Ulcerative Colitis Surgery: Things you must know

Ulcerative colitis is a kind of disease in which there is an inflammation in the colon and rectum along with irritation and sores. In some cases, medicine can be effective but sometimes surgery is required.

According to Crohn’s and Colitis Foundation, 25 to 40 percent of people suffering from ulcerative colitis need surgery.

Nowadays there are two basic methods for this surgery. This method depends on the age and other medical reports of the patient.

Mostly, people lead a very healthy and prosperous life following the surgery. This article is written for you to learn about the basic things related to ulcerative colitis surgery.

What ulcerative colitis surgery?

An ulcerative surgery becomes crucial if the medication has and other treatments are no more effective.

In case of colon cancer and precancerous changes, ulcerative colitis is required.

Having ulcerative colitis for more than 8 years can develop the chances of colon cancer.

In case of any perforation or bleeding in the colon, emergency surgery is required.

Types

Proctocolectomy with ileostomy

There are two main types of ulcerative colitis surgery:

Proctocolectomy with ileostomy involves the following events:

• Removal of the large intestine

• Placing one end of the ileum to a region in the lower abdomen, mostly on the right side.

• Create a surgical hole in the lower abdomen, termed a stoma

• Passing an end of the ileum through the stoma and connecting the intestine with the skin. This will create an orifice from the small intestine to the exterior of the body.

• Placing an ostomy bag, a bag, or pouch over the stoma. This pouch helps to collect the waste from the small intestine. And then this pouch is emptied into the toilet many times a day.

The feces that move out of the small intestine are not in a solid-state which is why it is hard to notice its movement into the pouch.

It’s not under the control of any patient to control the passing of feces, this is because a stoma has no muscles. Currently, the ostomy bags that are available in markets are very advance. They are flat, odorless, and blend completely with the dress.

After proctocolectomy along with ileostomy, a patient needs to take care of the stoma and should have basic training about the pouch and stomal care.

Some of the bags or pouches are disposable while some can be washed and used again. It depends on a patient’s choice.

• Proctocolectomy and ileoanal pouch-anal anastomosis

This is a new process that assists a patient to pass out feces naturally through anal. Most of the time this surgery is termed as J pouch surgery or ileoanal pouch reservoir surgery.

In this procedure, the anus is preserved rather than its removal. Following events occur during this surgery:

• Removal of the large intestine (colon and rectum), keeping anus safe.

• Making a J pouch or ileoanal reservoir using the small intestine. This internal pouch is used to collect the waste.

• Attaching an internally created pouch with the anus.

• Feces start to accumulate in the pouch and leave the body through the anus, making bowel movements normal and easier.

A patient can feel feces moving out of the anus and he or she will be able to use the toilet normally if they have strong and good anal muscles.

Though the anus has been preserved but still bowel movements are very loose or watery because the colon has been removed.

Fecal incontinence may be seen in some patients. There is nothing to worry about. It can be cured with medicines. It is necessary to have good anal muscles to avoid any incontinence.

In most cases, IPAA is performed in different stages. In the first step, a pouch is created and attached to the anus. Then this bag is left alone for healing, for many weeks.

A transitory stoma is created until the second surgery occurs.

Following 2-3 months this temporary stoma will be closed and waste will be redirected to the internal pouch and pass out through the anus.

Preparation

Preparation depends on the type of surgery. You will be given a detailed overview before the surgery.

Usually, a patient is advised to keep their bowel empty by practicing “bowel prep”. 

Patients may be asked to drink a laxative drink, have antibiotics, and are not allowed to take any solid food item 2 days before surgery.

Always ask your doctor before taking any kind of antibiotics or other drugs before the surgery. It may be allowed to have some medicine with a sip of water but usually, a patient needs to stop taking medicines.

Recovery:

If a surgeon performs the surgery using a long incision, termed as open surgery, then a patient needs to stay in hospital for many weeks.

While in some cases a less invasive surgery, termed laparoscopic surgery is used, then a patient can leave hospital earlier.

Still, it will take several weeks for both types of patients to recover fully.

Right after the surgery, a patient is shifted to recovery. In the recovery room catheter for urine and other drainage tubes are attached with abdomens.

As soon as a patient becomes conscious, the surgeon will tell the details about the removal of drainage tubes and catheters as well. A doctor may advise a patient to sit and have a walk if it is safe for him, this prevents blood clotting.

Complications

The most occurring complication is intestinal obstruction.

Symptoms of obstruction or blockages are:

• Worsening abdominal pain

• Thin, transparent, and foul-odor fluid in the bag

• Vomiting

• Liquid reduction in the pouch

• Bloating around stoma

If you notice any of the following symptoms, you should immediately contact your doctor.

Patients suffering from IPAA must notice the signs of pouchitis. This term is used for an infection in the internal pouch. It can be treated by taking antibiotics.

Nearly half of the patients have chances to get pouchitis. The main symptoms of pouchitis are:

• Diarrhea

• Increased bowel movements

• Pain in abdomen

• Temperature

• Pain in joints

Diet:

Without a colon, it is difficult for the body to digest food. That is why a patient needs to be more conscious about the diet.

It is advised to take small meals many times a day instead of having a large quantity at once.

The food items that are prohibited by the doctors are:

• Dry fruits such as dates, figs

• Raw fruits and veggies

• Spicy foods

• High sugar foods

• Coffee and caffeine food

Foods such as bananas, rice, potatoes can be healthy because they are called binding foods. Drinking a lot of water can help you to avoid dehydration. This will keep your intestines healthy.

 

Conclusion:

Even though ulcerative colitis is life-changing but it has positive aspects as well. This can help you to get rid of a permanent ostomy.

A doctor can guide you about every detail.

Moreover, therapists and support groups are available for the help of emotionally unstable patients.

All you want to know about Urostomy

What is Urostomy?

A surgery, in which an opening is created in the abdominal wall, permanently is called Urostomy. A stoma is a surgically created hole that allows waste to pass out of the body without passing the bladder. Waste is collected outside of the body in a pouch called, ostomy bag.

What does a bladder mean?

An organ that is located in the lower abdomen and stores urine temporarily before passing it out. It is a balloon-shaped organ. The muscles in the bladder control the passage of urine outside the body through a tube called the urethra.

Why a Urostomy is needed?

The patients who suffered from bladder cancer may have a defective bladder or maybe their bladder has been removed surgically, this process is called cystectomy. For these kinds of patients, a urostomy is needed to pass out the urine. Most women with cervical or uterine cancer need a urostomy.

People with injured or birth defected bladder may also need a urostomy.  Urostomy surgery is permanent and it has no way back.

Main Types:

Urostomy is of two types:

Standard or conventional urostomy: In this procedure, a piece of the small intestine is used to connect the ureter and the stoma made in the abdomen. This new passage is introduced for urine to pass out. Then the urine is collected in the pouch that is placed over the stoma, outside the body.

Continent urostomy: There is not a big difference between a continent and a standard urostomy. During continent urostomy, a surgeon creates a pouch inside the belly. This pouch is covered with valves on both of its sides. And prevent the urine flow back or leakage into the abdomen. A person needs to put a catheter into the stoma so that the urine could pass outside the body. The type of continent urostomy depends on the pouch.

What happens during surgery?

Right before surgery, you will be given anesthesia. A small hole is made in the lower abdomen, and then a 6-8 inch piece of the small intestine is removed by the surgeon. Then he connects the large and small intestine. The piece that was removed from the small intestine is used to connect the stoma and ureter tubes. It usually takes 3 to 5 hours for this surgery.

Following risk factors are included in this surgery:

• Issues with anesthesia 

• Any kind of infection

• Blood loss or blood clotting

• Harm to any other nearby organ

• Functional changes in bowel

Recovery time:

Most of the patients need to live in the hospital for 7 days, following the procedure. You will have to be diet conscious, not allowed to eat solid foods, and all the nutrients will be fed through a vein.

You should avoid lifting any load or any hard physical activity.

How to take care of Urostomy?

Emptying ostomy bag: Right after you get recovered from surgery, there is a need to empty your bag many times a day. It is recommended to empty it when it less than half-filled. An estimated time is 2 to 3 hours.

Colostomy bags have two main types:

• A single-piece pouch adheres to the skin barrier directly.

• Double-piece pouches, having a separate skin barrier and bag that can be removed from the body.

Skin Care:

The most important fact is that you must ensure that your pouch is linked with stoma properly. It might bring discomfort to the skin if not attached properly. This area needs to be neat and clean, it must be dried completely. There are chances to get an infection, so if you feel any changes in the stoma, please see your doctor immediately.

Using Catheter: In case of consistent urostomy; you need to drain urine with help of a catheter, many times a day. This should be done timely otherwise it will cause infection.

Major Concerns:

Maintaining urine pH balance: It is crucial to maintain the pH of the urine acidic. Acidic urine is helpful to avoid any kind of bacteria that may cause infection. pH can be maintained by taking a lot of fluids and water. Alkaline urine can increase the risk of crystal formation at the stoma. These crystals can cause itching and discomfort. These can be treated with the help of applying vinegar to the stoma. Mix an equal amount of water and vinegar and apply it to the stoma by using a clean towel.

Urinary tract infection:

If the bacteria attack urostomy, ureters, or kidneys, it can cause infection. It is very important to wash your hand before and after touching the ostomy bag. Empty your pouch on time, every 2 to 3 hours. If you feel pain in the kidney, urine with a strong odor, you should look at your doctor immediately.