Ulcerative Colitis

Treatment

Treating inflammatory bowel disease is both a science and an art. Because each case is different and no single treatment is universally effective, Mayo doctors design regiments to meet each person's unique needs. Those needs often change over time, and as your body responds to treatment, the most effective therapeutic approach is likely to change, too.

People who have ulcerative colitis often develop inflammation outside the colon — in their joints, eyes, skin or lungs. They may have other health problems, too, ranging from thyroid disorders to diabetes. Mayo Clinic's integrated approach to patient care ensures that any additional medical conditions are evaluated and treated quickly by Mayo specialists who work closely with your primary care team.

Mayo Clinic doctors involve you in all treatment decisions and collaborate with you in finding the approach that will provide you the greatest benefit with the fewest side effects. Your doctor will thoroughly discuss any concerns that you may have about a particular treatment, sometimes pulling in several specialists, so that you can make the most informed decision possible.

The last two decades have seen great advances in the understanding of inflammatory bowel disease and in the kinds of therapies available to patients. As more information emerges from research and clinical trials, the number of therapeutic options is likely to continue to grow. Mayo maintains a database of information on more than 2,300 patients to help assess the effectiveness of current treatments.

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Medications

Sometimes very mild ulcerative colitis symptoms can be controlled with diet and lifestyle changes. But most people need medications to relieve their symptoms. The traditional approach to managing ulcerative colitis with medication is to start treatment with the safest drugs and then switch to stronger medications if first-line drugs fail to relieve your symptoms.

The problem for doctors and patients is that all drugs have risks as well as benefits, and no single medication is entirely effective. But Mayo's approach, which combines the latest medical research with supportive care, can relieve symptoms and improve your quality of life with the fewest possible side effects.

Surgery

Although medications are the first-line treatment for ulcerative colitis, surgery may be recommended in some cases. This is especially true if your symptoms persist or worsen in spite of the best medical care, if serious complications or drug side effects develop, or if cancerous or precancerous changes occur in your colon. Mayo Clinic surgeons use both conventional open surgery and minimally invasive (laparoscopic) techniques to treat ulcerative colitis.

Unlike open surgery, which requires a long incision in the abdomen, laparoscopic surgery uses three or more small "keyhole" incisions. The surgeon inserts surgical instruments through ports in the incisions, and performs the procedure using images sent from the camera to a computer monitor.

Minimally invasive surgery for ulcerative colitis has long-term outcomes comparable to conventional surgery with the benefits of shorter hospital stays, less pain, and an easier recovery. Not everyone is a candidate for minimally invasive surgery. Your treatment team will help you decide which type of surgery would be most effective for you.

Ileoanal pouch surgery

Ileoanal pouch surgery, which removes the entire colon and rectum, has been used for 20 years and is the most common surgery for ulcerative colitis. Its primary advantage is that you can eliminate waste normally after the procedure.

Mayo Clinic surgeons have performed more than 3,000 ileoanal pouch surgeries (also called ileal pouch-anal anastomosis or restorative proctolectomy). Recent surveys have shown that 92 percent of people who had this procedure at Mayo Clinic are satisfied with the outcome and with their quality of life.

During ileoanal pouch surgery, your surgeon constructs a J-pouch from the end of your small intestine. The pouch is then attached directly to the anus. To allow time for the pouch to heal, your surgeon creates a temporary ileostomy (opening in the front of the abdomen). The ileostomy is reversed a few months later in a second operation and you can then have bowel movements through the anus, although they will be more watery and more frequent than usual.

In most cases, ileoanal pouch surgery can be performed laparoscopically, which means a smaller incision, less discomfort after the surgery and a shorter hospital stay — usually three to five days rather than seven to 10 days with traditional open surgery.

Most people who have ileoanal pouch surgery are continent and can resume their normal work schedule and other activities, including sports. If you're a woman of childbearing age, the surgery won't affect your ability to have a normal pregnancy and delivery.

The most common complication of this surgery is pouchitis, an inflammation of the newly created pouch lining. Pouchitis can cause symptoms similar to those of ulcerative colitis, including diarrhea, abdominal pain, fever, dehydration and joint pain. The risk of pouchitis increases the longer the pouch is in place and is greater if you smoke or have inflammatory joint disease or certain skin diseases.

In most cases, pouchitis can be treated with a short course of antibiotics. When pouchitis doesn't respond to treatment, the pouch is removed.

Proctocolectomy

Proctolectomy also involves removing the colon and rectum. But after removal, an opening (end-ileostomy) is created on the outside of your body, usually in the lower abdomen, and you wear a small bag over the opening to collect waste. Possible complications include infection and problems with the stoma — the opening through which waste is eliminated.

In addition to long-term complications, living with a stoma can present daily challenges. Mayo Clinic has a team of wound and stoma care specialists who provide counseling before surgery and education and compassionate support after it. Every member of your treatment team at Mayo Clinic is dedicated to helping you achieve the highest quality of life possible after colon surgery.

Nutritional care

Some people with ulcerative colitis — whether they have had surgery or not — have trouble maintaining a healthy weight. In that case, dietitians specializing in digestive disorders can provide education and support.