We have three goals in treating ulcerative colitis:
- Decrease swelling and redness in your child’s intestine and help it heal.
- Get rid of your child’s symptoms.
- Ensure your child is getting good nutrition.
We start treatment by using many types of medicine along with nutritional support. If these are not enough or if your child develops a serious complication, surgery may be needed to remove the colon. Removing the colon is the only way to cure ulcerative colitis.
Non-Surgical Treatments for Ulcerative Colitis
First, we will try treatment options that do not involve surgery.
Medicines for ulcerative colitis
Your child may need medicines that:
- Decrease inflammation (aminosalicylates)
- Suppress the immune system (corticosteroids)
- Block the immune reaction that worsens inflammation (immunomodulators or immune system suppressors)
- Control bacteria growth (antibiotics)
- Control diarrhea
Nutrition and ulcerative colitis
If the disease is making it hard for your child to get enough nutrients, the doctor may suggest your child:
- Makes sure to eat a variety of foods from all food groups
- Takes certain supplements to boost nutrients
- Avoids foods that cause symptoms to flare up, such as spicy or high-fiber foods
- Drinks a special liquid formula that’s high in calories
There may be times when your child needs bowel, or intestine, rest. This means eating either only certain foods or, in some cases, taking nothing by mouth. Resting the bowel gives it a chance to heal. Instead of eating by mouth, your child may be fed through:
- An IV (intravenous) line, which goes into a vein
- A nasogastric (NG) tube, which goes through the nose into the stomach
- A gastrostomy, an opening made in the wall of the belly that holds a tube or button so formula can be put directly into the stomach.
Surgery for Ulcerative Colitis
If medicines and changes in eating and drinking don’t control symptoms well enough, your child may need surgery. Surgery may also be needed if your child develops a serious complication, such as severe bleeding. Most people with ulcerative colitis need surgery at some point to remove the colon and reduce the risk of developing colon cancer.
There are two main types of surgery for ulcerative colitis. The most common surgery goes by a few names:
- Ileoanal anastomosis (pronounced ill-ee-oh-AIN-ull an-as-toe-MOE-sis)
- Pull-through operation
- Restorative proctocolectomy (pronounced prahk-toe-coal-EKT-uh-mee)
In this operation, surgeons remove the colon and the lining of the rectum. Then they create a pouch from the end of the small intestine. Next, they attach the pouch to the anus.
To give the pouch a chance to heal, surgeons usually do this operation in two steps:
- Remove the colon and lining of the rectum, create the pouch, and attach it to the anus.
- Connect the small intestine (ileum) to an opening made in the skin of the belly so waste can pass to a pouch attached on the outside. This is called ileostomy (pronounced ill-ee-OSS-tuh-mee).
Ileostomy is temporary. It allows the rectum to heal without stool passing through. In about two months, after the inside pouch heals, surgeons close the ileostomy. This allows waste to pass out through the anus.
The second type of surgery for ulcerative colitis is called proctocolectomy. This operation is rarely if ever needed. Surgeons remove the colon. If the rectum is too unhealthy to work well, surgeons take it out along with the colon. Then they create a permanent ileostomy.
Before either one of these surgeries, your child's surgical team will explain the details, including:
- What will happen before, during and after your child’s operation
- How long it’s likely to take
- How long your child may need to stay in the hospital afterward
- What kind of care your child will need at home after surgery