An estimated 1.6 million Americans are living with Crohn's disease and ulcerative colitis, the major forms of inflammatory bowel disease (IBD). While IBD can occur at any age, most people are diagnosed by age 30, according to the Crohn's & Colitis Foundation of America (CCFA).
What is IBD?
Inflammatory bowel disease is a category of conditions involving chronic inflammation of the gastrointestinal tract. The cause is unknown; however, there is thought that the inflammation is an improper immune response triggered by genetic and/or environmental factors.
"Crohn's disease can occur anywhere in the gastrointestinal tract (mouth to anus) and the full thickness of the bowel becomes inflamed. Ulcerative colitis involves only the inner lining of the colon (large intestine)," explains Doylestown Health colorectal surgeon Robert Akbari, MD.
The severity varies from mild flare-ups and periods of good health to ongoing disease. Symptoms include:
- Abdominal pain
- Frequent diarrhea that is sometimes bloody
- Intestinal blockage
- Sudden need to evacuate the bowels or feeling of needing to evacuate
- Weight loss, malnutrition, anemia
"IBD cannot be cured, but it can be treated with medical and surgical intervention. Gastroenterologists are the first line of defense, and they work closely with colorectal surgeons to ensure personalized, comprehensive care," says Dr. Akbari, "Gastroenterologists treat IBD with innovative medications and therapies to reduce tissue inflammation and promote healing, relieve symptoms and decrease the odds of a patient needing surgery."
Patients play an active role, focusing on self-care, exercise, reducing stress and avoiding trigger foods.
Surgery for IBD
"When medical management options are exhausted, surgery for IBD can be beneficial and even life-saving for some patients," says Dr. Akbari.
Generally, colorectal surgeons remove diseased areas of the large or small intestine, sparing as much healthy bowel as possible. Most procedures can be accomplished through minimally invasive laparoscopic and robotic procedures for faster healing, reduced infection risk and less pain.
Ulcerative Colitis Surgery
If medications aren't working, it would not be unusual for a person with ulcerative colitis to experience severe, bloody diarrhea 15 times a day, according to Dr. Akbari.
"Because ulcerative colitis affects only the large intestine (colon and rectum), we can surgically treat the condition by removing the entire large intestine and connecting the small intestine directly to the anus," says Dr. Akbari. In the past, the only option after removing the large intestine was to create an opening at the abdomen (ileal stoma) and attach a bag (ostomy) outside of the body to collect bowel movements.
Today, the J pouch procedure allows patients to move their bowels through the anus, even though the large intestine has been completely removed. "We reconfigure a portion of the small intestine into an internal pouch resembling the letter J. The pouch takes on the function of the rectum, providing a place for waste to collect inside the body," says Dr. Akbari.
"Generally, removing the colon and implementing the J pouch reduces bowel movements to six or seven a day with no more blood in the stool. It also helps patients tolerate food better," explains Dr. Akbari. If a patient's condition does not allow for a pouch, an ileal stoma may be recommended.
Surgery for Crohn's Disease
Though surgery does not cure Crohn's, it can alleviate symptoms and problems such as scarring, infection (abscess), perforations, blockages and abnormal connections between two body structures known as fistulas. Most people with Crohn's disease require multiple surgeries.
"Inflammation can cause the bowel to become sticky, leading to a small part of the intestinal tract becoming abnormally connected to part of the skin, bladder, vagina or another nearby organ," says Dr. Akbari. Surgery is required to close and repair the connection (fistula).
Anal fistulas are connections between the end of the rectum and the anus caused by IBD or infection (abscess), according to Dr. Akbari. Depending on the nature of the fistula, treatment may involve surgically opening the fistula to promote healing or closing the connection with a special plug. More complex repairs may require the colorectal surgeon to cut through muscle or insert tubes to drain infection before surgery.
Opening Narrowed or Blocked Intestines
"With Crohn's disease, inflammation or scarring can narrow and block the intestine," says Dr. Akbari. "Known as intestinal stricture, this can cause a backup of food or fluid. The blockage may be temporary and resolve with medication, but if a patient has long-term bowel inflammation it transitions to scar tissue which requires surgery."
A surgeon may opt to stretch the intestine from inside via a minimally invasive procedure threading a thin, flexible tube with a tiny camera (endoscope) through the rectum to the narrow area. The endoscope has a balloon attachment that inflates to stretch and widen the bowel.
To open a more severe narrowing of the intestine, options include cutting and reshaping the bowel (strictureplasty) or removing damaged segment(s) and reconnecting the healthy ends (resection).
Surgery for Colon Cancer and Precancer
Prolonged, active IBD can increase a person's risk for colon cancer. Colorectal surgeons perform biopsies to identify and remove precancerous tissue or remove cancer from the bowel.
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About Doylestown Health Colorectal
Doylestown Health Colorectal Specialists provide expert assessment, diagnosis, and treatment for a wide range of disorders of the colon, rectum, anus and small intestine. Our board-certified physicians offer compassionate, personalized care, continuing patient education and state-of-the-art technology, using advanced colon and rectal surgery and minimally invasive robotic surgery techniques.