Guide to Ulcerative Colitis

Reviewed by the physicians of Columbia’s Colorectal Surgery Team, March 2024

Ulcerative colitis is a chronic inflammatory condition that is characterized by tiny ulcers and small abscesses confined to the inner lining (mucosa) of the colon. In ulcerative colitis, sores (ulcers) develop in the mucosa, or inner lining of the colon or rectum, causing diarrhea, blood, and pus. Inflammation is usually most severe in the sigmoid and rectum and usually diminishes higher in the colon. The disease develops uniformly and consistently until, in some cases, the colon becomes rigid and foreshortened.

Approximately 20% to 25% of patients who do not respond to medical treatments for ulcerative colitis will require surgical treatment. The most common operation is total removal of the colon and rectum with ileal pouch-anal anastomosis, which today is no longer disfiguring and preserves the passage of stool through the anus. The current trend is to perform surgical intervention when it appears the inflammation is not responding to medication and before the patient becomes debilitated by the disease or develops cancer.

If you or a loved one has received a diagnosis of ulcerative colitis and would like a second opinion to confirm this diagnosis or discuss treatment options, please contact our Inflammatory Bowel Disease Center.

Note: Inflammatory bowel disease is a general term used to describe two disorders of the gastrointestinal tract for which no specific cause has been found — ulcerative colitis and Crohn's disease.

Read about Sara’s journey as an ulcerative colitis patient and experiences undergoing a K pouch procedure »

Treatment for Ulcerative Colitis

Surgeons in the Division of Colorectal Surgery have expert understanding of the nuances of the surgical management of inflammatory bowel disease, and we take an individualized approach to patients with indeterminate ulcerative and Crohn's colitis. Our interest in dysplasia and cancer-complicating colitis, modeling of operative strategy, surgical quality, outcomes and quality of life promotes a balanced discussion of the relative value of medical versus surgical therapy and the preferable operative strategy for those undergoing surgery. Our surgeons collaborate closely with experts in several specialties such as gastroenterologists, pathologists, nutrition, and radiologists in order to ensure optimal immediate and long-term management.

Some patients with ulcerative colitis require total proctocolectomy (removal of the rectum and all or part of the colon). We seek to eliminate disease, preserve continence, and maintain health and quality of life by creating an ileoanal J pouch reservoir. In this procedure, the large intestine and rectum are removed, but the anus and anal sphincter are left in place. A pouch is made out of the last portion of the small intestine and connected to the anus. This helps to preserve continence and avoids the need for ileostomy (an opening in the belly for removal of waste into a bag). We routinely consider a laparoscopic approach to promote early recovery.

When a J pouch is not an option, specialized techniques such as the ileorectal anastomosis, use of other pouch configurations, mucosectomy, redo pouch procedures and continent ileostomy creation may also allow preservation of continence.

Revisional Colorectal Surgeries

For patients with pouch dysfunction after a previous ileoanal pouch procedure, our experience with pouch salvage surgery, continent ileostomy (K-pouch) procedures and stoma revisional surgery may allow sphincter preservation and maintenance of continence and quality of life after previous failure. Specialized local perineal and abdominal techniques allow for pouch salvage. A revision of the J pouch (a redo J-pouch) or conversion of the J pouch reservoir into a continent ileostomy may be feasible in some circumstances.

We have extensive experience with the continent ileostomy (K-pouch) procedure and are able to offer this option to some patients with ileoanal pouch failure when a redo pouch is not feasible or desired.

Next Steps

If you or someone you love is in need of care for an IBD-related issue, we’re here to help. Our team is available for consultations, second opinions, and to perform any colorectal procedure, should one be necessary. Call us at (212) 305-9664 or request an appointment online.