Archive for the ‘Colitis Surgery Articles’ Category

Surgery for colitis has to be faced up to by a small percentage of sufferers and though the problems living with the symptoms of the disease are over, what then begins is a whole new set of challenges. But what does the patient face physically when the surgical procedures are complete?

The first stage of the surgical procedure for colitis is the removal of the entire large colon and this will also include the rectum. Even though only part of the large colon may be diseased, enough for surgery to be required in the first place, there is no option but for it to be removed entirely. It is important not to lose sight that this surgical process to remove the colon and rectum is the only permanent cure for colitis. Plus also, if it can be seen as a bonus, it will also eliminate any risk of being diagnosed with colon cancer.

Once the colon has been removed, a small opening is formed in the abdominal wall and the end of the small colon, which was formerly attached to the large colon, is then pushed through and attached to the skin. The length of what is called an ileostomy, or a stoma, will be between one and two inches. So what happens with this? This will be the outlet for the waste that would have otherwise passed through the large colon. It is collected in a bag attached to the skin and entirely encompasses the stoma. The bag is then emptied periodically when necessary.

The thought of living with part of the small intestine sticking out the front of the abdomen may not be appealing but it has to be remembered that it is all an essential part of the process to rid the patient of colitis. It is normally only temporary as the surgical consultants will do their best to try and create a more user friendly system of storing and riding the body of its solid waste.

In most cases, there will be an attempt to create an internal pouch created from the end of the small intestine that is then attached to the anus. This will act as a reservoir to collect waste to be evacuated in the same manner as when the patient had a large colon. This procedure will be undertaken some time after the initial operation and will most likely be given further convalescence time before being connected up. The surgical term for this procedure is an ileo anal pouch which, and after a period of getting used to, can give a very encouraging degree of normality of life back to many patients who have undergone this surgical procedure.

Surgery for colitis is a last solution for those faced with the onslaught of symptoms and as such should never be considered until many methods to try and control the symptoms have been tried and have not succeeded. It is a very major surgical procedure and comes with no guarantee of success. It brings with it many challenges and can for some be too problematic, yet for many it is the solution to the debilitating effect colitis has on their lives.

It is a very common thought and question every colitis sufferer will ask themselves and their doctor but the need for surgery for colitis is not inevitable. Only a small percentage of all those diagnosed with the disease have to ultimately undergo the surgical processes and they can be grouped into different categories depending on the extent of their colitis and how it affects their life.

The standard surgical procedure for colitis will involve the removal of the entire large colon and this will also include the complete removal of the rectum as well. It has to be understood and acknowledged that such an operation is the only permanent cure available for colitis. Whilst the sufferer may have come across many so called “cures”, they may reduce the symptoms but will never actually cure the disease.

So which people who have been diagnosed with colitis are most at risk of having to consider surgery? The first group will be those who suffer from fulminant colitis, where the extent of the inflammation affects over half of the entire colon. Whilst remission is possible with such extensive coverage, when a relapse happens the symptoms are severe and there are cases when they do not respond sufficiently to medications. At this point, the colitis can appear out of control and the only solution is surgery as there can be a further danger of perforation of the bowel occurring.

A second grouping of colitis sufferers who could face the prospect of surgery is those with long standing pancolitis or left-sided colitis, which describes the area of the bowel leading down to the rectum. Again, the symptoms may not be able to be brought under control or the sufferer has over a period of time be unable to attain a satisfactory amount of time in remission. Someone diagnosed with this extent of colitis will also face an increased risk of developing colon cancers. The removal of the entire large colon is important when precancerous changes are detected in the colon lining.

There is a third group that can also face the prospect of surgery for colitis. These are people who have not been able to gain much respite from colitis symptoms. Whilst the extent of the inflammation can be quite small, there are some who just cannot bring symptoms under control and live in such a state for several years. Lifestyle, diet and medications have all been trialled and tested but to no avail. In order to achieve a quality of life that resembles the norm, many chose the surgery option to rid themselves of colitis for good. Life does change when surgery happens, but at least these patients can look forward to a less painful and more normal and active life ahead.

It can either be a considered decision to opt to have surgery for colitis to bring some kind of normality back to a life for those that have moderate yet continuous symptoms or the decision to have surgery can be forced upon the patient due to symptoms being out of control and unresponsive the treatment. Whatever the reason for surgery for colitis, it is a life changing event that, whilst bringing its own challenges in the immediate aftermath and requiring the need to alter daily habits for the remaining lifetime, it can offer welcome respite from the painful grip that colitis has over so many sufferers.

When suffering from colitis symptoms, either from a relapse or from their continuous presence, it is only natural for the patient to, at some point in time, consider the merits of surgery for colitis. With so much discomfort being experienced, the prospect of perpetual relief can be attractive but any decision has to be carefully considered because the ramifications are major.

The process of surgery for colitis involves extraction of the large colon and this is irrespective of whether it is diseased in its entirety or only concentrated on a specific area. As the function of the large colon is simply a storage area for solid body waste to be held while water is reabsorbed into the body, if it is removed then the waste becomes a more liquid form. This is then eliminated through the anus or an opening that is formed on the side of the abdomen, called an ileostomy though this shall depend on the actual form of reconstruction of the waste system during surgery.

So do a few flare ups of colitis constitute a reason for a sufferer to consider the option of surgery? It is usually only considered for patients who have experienced it over a period of several years with a pattern of regular attacks and short periods of remission or for those who suffer virtually constant symptoms. There are other circumstances such as where the bowel is about to or has perforated, or has become toxic where the colon becomes extremely distended plus also the urgent situation known as fulminant colitis, where severe diarrhoea and bleeding is suffered and a course of intravenous steroids has been administered but not brought the symptoms under control.

For the average sufferer the principle factor that has to be taken into consideration is their quality of life and how the disease impacts on it. If the symptoms appear every couple of years for a few months then this can hardly suggest that the patient is severely restricted in life and only through surgery can some form of normality be achieved again. There can be feelings in the depths of a relapse that can create thoughts of “I never want to experience this again”, or “I wish they would just cut this thing out of me” yet when faced with the challenge of an attack against the life changing event of surgery for colitis, the sufferer will most likely conclude that they can endure what the disease does to them when it’s experienced on a periodic basis.

The general belief is that if a sufferer of colitis can cope with relapses whenever they happen and then make a good recovery and get back into a full life again, the subject of surgery should really not be considered. It is the case that there is no set pattern for relapses to occur so a period of several years where there have been several does not necessarily suggest that the next few years will follow the same pattern. They could in fact reduce in number due to several factors such as a change in lifestyle, understanding of how to manage the disease more effectively including the role of diet and reducing levels of stress.

Whilst it is a choice that ultimately the individual will make, it is important for detailed discussions with doctors and consultants plus also friends and family to be undertaken. It is advantageous for sufferers considering surgery to be fully informed of the procedures and consequences and to listen to opinion and advice from other former sufferers who have themselves faced the dilemma, experienced surgery for colitis and can advise of the outcomes and their thoughts on the very big decision that they took.

For the vast majority of people diagnosed with colitis, the prospect of surgery will never have to be addressed though that does not stop many from worrying about this unlikely scenario. For some though, it is something that has to be faced, often as a consequence of continuous symptoms. It is therefore important that there is an understanding of the procedure involved with surgery for colitis.

When it comes to the initial surgical treatment it is really straight forward. There are no choices to make of types of surgical procedure involved. There is only one and it is called a total colectomy where the entire large colon is removed. The result of such a procedure is that colitis is in fact removed and thus the sufferer is cured. But that is only part of the story as the challenge is now to ensure a comfortable system is put in place for the removal of body waste.

As the entire large colon is removed irrespective of how much of it is actually diseased, the process of eliminating waste obviously has to alter. The function of the large colon is that of a storage area for the waste to be held whilst the process of water being reabsorbed into the body is undertaken. Without the benefit of a large colon the waste that is eliminated will take on a more liquid form and is passed through an ileostomy and, after further available surgical procedure, the anus by way of a specially formed internal pouch.

An ileostomy is formed by creating a small opening in the abdominal wall and the end of the small intestine is brought out. Waste then drains automatically into a specially fitted bag that sticks against the abdomen and can easily be emptied when it fills. The bag can be very discrete under clothes and only those that are informed about it will know of its existence. A variation of this, though much less frequently created is when a continent ostomy is formed. This is where an internal pouch is formed under the abdominal wall for the purpose of waste collection and a valve is created on the abdominal wall through which a rigid tube is in order to drain the pouch.
These measures can either be permanent or for the majority of patients just temporary whilst the body recovers from the first operation before the creation of a permanent ileo-anal pouch. The procedure involves the end part of the small intestine being cut open and stitched back to form what is called a J pouch. This is then attached to where the rectum used to be to enable the holding of waste in the pouch until elimination is required through the anus.

There is a good track record of success for such a surgical procedure and the patient will, when used to the workings of the pouch and after having seen the capacity of it increase, have approximately six to eight movements per twenty four hours. With the aid of medication and attention to diet, this can be reduced to as low as three to four times per twenty four hour period. There are however some patients where the pouch does not function properly and bowel incontinence becomes a big problem or that the body rejects the surgery. In such cases, the operative procedure can be reversed and the patient will then have a permanent ileostomy.

Whilst surgery for colitis does have to be faced by a minority of sufferers, it does not mean a very restrictive life has to follow. In fact, most patients find that they can reclaim their life and enjoy one as close to normal as possible, a scenario that was often denied them during the period of their own colitis diagnosis.

At least one thing is guaranteed, after colitis surgery you will experience some pain. This is a major operation that you will have been through and depending on your state of health pre operation, the first week after the procedure will be challenging both physically and mentally.

You will most likely have access to morphine in the days immediately after the operation with other drugs made available to you once the morphine is withdrawn but unfortunately you will still encounter some element of pain both when moving and lying stationary..

One of the first things the medical staff will want you to do is get out of bed, even just to sit up in the bedside chair for an hour. The prospect of moving can seen horrific as even undertaking a small movement can be very sore. Remember, susceptible areas to pain will include both the area around the surgical incision, including the surgical stitching or stapling and the internal surgery itself. The morphine will dampen a lot of it but you will undoubtedly suffer discomfort. You may find for a few days after the surgery a real rawness internally. As the small bowel had been touch, moved, inspected, cut and stitched this is really no surprise.

After a couple of days, you will be encouraged to try a little walking. This may appear easier said than done as not only do you have to contend with the pain and discomfort of moving, but also as you are tied to several leads you will have to push along a stand that your drips etc are attached to. At the start it may feel that you are learning to walk again.

Standing up with both hands holding onto the medication stand, it really is one foot slowly in front of the other. Don’t try and walk before you can run. In fact don’t try and walk to the end of the corridor if it appears too far. Walk perhaps for a couple of minutes one way then back again for the first few attempts.

The act of getting up and sitting and trying little walks is all part of your rehabilitation and pain management. Most hospitals will have a member of staff that is qualified in pain management. Ensure you get the chance to speak to them and discuss what you are experiencing. They will have experience of many patients who have undergone this type of surgery and will be able to advise you of an appropriate course of action.

Each day that passes, your body will become more supple, the lacerations from the surgery will start to ease and you will feel the pain being replaced by the return of your strength. What you regard as second nature will become major efforts post surgery, yet the convalescence process can be quickened by adopting the successful strategies of those who have been through the experience and know exactly how to reduce pain and get back on their feet quickly.

It is the question that has to be addressed and answered for more people nowadays who have been diagnosed with colitis. You may have thought that colitis surgery was a last resort for someone whose symptoms are now out of control and can’t be stabilised with stronger medication. Yet that is not always the case.

Some patients have no choice with regards to surgery because their symptoms are so far advanced that they are in danger of experiencing perforation of the bowel and now medication can bring the symptoms under control. In addition to this group, there is another group of people with colitis that endure periods of relapses then recover to an extent but don’t achieve full health. There is always some degree of colitis symptoms that prevail. There are some who just persist with this and can manage their lives satisfactorily. Others feel that the pattern is set and will never be broken and are seeking to achieve a better quality of live if they undertook surgery to have the inflamed colon extracted. They have to understand and appreciate that with an ileostomy or j pouch, life does have to adapt but they are willing to take these challenges on to rid themselves of the discomfort and pain that colitis brings.

What has to be addressed is the risk in undergoing surgery. These operations are not simple. They are lengthy and as with any surgery there is risk. The risk of infection is always there. Plus the greatest unknown risk is how your body will react to the change that it has undergone. This is not so much a factor with an ileostomy than with a j pouch. For some, and thankfully it is a small number, their body never really accepts the creation and function of a pouch and their quality of life suffers to the point where they may face their days having to be planned around trips to the toilet. Minus the pain and discomfort, this is the same scenario as their former life affected with colitis. If that is the case, there is only one option and that is a further operation to replace the pouch with a permanent ileostomy.

For someone who has colitis and suffers the occasional relapse, though who enjoys periods when they return to full health, it is very unusual for them to consider surgery. If they can cope with relapses when they occur and recover sufficiently well to enjoy good health again then few doctors would ever recommend surgery. Who knows, the relapses may become fewer in number perhaps as a result of better understanding by the patient of how to give their body the best chance to reduce the instances of a relapse happening.

Here is another important point to note. There is a lot of misconception amongst the general public about colitis and surgery. It appears that people can think that as soon as you are diagnosed with colitis that it will only be a matter of time before you will be lying on the surgeon’s table about to be cut open. Nothing could be further from the truth. Only a small percentage of those diagnosed with colitis ever end up in the operating theatre. I have seen figures quoted as much as 40% of sufferers go on to have surgery. This is just not true and you should not worry about it. The actual figure is less than 10%.

Ultimately, only you can make the decision to proceed with the surgical process but it is vital that you discuss all the implications not only with you doctor but also the hospital consultant and the surgical team so you fully understand all the issues that require to be addressed before any action is actually taken. Remember, for the vast majority who do undergo surgery, they achieve their goal of a better quality of life, free of the pain and discomfort that colitis brings. It is essential that the sufferer is fully informed and has access to others who have experienced not only the prospect of surgery but who have ultimately undergone the process and brought some control back to their lives.

There comes a time when a percentage of colitis sufferers reach the point when they are faced with the prospect of surgery to remove the large intestine. Whatever the varying reasons for this, the prospect of having a major organ taken out of the body is both alarming and anxiety ridden for the patient.

Often, colitis surgery is undertaken due to the symptoms having reached an uncontrolled state. The patient will by then have been admitted to hospital and will be administered high dosages of powerful steroids which will not have the desired effect of bringing under control the diarrhoea and blood being passed.

The operation to extract the diseased large colon is major and will take approximately four to five hours. The patient will require the formation of an ileostomy which shall be used as the end point of the bowel to evacuate waste. The end of the ileostomy is in fact the end of the small bowel which is brought through a hole formed on the abdominal wall. It pokes out by approximately two to four centimetres and a bag is attached to the surrounding skin to catch and store the body’s waste.

After surgery, the patient will feel sore from both the surgical wound and internally. As the small bowel will have been handled and inspected it will feel quite raw though the bonus is that it will not be in an operative state. After such major surgery, the bowel goes into a period of abeyance which can last for a few days before it reawakens and starts to function again.

The ilesotomy will remain for a period of time to let the body heal before further surgery is undertaken. The length of the period will be determined by the health of the patient when they were admitted to hospital. Some patients, often older, prefer to keep the ileostomy but this is not the only option available. Many decide to have further operations to form what is known as a j pouch which is an internal area formed from the small intestine and used to store the waste until evacuation and does away with the need for an ilesotomy.

Colitis surgery is major and can take the form of one or several operations where the formation of an ileostomy can be either temporary or permanent. It is a time of major anxiety about the procedure itself and how to cope not just in the immediate days after but in the long term as well. Questions such as what does it feel like not to have a large colon, how is the diet affected, how is daily life affected by wearing a bag are commonly asked. By finding practical answers to problems, the patient will be able to ensure that their immediate post surgery period and living with an ileostomy or j pouch is made much easier and the anxieties that are present can be addressed. The answers are now provided to you by a survivor who has experienced it all and can provide you with knowledge few doctors are able to offer. It is all available to you at The Colitis Experience