When is surgery needed for IBD?
Surgery is not usually the first step, but it becomes necessary when medication cannot control the disease, when there is an emergency such as severe inflammation, a blockage, a perforation, or heavy bleeding, or when pre-cancerous changes are found. In ulcerative colitis it is also an option when symptoms badly affect quality of life, since removing the colon can stop the disease. Most people are not in this position, but knowing the triggers helps.
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Surgery can feel like a frightening word, so it helps to know it is not usually the first move and not a sign of failure. It is a tool used at specific points, mainly in three situations.
When medication is not enough
The most common reason is that medication is no longer keeping the disease under control. Crohn's & Colitis UK notes that if medicines are not suitable or are not working well, your doctor may suggest surgery. Surgery may also be needed if a colonoscopy finds pre-cancerous changes in people at higher risk (Crohn's & Colitis UK). This kind of planned surgery is a decision made over time, with your team.
In an emergency
Sometimes surgery cannot wait. Acute severe ulcerative colitis is a medical emergency, and complications such as toxic megacolon or a perforation of the bowel may need emergency surgery (Crohn's & Colitis UK). A colectomy is one of the operations used for severe IBD (Cleveland Clinic). In Crohn's disease, surgery is often needed at some point to deal with complications such as a stricture or a fistula.
How common it is
Surgery is far from inevitable. Crohn's & Colitis UK reports that around 7 in 100 people with colitis need major surgery in the first five years after diagnosis, rising to around 10 in 100 within ten years (Crohn's & Colitis UK).