A colectomy, or large bowel resection, is a type of surgery sometimes used in the treatment of diseases of the large intestine, such as ulcerative colitis (UC).
Surgery for UC isn’t as common as it once was. However, it’s estimated that 7 in 100 people with this type of IBD may require surgery in the first 5 years after their diagnosis if medications and lifestyle changes aren’t enough to manage the symptoms of UC.
However, not all surgeries are total colectomies, some can be partial colectomies.
Learn more about the benefits and risks of a colectomy and what may be involved with this procedure.
A type of inflammatory bowel disease (IBD), UC affects the large intestine, which consists of three parts:
- Colon: The part of the large intestine that absorbs the remaining water and nutrients from partially digested food and forms the stool.
- Rectum: The area between your colon and anus that holds stool.
- Anus: The opening at the end of your colon.
A colectomy is the surgical removal of part or the entire large intestine. This procedure is intended to remove severely inflamed or damaged portions of your colon. A partial colectomy is the removal of part of the colon or large bowel.
The type of surgery you have may be linked to certain cancer risks like dysplasia.
There are several types of colectomy your doctor may consider:
- Proctocolectomy: This involves removal of the colon, rectum, and anus.
- Subtotal (partial) colectomy: This involves the removal of either the ascending colon (attached to your small intestine on the right side of your abdomen) or the descending colon (attached to your rectum on the left side).
Which type you may require depends on:
- whether you have partial or total UC (pancolitis)
- the extent of damage and inflammation to your large intestine
The purpose of a colectomy is to remove the diseased portions of the large intestine so that you may experience fewer flare-ups and complications.
A colectomy is usually considered a last resort for UC when other treatment measures haven’t helped address or manage symptoms of UC.
A long-term study published in 2018 found that 4.1% of people with UC needed a colectomy after 5 years, and 14.4% needed one after 20 years.
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Reasons for surgery
The most common reasons for surgery for UC include:
- frequent flare-ups that can cause symptoms severe enough to interfere with your daily life, including severe abdominal pain, fatigue, weight loss, and mucus-filled or bloody stools
- acute symptoms that don’t respond to medications as before, as these can be a sign of rapid enlargement of your colon (toxic megacolon) and cause symptoms like dehydration, fever, and bloody diarrhea
- holes, tears, or severe damage to the colon
- severe or heavy rectal bleeding
- cases of colon cancer from UC
- hospitalization for severe acute illness
UC may only be resolved with a colectomy if your entire large intestine is removed.
One advantage to a proctocolectomy is that you would also no longer be at risk for developing colon cancer. Your doctor will also take your personal choice into consideration. There are times when colon cancer can develop without total UC.
One study found that privately insured patients paid over $4,000 out-of-pocket for a colectomy, which is 4.5% of the total costs.
The actual cost is hard to say due to variables in health insurance, but it can run from $5,000 to $30,000. The cost also depends on the type of surgery you’re having, with open surgeries being more expensive.
A colectomy for UC is typically covered by health insurance. But you should call your insurance provider ahead of time to determine what out-of-pocket costs you should expect, if any.
Keep in mind that fees related to your hospital stay and the anesthesiologist are separate from those paid to a surgeon.
The benefits of a colectomy generally outweigh the risks.
But talk with a doctor first about possible risks that have been associated with colectomy for UC, such as:
- infections, particularly at the site of a stoma
- urinary incontinence
- fecal incontinence
- the feeling of a “phantom rectum” (temporary)
- intestinal blockage
- prolapse or retraction of the stoma
- changes in sex life
- painful intercourse (temporary)
If your UC colectomy is planned (not an emergency surgery), talk with a doctor about how you can prepare for your procedure. They may make the following recommendations:
- Gain weight before surgery with a liquid diet if a doctor considers your body weight too low.
- Stop smoking, if you smoke.
- Stop taking blood-thinning medications, herbs, or supplements, and tell the doctor or surgeon in advance about any over-the-counter medications you take and give a full list of prescriptions.
- Clear out your bowels the day before surgery with either a strong laxative or enema (the exact type is usually recommended by a doctor).
- Drink plenty of fluids right before your surgery or follow a liquid diet (if recommended by a doctor).
- Avoid eating or drinking anything after midnight before your surgery.
Which type will I get?
The steps performed during a colectomy will depend on whether you’re having your colon removed (partial colectomy) or your entire large intestine (proctocolectomy).
Partial/subtotal colectomy
Also known as a “partial” colectomy, a subtotal colectomy removes a section of your large intestine. The goal is to remove sections that may be affected by fistulas or other damaged portions.
A partial colectomy may consist of either open surgery or a laparoscopic colectomy. With both types, your doctor will remove diseased sections of your large intestine and then reconnect the non-diseased portions together.
The key difference is the length of incisions made.
Laparoscopic colectomies require smaller incisions because your surgeon uses a camera inside your abdomen to view the inside of your body. An open surgery creates incisions up to 8 inches long so that your surgeon can fully view the entire surgical area.
Proctocolectomy
A proctocolectomy is the removal of your entire large intestine. This surgery is performed in cases of severe large intestinal damage from IBD.
The procedure may be done in conjunction with an ileostomy. This is done by creating a new opening in your body called a stoma to help pass stool. You’ll need to wear a removable ostomy pouch to collect your stool.
Another type of proctocolectomy removes the rectum and colon but not the anus. Instead of an ostomy pouch, your surgeon will create an internal pouch, called a J pouch, to help with the elimination of waste.
You may notice immediate improvements in your UC symptoms following a colectomy.
But as with any major surgery, you’ll need to take time off to recover and reduce the risk of infections and bleeding. You’ll also have pain in your abdomen due to the incisions.
A doctor may recommend a liquid or soft food diet for a few days after your procedure. They may also advise against exercising for at least 6 weeks. You may consider taking a few weeks off work or opt for a work-from-home option, if available.
It may take up to 1 year to fully recover from a proctocolectomy. You may experience multiple bowel movements per day for several months.
After recovering from a colectomy for UC, you should be able to engage in your normal recreational and daily activities. In some cases, you may find that you can increase activity levels due to the absence of UC symptoms.
At first, you may feel self-conscious about wearing an ostomy bag as you’re getting used to it. But most ostomy bags are sleek enough to fit under clothing and aren’t visible to other people.
To reduce the risk of dehydration and loose stools, it’s important that you drink enough fluids throughout the day. Eating high-pectin foods may also help. Bananas, applesauce, and carrots are all good sources of pectin.
If your UC is worsening despite treatment, your doctor may recommend a colectomy to remove some or all of your large intestine. The surgery is also used in emergency situations, such as with cancer or severe damage to the colon.
Overall, the outlook for colectomy for UC is positive, with
The benefits of having this surgery may far outweigh the possible changes in urinary and stool habits along with changes in sex life.
It’s important to thoroughly discuss the benefits and risks of surgery with a doctor and how this may impact your type of UC. See a medical professional right away if you’re experiencing a flare-up that’s not responding to your usual medications.