An ulcerative colitis (UC) colectomy is often a last-resort treatment when other therapies do not work or when UC symptoms become severe.

UC is a common form of inflammatory bowel disease. Several treatments can help manage the symptoms, but they may not work well for every person.

A colectomy may remove part (subtotal colectomy) or all (proctocolectomy) of the large intestine (colon) and rectum. While a colectomy can cure UC, it may not be the right choice for everyone.

This article provides information about what a UC colectomy is, what it does, and other considerations about the procedure.

A colectomy is a procedure to remove the colon and rectum. A total proctocolectomy involves the complete removal of the colon and rectum, while a subtotal colectomy involves the removal of only the affected parts of the colon.

During a total colectomy, surgeons may also perform an ileostomy. This procedure involves creating an opening on the side of the abdomen for stool to pass through into a removal pouch.

In other cases, a surgeon may create an internal pouch and connect it to the anus to allow a person to have bowel movements similarly to the way they did before the surgery.

In the United States, the risk of needing a colectomy increases over time after diagnosis. At 1 year from diagnosis, the risk of needing surgery is a little over 4%. At 5 years from diagnosis, it rises to a little over 10%. And at 10 years, the risk is close to 15%.

A doctor may recommend a colectomy if someone has severe UC or if other, less invasive treatments have not worked well for them.

Other common reasons a doctor may recommend a colectomy include:

  • side effects of medications that become unbearable
  • toxic megacolon (swelling and inflammation that spread into deeper layers of the colon)
  • perforation (a small hole or puncture in the colon)
  • delayed growth in children
  • strictures (narrowing of the colon)
  • cancer
  • uncontrollable bleeding
  • unresectable high grade or multifocal dysplasia (the growth of abnormal, possibly precancerous tissue/cells)

Does a colectomy cure ulcerative colitis?

Doctors and other experts generally consider a total proctocolectomy curative for UC. However, for some people, a total colectomy can cause new symptoms related to inflammation around the pouch. A person may need antibiotics or other treatments to manage these symptoms.

Not everyone likes the idea of a permanent ostomy bag, but for others, the absence of UC symptoms is worth it. Also, many modern bags have a sleek design and can fit under most clothes.

A UC colectomy is an invasive procedure that requires general anesthesia to perform. The procedure varies somewhat depending on the type of colectomy a person’s healthcare team recommends.

A subtotal colectomy for UC involves partial removal of the colon. The surgeon will target the affected areas of the colon to remove.

There are two types of subtotal colectomy: open and laparoscopic. The main difference is the size of the incision (opening) the surgeon makes.

During an open colectomy, the surgeon creates a large incision to get a full view of the area they need to remove. During a laparoscopic colectomy, the surgeon makes a small incision and then inserts instruments and a camera in the opening to remove the affected sections of colon.

A total colectomy involves removing the entire colon. This procedure is the gold standard for a single curative treatment for UC. Surgeons often pair this procedure with an ileostomy.

During an ileostomy, a surgeon creates an opening in the abdominal wall. They then attach an ostomy bag to the opening, on the outside of the body, to collect solid waste (stool).

In other cases, a surgeon may create an internal pouch and attach it to the anus. This artificial rectum will allow a person to pass stool similarly to the way they did before the procedure.

Are there any risks?

Any surgical procedure carries some general risks, such as reactions to anesthesia and infections at the incision sites.

UC colectomy increases a person’s risk of developing a blood clot in a deep vein, which is known as deep vein thrombosis (DVT). A 2024 study suggests that doctors diagnose most cases of DVT within the first 30 days after the procedure.

Some people may experience chronic inflammation of the pouch, which may require additional treatment such as antibiotics.

How do I prepare for an ulcerative colitis colectomy?

A person will want to discuss specific preparations and ask questions of the surgeon who will be performing the colectomy. The surgeon can provide instructions on when and whether a person should stop taking certain medications and when they should stop consuming food and water before their surgery time.

Some general steps to prepare for a colectomy can include:

  • not smoking for a few days before the procedure, if a person typically smokes
  • drinking only clear liquids leading up to the procedure
  • performing a bowel cleansing prep as directed
  • not eating for several hours before the procedure
  • discussing with the surgeon any use of medications, alcohol, or other drugs before the procedure

A person can expect recovery to take some time after a UC colectomy.

For the first few days, a person will typically recover in the hospital. Nurses and doctors can help monitor the person’s recovery.

After discharge, a person will need to continue to rest and take it easy for several weeks. In most cases, a person will need to avoid exercise and other physical exertion for about 6 weeks.

According to the Crohn’s & Colitis Foundation, it may take up to a year for a person to fully adjust to life after surgery.

In many cases, a person will experience sudden relief of their UC symptoms after a colectomy.

Health experts consider a total colectomy the gold standard curative treatment for UC. However, modern treatment options such as biologics may have moderately reduced the overall need for colectomies to treat UC.

The procedure can cause some emotional distress, including potential body image concerns and depression. However, a person can typically resume their usual level of activity once they have recovered from the surgery.

A colectomy can also help reduce the risk of colorectal cancer in people with UC, who have a higher risk of this cancer than people without UC.

Colectomy for UC is often a last-resort treatment when people have severe UC or when other therapies do not work to manage UC symptoms.

The procedure involves removing either part or all of the colon. After the procedure, a person can expect their UC symptoms to clear up. A person should also be able to resume their usual activities once they recover from surgery.

Many people find that their UC symptoms go away and their quality of life improves after surgery. However, complications are possible, and a person should consider discussing the potential negative effects of the procedure with a healthcare professional.

The following sections provide answers to some frequently asked questions.

How common is it to have a colon removed with UC?

A colectomy is generally a last-resort option for treating UC. Healthcare professionals typically recommend it in people who have severe UC, symptoms that they cannot manage with other treatments, or other complications associated with UC.

How will a colectomy change my lifestyle?

Many people find that they can take part in the same activities as they could before the surgery. However, some people may experience emotional stress due to changes in body image or depression related to the procedure.

Can you still poop after colectomy?

Whether a person can still pass stool depends on the procedure they undergo. During a proctocolectomy with Ileal pouch-anal anastomosis, a surgeon creates an artificial rectum that allows a person to maintain regular bowel function.

In other cases, a surgeon attaches a pouch to the side of the abdomen, and stool passes into the pouch. A person will need to change the pouch regularly throughout the day.