Crohn's and Ulcerative Colitis: When Does IBD Need Surgery?

Inflammatory bowel disease (IBD) includes Crohn's disease and ulcerative colitis. Most people manage IBD with medications prescribed by their gastroenterologist. But for some, surgery becomes an important part of treatment, and sometimes it brings a dramatic improvement in quality of life.

Crohn's disease vs. ulcerative colitis

• Crohn's disease: can affect any part of the digestive tract, from the mouth to the anus. It often involves the end of the small intestine and can affect the full thickness of the bowel wall.
• Ulcerative colitis: affects only the colon and rectum, starting in the inner lining.

Both can cause diarrhea, belly pain, rectal bleeding, fatigue and weight loss.

When might surgery be recommended?

• Symptoms that don't respond to medication, or medication side effects that are hard to tolerate
• A narrowing (stricture) that blocks the intestine
• Abscesses or fistulas, which are abnormal tunnels between the bowel and other organs or the skin
• Severe bleeding or a sudden, severe flare that doesn't improve in the hospital
• A perforation (hole) in the bowel
• Precancerous changes or cancer found during colonoscopy

Surgery for Crohn's disease

Surgery doesn't cure Crohn's, so surgeons aim to save as much bowel as possible. Options may include removing a diseased segment and reconnecting the healthy ends, widening a narrowed area (strictureplasty) or draining abscesses and treating fistulas. Many of these operations can be done with minimally invasive or robotic techniques.

Surgery for ulcerative colitis

Because ulcerative colitis affects only the colon and rectum, removing them can eliminate the disease. Many patients have a procedure that creates an internal pouch from the small intestine (often called a J-pouch), allowing bowel movements through the normal route after recovery. This is often done in stages.

A team approach

The best IBD care comes from your gastroenterologist and colorectal surgeon working together. Our team includes a double-board certified specialist in colon and rectal surgery who collaborates closely with your GI doctor.

This article is for educational purposes and is not a substitute for medical advice. If you have symptoms, please see your healthcare provider.