Ulcerative Colitis – Treatment

Most patients with mild or moderate disease receive 5-ASA agents, a combination of the drugs sulfonamide, sulphapyridine and salicylates at the beginning of treatment to help control inflammation. The most common of these drugs is sulfasalazine. Sulfasalazine can be used for as long as needed and may be given along with other medications. Patients who do not respond well to sulfasalazine may have a better response to the newer 5-ASA agents. Possible side effects of 5-ASAs include nausea, vomiting, burning, diarrhea, and headache.

Sufferers of the severe form of the condition, but where they do not respond to mesalamine, may be given corticosteroids. Prednisone and hydrocortisone are two corticosteroids used to reduce inflammation. They can be taken orally, intravenously, by enema or in a suppository, depending on the site of inflammation. Corticosteroids can cause side effects such as weight gain, acne, facial hair, hypertension, moodiness and increased risk of infection. So, doctors carefully monitor patients taking these medications. Other medications may be given to relax the patient or to relieve pain, diarrhea or infection.

In some cases, the symptoms are so severe that the patient may need hospitalization. For example, a person may experience severe bleeding or severe diarrhea, causing dehydration. In these cases, the doctor tries to stop the diarrhea and the loss of blood, fluids and minerals. The patient may need a special diet, intravenous feeding, medication or, sometimes, surgery.

Approximately 25 to 40% of ulcerative colitis sufferers eventually need their colon removed due to total bleeding, severe disease, rupture of the colon or risk of cancer. Sometimes, the doctor recommends removal of the colon if medication fails or if the side effects of corticosteroids or other drugs threaten the patient’s health.

Various operations may be performed. The most common is proctocolectomy with ileostomy, which is performed in two stages. In a proctocolectomy, the surgeon removes the colon and the anus. In an ileostomy, the surgeon creates a small opening in the abdomen, called an ostomy, and sticks the last part of the small intestine, called the ileum, into it. This type of ileostomy is called a Brooke ileostomy. Stool moves through the small intestine and exits the body through the stoma. The stoma is one-quarter the size of a quarter and is usually located in the lower right part of the abdomen near the belt line. A pouch (neo-liquor) is placed around the opening to collect the stool, and the patient empties the pouch as needed.

An alternative method to the Brooke ileostomy is the continent ileostomy. In this surgery, the surgeon uses the ileum to create a pouch inside the lower abdomen. Waste is emptied into the pouch, and the patient empties the pouch by inserting a tube into it through a small hole that is protected from leaks. The patient only needs to wear an external pouch for the first few months after the operation. Possible complications of continent ileostomy include dysfunction of the stoma opening, which requires surgical correction, and inflammation of the skin around the stoma, which is treated with antibiotics.

An ileal anastomosis or a pull-through surgery – creating a neointima and ileal anastomosis – allows patients to have normal bowel movements because it preserves part of the anus. This procedure is becoming increasingly common for ulcerative colitis. In this surgery, the surgeon removes the diseased part of the colon and the inside of the anus, leaving the outer muscles of the anus. Then, he glues the ileum to the inside of the rectum and anus, creating a pouch – a neoligium. The waste is stored in the pouch and passed through the rectum in the usual way. Bowel movements in this case may be more frequent and more fluid than usual. Inflammation, however, of this neovagina is a possible complication of this process.

Not all operations are suitable for everyone. The type of surgery required depends on the severity of the condition and the patient’s needs, expectations and lifestyle. People faced with this decision should consult their doctors with great care. Patient support organizations can direct people to support groups or other sources of information.

Most people with ulcerative colitis will never need surgery. However, if the need ever arises, the optimistic fact is that after surgery, the colitis is cured and most patients go on to lead normal and active lives post-operatively.