Surgery for Ulcerative Colitis

Written by Carlie Olenick
Medically Reviewed by Carol DerSarkissian, MD and Melinda Ratini, MS, DO on March 30, 2025
12 min read

Ulcerative colitis (UC) is a chronic, long-term medical condition. It's a type of inflammatory bowel disease (IBD). UC can cause inflammation and ulcers in the lining of your colon (large intestine) and rectum. You can choose surgery if your:

  • Symptoms persist and other medical treatments (like medication) don't help.
  • Risk for cancer is higher because you have polyps or a long history of UC.
  • Treatment causes side effects serious enough to weaken your health.
  • UC symptoms aren't going away.

You may need surgery sooner if you get certain UC problems. These can include acute fulminant colitis. It's a sudden, serious onset of UC symptoms. If medication doesn't help, your doctor may suggest surgery if you:

  • Get more than 10 stools in a day
  • Have constant bleeding
  • Get pain in your belly
  • Bloat
  • Can't eat or get toxic symptoms like a high temperature (fever)

You'll need emergency surgery if your UC becomes life-threatening. You may need surgery right away if your:

  • Colon has ruptured.
  • Have a lot of bleeding.
  • Get a life-threatening dilation of your colon (toxic megacolon) 

A toxic megacolon is a serious medical condition. Get medical help right away. It can put you at risk for (a rupture) bursting your intestines.

About 7 out of every 100 people get major surgery within the first five years of their ulcerative colitis diagnosis. And a third need surgery after having this chronic condition for 30 years.

Common surgical options for UC include ileostomy and J-pouch surgery. People typically consider surgery when other treatments aren’t working. Or they may get it right away if serious problems arise, such as: 

Acute fulminant colitis. Sudden, serious inflammation causing serious symptoms like frequent stools, bleeding, and belly (abdominal) pain. 

Toxic megacolon. A serious, life-threatening condition where your colon gets bigger (enlarges). Toxic megacolon can also burst (rupture) your colon. 

Dysplasia. Sometimes, abnormal tissue can grow in your colon. It can potentially be cancer or precancer.

Ulcerative colitis surgery is a useful treatment, too. It’s important to know that surgery isn’t a sign that other treatments failed. 

Surgery for UC is simply another tool. It can help you manage your health. Whether you need it can depend on complications and your symptoms.

There are different types of surgeries that can help you. Your symptoms and health issues matter, but you'll help your doctor decide. Talk with your surgeon about which one they suggest.

Proctocolectomy with ileal pouch-anal anastomosis (IPAA) or J-pouch

There are usually two steps for this surgery. But if your surgeon decides to complete it, you won't have a stoma (opening through your belly). Instead, they'll sew or staple your ileal pouch and anus together. 

If your surgeon decides to make a stoma, they'll likely do an IPAA. First, they'll make your pelvic pouch. It uses a temporary hole in your small intestine and belly (abdomen) called a stoma. 

You may still be able to pass stool through your anus if your stoma is reversed. The reversal surgery is done later. You'll get this second surgery after a few months. You'll first need to complete your treatment and fully heal. 

A proctocolectomy takes out your colon and rectum. It’s sometimes called a restorative proctocolectomy. Keeping your anal sphincter can also help you keep stool (poop) in and not have fecal incontinence (leak poop). 

Next, the IPAA (J-pouch) is made. It connects to your anus to serve as your new rectum. Your surgeon will protect the healing anastomosis and make a temporary ileostomy loop. This will have your stoma where a bag can catch your stools. 

But after the area heals, your surgeon will do the reversal surgery after 2 to 3 months. Then, you’ll pass stool through your anus.

Total colectomy

A total colectomy is a surgery to remove your entire colon. But it leaves your rectum intact. Together, the colon and rectum make up your large bowel. During the surgery, your surgeon may also do an ileostomy.

They'll connect a small section of your small intestine through an opening. They do this at the top of your stomach. The stoma allows stool to exit through the opening into a stoma bag. 

But this surgery isn't done very often for UC since it leaves behind the rectum. The rectum can still get inflamed and cause UC symptoms.

Permanent ileostomy

If a restorative proctocolectomy with an IPAA is not a good option, your doctor may suggest a permanent ileostomy. 

The tip of your lower small intestine is brought through the stoma. An external bag, or pouch, is attached to it. This is called a permanent ileostomy. Stools pass through this opening to collect in the pouch. The pouch must be worn at all times.

Continent ileostomy

The continent ileostomy, or Kock pouch, is another option. It's a good option if you'd like to get your ileostomy made into an internal pouch. It's also an option if an IPAA isn't possible.

This surgery makes a stoma but doesn't require a bag. The colon and rectum are removed first. Next, an internal storage pouch is created from your small intestine.

A small hole is made in your belly (abdominal wall). Then, a storage pouch is joined to the skin with a nipple valve. When you need to drain your pouch, you'll insert a catheter through the valve into the internal reservoir. 

It's not the preferred surgical treatment for UC. That's because it can have uncertain results. And you may need more surgery later.

Hemicolectomy

This surgery only removes part of your colon. It's not preferred for UC because the other part of your colon can still get inflamed. But it may be a good option if only part of your colon has UC. There are two types done. It can depend on where your problem area is:

Right hemicolectomy. Removes the right, or ascending, part of your colon. Your surgeon may also take out some other areas. They may take out your appendix. Your surgeon may also take out the middle part of your large intestine. Then, they'll connect what's left of your colon to your small intestine.

Left hemicolectomy. Removes the left, or descending, part of your colon. Your surgeon will attach the right and middle parts to your rectum. This is the last place your bowel movements pass through on the way out.

Expect to stay in the hospital for at least a few days. But you may stay up to a week after surgery. It can depend on your healing time and other medical conditions. You'll likely get IV fluids to keep you hydrated as you adjust.

You'll be on a liquid diet for the first few days. How long can depend on your surgery, and how your body adjusts. Don't push yourself, listen to your body, and go slowly.

You'll need up to a year to fully recover. Allow your body time to get used to the new changes. It's learning to digest your nutrients differently.

You'll slowly go from liquids to soft, mushy foods in the hospital. If you do well on mushy foods for a few days, you'll get bland, soft foods next. After your body digests soft foods, try to chew solid foods slowly. 

Drink lots of water and keep hydrated. To stay hydrated, you may find oral rehydration solutions helpful. You can also try to eat and drink foods high in electrolytes.

Medicine will help with pain, but you probably won’t do normal activities for a couple of weeks. If you have open surgery, it might take longer. Your doctor will probably tell you not to lift any heavy objects for at least six weeks.

“Both the American Society of Colon and Rectal Surgeons and the Society of American Gastrointestinal and Endoscopic Surgeons advocate for preoperative education and stoma training for patients undergoing ileostomy creation," says Nikhil Kadle, MD, a gastroenterologist at Digestive Healthcare of Georgia in Newnan, Georgia. "These measures can improve recovery and minimize complications." 

Stoma training can teach you how your surgery is done. Some can teach you how to care for your stoma, and where to buy equipment. Classes also help you learn how to live with your stoma. They can give you ideas about how to talk with your partner about the stoma, too.

You should be able to eat and go to the bathroom normally after you recover. But if you have a stoma bag, you may still get an urge to go to the bathroom. That's normal, too --- it's called a phantom rectum. Be patient: The urge will go away after your body adjusts.

Everyone heals at their own pace, so take it easy until you feel better. Ask your doctor what to expect.

Call your doctor if you:

  • Have a fever of 100.4 F or higher.
  • Have cuts that swell or leak blood, fluid, or pus.
  • Get pain that worsens.
  • Can’t stop throwing up.
  • Still haven’t pooped three days after surgery.
  • Have blood in your stool.

And if you have a hard time breathing, call 911 and get medical help immediately.

Ask your surgeon when it’s safe to eat solid meals. It will take some time for your intestines and gut to digest normally. While you recover, your colon may also have trouble taking in water.

You might have:

  • Diarrhea or more bowel movements
  • Dehydration
  • Smelly or frequent gas

Here are some things you can do after surgery to help:

Talk to a dietitian. It’s important to discuss what’s safe to eat while your bowels heal. Ask your doctor about seeing a dietitian. They’ll help you create a personalized diet for your health.

It’s common to have problems with certain foods at first. Talk to your doctor or dietitian about it. They can help you adjust or offer advice. It’s likely temporary while your intestines heal. They'll slowly help you eat certain foods again safely.

Rest your gut. To give your gut a rest, your doctor may also ask you to follow a low-residue diet. You may need to stay on it for about four to six weeks.

This can make your bowel movements smaller. Or you may go less often. It can also cut out most of your fiber. The diet may restrict some dairy, too. Some “low-residue” foods you can eat include:

  • Applesauce
  • Bananas
  • Bread or toast
  • Peanut butter
  • Yogurt
  • Potatoes
  • White rice
  • Cheese
  • Pasta
  • Tofu or easy-to-eat meat

Some foods you may need to avoid include:

  • Processed meat like hot dogs or sausage
  • Nuts
  • Beans, peas, lentils, or legumes
  • Fruits with skins like apples, pineapple, or coconut
  • Popcorn

Stay hydrated. Make sure you drink eight to 10 glasses of water or other fluids a day. This can help keep you hydrated. That means keeping the right balance of electrolytes and water in your body. 

Notice the weather, too. Drink more if it’s hot or you’re more active. If you feel dehydrated or your stool is thicker, try to drink more liquids. You can add more broth, soups, or vegetable juice during the day. 

You can also drink oral hydration solutions, electrolyte beverages, or pediatric electrolyte solutions, too. Ask your doctor or dietitian what they suggest for your health.

Vitamins and minerals. There are three main vitamins you may keep an eye on after surgery: vitamin D, vitamin B12, and iron. Vitamin D helps your bones stay healthy. 

Vitamin B12 is key for oxygen and your nerves. Iron helps your oxygen levels, too. If you have a J-pouch surgery, your doctor may check your iron.

"Nutritional status plays a pivotal role in recovery, with malnutrition and hypoalbuminemia linked to longer hospital stays,“ says Kadle. "And [poor nutrition] can increase risk of complications."

Hypoalbuminemia (low levels of a protein called albumin) can happen due to inflammation. Try to eat a balanced diet during your recovery. Ask your doctor or dietitian about nutritious foods to include in your diet.

Removing the entire colon and rectum can cure ulcerative colitis. This can put an end to the diarrhea, abdominal pain, anemia, or other symptoms. Surgery can also prevent colon cancer.

About 4.5 in 100 people get colon cancer after having ulcerative colitis for 20 years. But colon cancer screening or surgery to cure UC can prevent it, too.

Your doctor may suggest surgery if you're at higher risk for colon cancer. For example, if your ulcerative colitis affects your entire colon, you may have a higher cancer risk.

Complications from ileoanal anastomosis may include:

  • More frequent and more watery bowel movements
  • Inflammation of the pouch (pouchitis)
  • Blockage of your intestine (bowel obstruction) from internal scar tissue (adhesions)
  • Pouch failure, which happens within five years in about 4 out of every 100 people with IPAA

If your pouch fails, you’ll need a permanent ileostomy. A hemicolectomy also has some of the same risks as other surgeries. 

It’s safe for most people, but you could have a reaction that makes you feel sick for a few days. It’s rare, but some people may feel confused for a week or so.

You could also get blood clots in your legs or lungs. To lessen the chances of clots, you'll walk around every hour or so in your hospital room. Other possible problems include:

  • Infection
  • Scar tissue blocking your intestines
  • Leakage where your intestines reconnect
  • Hernia
  • Injury to nearby organs
  • Internal bleeding

Your doctor will want to see how you're doing after surgery. Talk to them about when you should follow-up. They may want you to visit within a couple of weeks. But your check-up schedule could be different, depending on why you needed the procedure. 

You may have mixed feelings about your stoma after surgery. You may be uncertain about living with it. But often, you'll be able to return to activities like swimming, travel, and work. 

If your stoma is temporary or permanent, it's normal to wonder about the bag. It lays pretty flat against your skin. But there are other pouch systems you can choose from.

Also talk to your doctor about any feelings of anxiety or depression. Your emotional and mental health and well-being are important, too. 

You can get support at the United Ostomy Associations of America . And you can ask your doctor or talk to your therapist about local support groups, too.

Ulcerative colitis surgery can help relieve symptoms and prevent your risk of colorectal cancer. Proctocolectomy with an ileal pouch-anal anastomosis (IPAA) or J-pouch is the most common one. You'll recover in a hospital and may have some diet changes. Some risks include pouchitis or blockages, but you’ll gradually get back to your usual routine. 

When is surgery needed for UC?

Surgery for UC may be needed if your symptoms persist or worsen despite treatment. You'll also need surgery if you have serious UC problems:

  • Toxic megacolon
  • Acute fulminant colitis
  • Polyps or dysplasia
  • Ruptured colon
  • Hemorrhage (a lot of bleeding)

How successful is surgery for ulcerative colitis?

Proctocolectomy with an ileal pouch-anal anastomosis (IPAA) or J-pouch is the most common UC surgery. It's highly successful, and more than 90 in 100 people report positive long-term results. Although usually successful, you'll need follow-up care if you have any problems later.

What are the risks of ulcerative colitis surgery?

Ulcerative colitis surgery carries risks like blood clots. These are common for UC. Other potential risks include: 

  • Anastomotic leaks

  • Pouchitis treated with antibiotics

  • Bowel obstructions from scar tissue 

Your surgical team will review your risks with you. They'll help you take steps to lower your risks for problems.

How long does it take to recover from ulcerative colitis surgery?

Recovery from ulcerative colitis surgery usually takes at least six weeks. You may be in the hospital for 3 to 10 days. It can depend on your healing time and other medical conditions. 

You’ll likely feel weak at first. Your doctor may suggest avoiding hard (strenuous) exercise for a few weeks or more. It can depend on the type of surgery you have and your health. Wait until you heal. Full recovery time varies for each person.

What is the life expectancy of someone with ulcerative colitis?

Life expectancy with UC can depend on factors like age, seriousness of the disease, and other medical problems. Most people who have UC live a normal lifespan. Repeated surgeries, colorectal cancer, or toxic megacolon can slightly reduce your life expectancy, though.