Inflammatory Bowel Disease

Inflammatory bowel disease (IBD) describes two related conditions. Ulcerative colitis causes inflammation of the lining of the colon and rectum. Crohn's disease can affect any part of the digestive tract, from mouth to anus, and can involve the full thickness of the bowel wall, leading to narrowing (strictures), abscesses and fistulas.

Both conditions are lifelong and tend to flare and settle. Treatment is shared between your gastroenterologist, who manages medications such as immunosuppressants and biologic therapies, and your colorectal surgeon.

Surgery is considered when symptoms are not controlled despite medication, when side effects of treatment are unacceptable, or when complications develop. In Crohn's disease this may include a stricture causing blockage, an abscess or fistula, or perianal disease. In ulcerative colitis surgery may be needed for severe disease that does not respond to medication, or where long-standing inflammation has led to pre-cancerous changes or cancer.

Decisions about surgery are made jointly with your gastroenterologist, and the aim is always to relieve symptoms while preserving as much bowel as possible.

Common operations include resection of a diseased segment of bowel, strictureplasty to widen a narrowing without removing bowel, and drainage or seton placement for perianal abscesses and fistulas. In ulcerative colitis, removing the colon (colectomy) can cure the bowel disease; the rectum may be removed at the same time or later, and some patients are suitable for a pouch (ileoanal pouch) that avoids a permanent stoma.

Wherever possible, operations are performed using laparoscopic or robotic techniques. Some patients require a temporary stoma to allow the bowel to heal safely.

Most patients recover well and return to normal activity within a few weeks. Ongoing care continues with your gastroenterologist, and you will be reviewed regularly by your surgeon. Because Crohn's disease can recur, medication is often continued or restarted after surgery to reduce this risk. If a stoma is needed, stomal therapy nurses will support you before and after your operation.