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Bowel surgery for inflammatory bowel disease (IBD)

Published by Bupa's health information team, February 2009.

This factsheet is for people who are planning to have surgery to treat inflammatory bowel disease, or who would like information about it.

Inflammatory bowel disease (IBD) is a blanket term for two separate diseases, ulcerative colitis and Crohn's disease. Surgery is done if symptoms don't respond to medical treatment.

Your care will be adapted to meet your individual needs and may differ from what is described here. So it's important that you follow your surgeon's advice.

About the bowel
Preparing for your operation
About the operation
What to expect afterwards
Recovering from bowel surgery
What are the risks?
Further information
Questions and answers
Related topics
Sources

About the bowel

The small bowel, large bowel (colon) and rectum are part of your digestive system. Food passes from your stomach into your small bowel. The colon absorbs water and nutrients from the digested food and waste collects in the rectum. The waste passes out through your anus as a bowel movement.

Illustration showing the location of the large and small bowel
The location of the large and small bowel

Ulcerative colitis usually affects the colon and rectum only, with inflammation and bleeding of the bowel wall. Crohn's disease most commonly affects the small bowel, but can occur anywhere in the digestive system. It may affect more than one section leaving unaffected areas in-between. IBD is a chronic disease with flare-ups and periods of remission.

Bowel surgery is recommended if your symptoms don't respond to medical treatment. The aim of surgery is to remove the affected area of your bowel.

Preparing for your operation

The traditional approach (open bowel surgery) usually requires a hospital stay of seven to ten days. Laparoscopic (keyhole) surgery may require a shorter stay of three to five days.

You will usually be asked to attend a pre-assessment clinic for routine tests a few days before your admission. Your surgeon will explain how to prepare for your operation. For example, if you smoke, you will be asked to stop as smoking increases your risk of getting a chest and wound infection, which can slow your recovery.

Your bowel has to be completely empty before the operation. You may be asked to follow a special diet for a day or two and you may be given laxatives to take the day before surgery.

The operation is usually done under general anaesthesia. This means you will be asleep during the procedure. You will be asked to follow fasting instructions. Typically you must not eat or drink for about six hours before a general anaesthetic. However, some anaesthetists allow occasional sips of water until two hours beforehand.

At the hospital your nurse may check your heart rate and blood pressure, and test your urine. You may also be given a bowel washout (an enema). A tube is passed into your rectum and the remaining contents of your bowel are flushed out using water.

Your surgeon will usually ask you to sign a consent form. This confirms that you understand the risks, benefits and possible alternatives to the procedure and have given your permission for it to go ahead.

You may be asked to wear compression stockings to help prevent blood clots forming in the veins in your legs. You may need to have an injection of an anti-clotting medicine called heparin as well as, or instead of, compression stockings.

About the operation

The operation can be done using open or keyhole surgery and usually takes two hours.

Open surgery - a single large cut is made over your abdomen.
Keyhole surgery - several small cuts (up to five) are made in your abdomen. A tube-like telescopic camera is passed through a cut to view the area and the operation is done using special instruments.

The exact procedure will vary. Parts of the bowel may be removed and healthy ends rejoined using stitches or staples. Sometimes, it isn't possible to rejoin the bowel. In these circumstances, the bowel is brought to the surface as a stoma. A bag is worn over the stoma which collects waste from your bowel. It's called a colostomy if it involves the large bowel and an ileostomy if it involves the small bowel. The stoma is usually temporary but can be permanent. Your surgeon will discuss this with you beforehand.

You will usually be given antibiotics during surgery to reduce your risk of infection.

What to expect afterwards

You will be taken from the operating theatre to the high dependency unit where you will be closely monitored for around 24 hours. You will be connected to machines that monitor the activity of your heart and other body systems. You will have a drip in your arm to keep you hydrated. Once the medical team is happy with your progress, you will be taken back to your room.

You will need pain relief as the general anaesthetic wears off. Controlling pain after an operation is very important because pain can interfere with your recovery. You may be offered patient controlled analgesia (PCA). This is a pump connected to your cannula that allows you to control how much pain medicine you have.

When you no longer need intravenous medicines and are able to drink enough fluids, the cannula and drip will be removed.

On the first day, you may have to wear special pads, attached to an intermittent compression pump, on your lower legs. The pump inflates the pads and encourages healthy blood flow in your legs and helps to prevent DVT. You may also have compression stockings on your legs to help maintain circulation.

You will have a fine tube (catheter) fitted to drain urine from your bladder into a bag. This will usually be removed when you are ready to get out of bed and walk around.

You will be encouraged to get out of bed and move around as soon as possible as this helps prevent chest infections and blood clots in the legs. You may have daily injections for a few days to help prevent blood clots.

Your surgeon will visit you to assess your progress and answer any questions you have about the operation.

If you have a stoma, a nurse specialist will visit you to help you learn how the bag works and to provide support and advice.

You may find that you don't have any bowel movement for several days. If you don't have a stoma, try not to strain when you go to the toilet. Laxatives will be available if you need them. You may see blood in your faeces for a few days.

Your nurse will give you some advice about caring for your healing wounds before you go home. You may be given a date for a follow-up appointment. You will need to arrange for someone to drive you home. You should try to have a friend or relative stay with you for the first 24 hours.

Recovering from bowel surgery

If you need pain relief, you can take over-the-counter painkillers such as paracetamol or ibuprofen. Always read the patient information that comes with your medicine and if you have any questions, ask your pharmacist for advice.

Follow your surgeon's advice about strenuous exercise, lifting and driving. You shouldn't drive until you feel confident that you could perform an emergency stop without discomfort. If you are in any doubt about driving, please contact your motor insurer so that you are aware of their recommendations, and always follow your surgeon's advice.

A full recovery can take up to 12 weeks.

What are the risks?

Bowel surgery is commonly performed and generally safe. However, in order to make an informed decision and give your consent, you need to be aware of the possible side-effects and the risk of complications of this procedure.

Side-effects

These are the unwanted but mostly temporary effects of a successful operation, for example feeling sick as a result of the general anaesthetic.

Side-effects of bowel surgery include:

pain and discomfort in your abdomen for the first few weeks
scarring - scars are usually permanent but should fade gradually over time

Complications

This is when problems occur during or after the operation. Most people are not affected. The possible complications of any operation include an unexpected reaction to the anaesthetic, excessive bleeding or developing a blood clot, usually in a vein in the leg (deep vein thrombosis, DVT).

Complications specific to bowel surgery are uncommon but can include:

infection - antibiotics are given during surgery to help prevent this, but a serious infection may need further surgery
damage to internal organs - this can be fatal
failure of new join - the new join may fail and leak, and will need further surgery
bleeding under your skin (haematoma) - this may require surgery to stop the bleeding and drain the area
numbness - nerves can be damaged during surgery, this can lead to loss of sensation and very rarely it can affect sexual function
unusually red or raised scars (keloids) - these can take a long time to heal
hernia formation - rarely, a hernia can occur at the surgical site

If you have keyhole surgery, there is a chance your surgeon may need to convert your keyhole procedure to open surgery.

The exact risks are specific to you and differ for every person, so we have not included statistics here. Ask your surgeon to explain how these risks apply to you.

Further information

National Association for Colitis and Crohn's Disease (NACC)
0845 130 2233
www.nacc.org.uk