcerative colitis. One of the big differences between the two groups was social support: those who had had a colectomy had more support than those who had not.

Making Sense of Personal Choices

The results of the study make some obvious sense: if you had ulcerative colitis and knew others with ulcerative colitis who felt they were better off after colectomy surgery, you might be swayed to get the surgery yourself. As it stands, there isn't exactly a universal way to "review" your surgery and its outcome for others to take advantage of your experience and potentially learn from your mistakes.

Your gastroenterologist or surgeon may be able to put you in touch with others who have IBD, or a colectomy, or a j-pouch, or you could go to a forum or message board for people with IBD. Even so, I'm willing to bet most of us would spend more time researching our next vehicle purchase than we would researching colectomy surgery.

Another facet of personal choice is the idea that there could be complications. Complications with colectomy surgery aren't common, but the concern over the potential may prevent some from having the surgery. In the end, unless the surgery is mandated by physical reasons, the choice is very personal, and is very much a result of the information and the support structure available to patients.


Waljee AK, Higgins PD, Waljee JF, et al. "Perceived and Actual Quality of Life With Ulcerative Colitis: A Comparison of Medically and Surgically Treated Patients." Amer J Gastroenterol 2011; 106:794-799. 3 May 2011.