Inflammatory Bowel Disease: How to know if it’s time for surgery


by Randy Crim, MD

Jun 9, 2021

For people living with inflammatory bowel disease (IBD), there are days it can be hard to live a normal life. IBD symptoms can interfere with the ability to work, go to school or just enjoy sports or other recreational activities. Many people give up and just stay at home because they have to be close to a bathroom. When they do venture out, I know many patients who can identify the location of every restroom between their home and their ultimate destination.

Inflammatory bowel disease is an umbrella term for two conditions that create chronic inflammation in your digestive tract: ulcerative colitis and Crohn’s disease.

Ulcerative colitis involves inflammation and sores along the lining of your large intestine (colon) and rectum. Crohn’s disease can cause inflammation along your entire intestinal tract, from the mouth to the anal canal, although it usually affects the small bowel, colon and rectal area. Symptoms of Crohn’s disease can include diarrhea, pain and bowel obstruction, while ulcerative colitis can cause diarrhea and rectal bleeding. Although Crohn’s disease and ulcerative colitis are distinct conditions, the symptoms can often overlap.

The good news is, many people are able to manage symptoms without needing surgical intervention. Today, Crohn’s disease and ulcerative colitis can be managed very well by the use of newer biologic medications that block inflammation. Because of the effectiveness of these biologics, surgery for these conditions is not needed as often as it was 20 to 30 years ago.

However, in some cases, a person’s condition may be too medically severe to be controlled by biologics alone. In those cases, surgery is usually the best path forward.

So, how do you know if it’s time to start thinking about surgery? It comes down to you — how you feel and to what extent IBD is inhibiting you from enjoying your life. When patients consult a colorectal surgeon like me, they are generally sick and tired of being sick and tired. They have lost control of their health and their lives. As a surgeon, my goals are to return them to health and give them back control of their lives.

Surgery for ulcerative colitis involves removing the entire colon and reconstructing the intestinal tract. For most people, a new rectum is created out of the small bowel by joining it to the anal canal in what is called a J pouch. This allows you to eliminate waste normally after the procedure.

With Crohn’s disease, the goal is to not only alleviate symptoms but also preserve the intestinal tract, if possible. These surgeries may involve draining any infection, relieving possible obstruction and/or removing some of the diseased intestine. Because Crohn’s disease can recur, it is very important for stay on top of any prescribed medications.

While dealing with the symptoms of IBD can feel overwhelming, there is help for you to feel better, be healthier and take back some control of your life. If you’re ready to take that step toward surgery, find a colorectal surgeon today.

About the Author

Randy Crim, MD, is a colorectal surgeon on the medical staff at Baylor Scott & White Medical Center – Irving. Connect with Dr. Crim today.

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