Total colectomy (removing the large bowel)
An operation to remove all or most of the large bowel (colon), used for conditions such as severe ulcerative colitis, some inherited polyp conditions or certain cancers.
✓ Medically reviewed by a GMC-registered consultant · last reviewed September 2026 · next review September 2027 · how we review
In short
- It removes all (total) or most (subtotal) of the large bowel, often for severe ulcerative colitis, inherited polyp conditions or certain cancers.
- Most people have a stoma (ileostomy), at least for a time; some can have the bowel joined or an internal pouch built, often in stages.
- It is major surgery with a recovery of 8 weeks or more, and bowel pattern changes afterwards depending on the reconstruction.
- It is a big, often planned decision (sometimes an emergency); discuss the options, stoma realities and, for cancer, the MDT plan and follow-up.
A plain-English summary. The detail — including risks and recovery — is below.
At a glance
A general guide. Your surgeon will give you advice for your situation.
Can remove diseased bowel and greatly improve symptoms in severe or hard-to-treat ulcerative colitis
Colitis that can still be controlled with medical treatment, where surgery may not yet be needed.
You recover on the ward, usually encouraged to sip fluids, eat lightly and get out of bed early. Pain is controlled with regular medicines; a tube may...
An enhanced-recovery plan with clear advice on eating, moving, pain relief and return to activity.
You recover on the ward, usually encouraged to sip fluids, eat lightly and get out of bed early. Pain is...
The stoma or bowel settles into a pattern and you build up eating and moving. Attention is paid to fluids and...
Energy slowly returns, especially if you were run down by colitis. Walk little and often and avoid heavy lifting...
Most people feel steadily stronger; lighter work is often possible. Further planned operations (such as building a...
What is a total colectomy?
A total colectomy removes the whole large bowel (colon). A subtotal colectomy removes most of it but leaves the lower part (the rectum) in place for now. These operations are used for conditions affecting the whole colon — most often severe or hard-to-treat ulcerative colitis, an inherited condition that causes many polyps (such as familial adenomatous polyposis, FAP), some inherited cancer-risk conditions, or certain cancers and emergencies such as severe bleeding or a perforation.
What happens to the bowel afterwards depends on the situation. The surgeon may bring the end of the small bowel out as a stoma (an ileostomy with a bag); join the small bowel to the remaining rectum (ileorectal anastomosis); or, in selected people, build an internal pouch from the small bowel and join it to the anus (an ileal pouch), often in stages. Some of these can be planned together; others are done as separate operations.
The operation may be planned or an emergency, and may be done by keyhole (laparoscopic) or open surgery. Emergency surgery (for example for a severe colitis flare that is not improving) is often a subtotal colectomy with a stoma first, with decisions about the rectum and any reconstruction made later when you are well.
For inflammatory bowel disease, removing the colon can greatly improve symptoms and quality of life, but it is a major decision with lasting effects on bowel function. For cancer, it is one part of MDT-planned treatment and does not on its own guarantee a cure.
Types & techniques
There isn't one single operation. The right approach depends on you — which is something to discuss with your surgeon.
Stoma vs internal pouch
| Permanent ileostomy | Ileal pouch (J-pouch) |
|---|---|
| Stoma bag on the tummy | Stool passed via the back passage |
| No pouch surgery needed | Built in stages, temporary stoma |
| Usually one operation | Usually two or three operations |
| Stoma care needed | Frequent stools, pouch can inflame |
| Often simpler, predictable | Avoids a permanent stoma |
There is no single right choice. A permanent ileostomy is simpler and reliable; an ileal pouch avoids a permanent stoma but means more surgery and its own function and complication trade-offs. The right option depends on your condition, the rectum and your preferences.
Preparing for your surgery
- See the operating surgeon to discuss why surgery is advised, the reconstruction options and what each means for daily life.
- Have any recommended tests, such as colonoscopy, scans, or (for inherited conditions) genetic input, beforehand.
- Meet the stoma nurse, have a stoma site marked and learn the basics — most people have a stoma at least for a time.
- Tell the team about all medicines, especially steroids, immune-suppressing drugs and blood thinners, and about other health problems.
- Stop smoking beforehand if you can, as it raises the risk of wound, chest and healing problems.
- Follow the unit's enhanced-recovery and nutrition advice; people with colitis are sometimes run down and may need building up first.
- Arrange time off work (often 8 weeks or more), a lift home and help at home for the first weeks.
What happens
The operation is done under general anaesthetic, so you are asleep, and usually takes about 3 to 5 hours. The surgeon frees and removes all or most of the large bowel (and, in a proctocolectomy, the rectum too), by keyhole or open surgery.
What happens next depends on the plan: the end of the small bowel may be brought out as an ileostomy; joined to the remaining rectum; or used to build an internal pouch joined to the anus (often with a temporary protecting stoma). In an emergency, the surgeon usually does the safest, simplest step first — commonly a subtotal colectomy with a stoma — and leaves bigger decisions until you are well.
Afterwards you recover on a ward, usually within an enhanced-recovery programme that helps you eat, drink and move sooner. Caring for a stoma, if you have one, is an important part of early recovery with stoma-nurse support. The removed bowel is examined in the laboratory; for cancer or inherited conditions, the results help plan further care.
Is this operation right for me?
A good consultation should explore whether it's the right choice for you now — including reasons to wait or consider something else.
May not be suitable if…
- Colitis that can still be controlled with medical treatment, where surgery may not yet be needed.
- You are not fit enough for a general anaesthetic and major surgery until other health problems are managed.
- A pouch reconstruction may be unsuitable if there is poor sphincter function, certain Crohn's disease features or a low rectal cancer.
- For cancer, a situation where the MDT advises a different operation or other treatment first.
Delay surgery if…
- You have an active infection elsewhere or are acutely unwell from causes that can be stabilised first (though some colitis flares need urgent surgery).
- You are very run down or malnourished and could be built up before planned surgery.
- High-dose steroids or immune-suppressing medicines need careful planning around surgery.
- Important results, scans or genetic advice are not yet available to plan the right operation.
- You have not yet met the stoma nurse or had a site marked.
Alternatives to discuss
- Medical treatment for ulcerative colitis (such as steroids, immune-modifying drugs or biologics) where the disease can still be controlled.
- Close surveillance (colonoscopy) for inherited polyp conditions, until surgery is advised.
- A staged or different operation (for example a stoma first, deciding on a pouch later).
- For cancer, a more limited resection where the disease allows.
- The NHS pathway rather than private care where speed is not the priority.
Before you decide
Use this as a shared-decision checklist. The aim is not just “can this be done?”, but whether it is right for you, now, with the risks and alternatives clearly understood.
What matters most to me?
Think about symptoms, daily life, work, caring responsibilities, sport, fertility, travel, appearance and anxiety — the right choice depends on your priorities, not just the medical facts.
What are all my options?
Ask about waiting, monitoring, medicines, rehabilitation, a smaller or larger procedure, a different test, NHS referral, or a second opinion where that would help.
What would make me pause?
Active infection, pregnancy, unstable medical problems, smoking, medicines that increase bleeding, poor support at home, or feeling pressured are all reasons to slow down and get tailored advice.
What happens if I do nothing today?
For some problems, waiting is safe; for others, delay can make treatment harder. A good consultation should explain the trade-off in plain English.
Anaesthetic choices
The safest option depends on the operation, your health, the facility and your surgeon/anaesthetist. Ask what is planned and why.
Benefits
- Can remove diseased bowel and greatly improve symptoms in severe or hard-to-treat ulcerative colitis
- Removes the high future cancer risk from the colon in inherited polyp conditions
- Can be life-saving in an emergency such as severe bleeding, perforation or a colitis flare that is not improving
- For cancer, removes the affected bowel and lymph nodes as part of treatment
- Lets many people come off long-term colitis medicines and feel substantially better over time
Risks & complications
- Changes in bowel pattern — frequent, loose stools through a stoma or pouch, or more frequent motions after an ileorectal join
- Tiredness, pain and reduced appetite while you recover
- A stoma to care for, at least temporarily
- Wound discomfort and a small risk of wound infection
- Dehydration if a stoma produces a lot of fluid, needing attention to drinks and salts
- Bleeding, sometimes needing a transfusion
- Needing to convert from keyhole to open surgery
- Bladder or sexual problems from nerves in the pelvis (more relevant when the rectum is removed)
- Chest or urine infection after surgery
- Blood clots in the legs or lungs
- Leak from a bowel join or pouch, which is serious and may need further surgery and a stoma
- A collection of infection (abscess) inside the tummy or pelvis needing drainage
- Injury to nearby organs such as the ureter, bladder or small bowel
- Pouch problems later, such as inflammation (pouchitis) or, occasionally, pouch failure needing a permanent stoma
- Serious problems related to the general anaesthetic, including very rarely a risk to life
These are major operations with significant, lasting effects on bowel function, and the risks differ depending on whether the rectum is kept, removed or used to build a pouch. A high-output stoma can cause dehydration that needs attention. If a join or pouch is made, a leak is the most serious specific risk. Ask your surgeon which reconstruction is right for you, what each means day to day, and what would happen if a leak or pouch problem occurred.
Published figures to discuss
Risk depends heavily on whether surgery is planned or an emergency, the underlying condition, your nutritional state and medicines (such as steroids), and which reconstruction is done. The information below is cautious and source-defensible; exact figures vary widely between situations, so qualitative wording is used where precise rates are not robust.
| Figure | Reported range | How to interpret it | Source / confidence |
|---|---|---|---|
| Anastomotic or pouch leak (when a join or pouch is made) | Varies by reconstruction and circumstances; an important serious complication where a join is made | Higher in emergency surgery and with steroids or poor nutrition. May need further surgery and a stoma. Source: colorectal surgical literature. | Ileorectal anastomosis and proctocolectomy with end ileostomy for ulcerative colitis (PMC)pmc.ncbi.nlm.nih.govSource-linked context |
| High-output stoma and dehydration | Common in the early period after an ileostomy | Needs attention to fluids and salts; sometimes needs medicines or readmission. Source: stoma-care guidance and surgical literature. | Ileorectal anastomosis and proctocolectomy with end ileostomy for ulcerative colitis (PMC)pmc.ncbi.nlm.nih.govSource-linked context |
| Pouchitis (inflammation of an ileal pouch) | Common over time in people with an ileal pouch for ulcerative colitis | Usually treated with antibiotics; can recur. Source: IBD surgical literature. | Guide sourcesClinical context |
| Pouch failure needing a permanent stoma | A small but real minority over the longer term | More likely with complications, certain Crohn's features or poor pouch function. Source: IBD surgical literature. | Ileorectal anastomosis and proctocolectomy with end ileostomy for ulcerative colitis (PMC)pmc.ncbi.nlm.nih.govSource-linked context |
These are literature figures, not a personalised prediction. Your own risks and likely benefits depend on your circumstances, your health, and how your care is carried out and followed up.
Recovery — what to expect, and when
Total colectomy is major bowel surgery. Most people are in hospital for around a week or more and take 8 weeks or longer to feel back to normal, sometimes longer after emergency or open surgery or when run down beforehand. Bowel pattern keeps adjusting for months.
- Frequent, loose output from a stoma or pouch that gradually settles into a pattern
- Tiredness for several weeks, often more so if you were unwell before surgery
- A bloated tummy and reduced appetite in the early days
- Soreness around the wounds and any stoma site
- Getting used to stoma care and to drinking enough to avoid dehydration
Aftercare
- Take painkillers as advised and keep moving little and often to lower clot and chest-infection risk.
- If you have a stoma, use the stoma nurse's support and watch your fluids and salts to avoid dehydration.
- Build up activity gradually and avoid heavy lifting until your surgeon says it is safe.
- Eat regular, balanced meals and follow advice on managing loose, frequent output.
- Keep wounds clean and dry and follow advice on showering and dressings.
- Do not drive until you can brake hard comfortably, are off strong painkillers and your insurer agrees.
- Watch for warning signs such as severe tummy pain, fever, a swollen tummy or signs of dehydration.
- Keep follow-up appointments and ask for your laboratory (pathology) results to be explained.
- Painkillers in stock with a plan for taking them regularly
- Stoma supplies and the stoma nurse's number ready, if you have a stoma
- A plan for drinks and salts to avoid dehydration with a high-output stoma
- Help arranged at home for the first weeks and easy, balanced meals
- Time off work booked (often 8 weeks or more)
- Knowledge of warning signs (severe pain, fever, dehydration, no output)
- The ward or clinic's contact number saved for problems
Scars and how they heal
Keyhole surgery leaves a few small scars plus a slightly larger cut where the bowel is removed. Open surgery leaves a longer scar down the middle of the tummy. If you have a stoma, there is also a small round site on the abdomen, which closes to a small scar if the stoma is later reversed. Scars are pink and firm at first and usually fade over months.
⚠ Get urgent help if…
- Severe or worsening tummy pain, or a hard, swollen, tender tummy
- A high temperature, shivering or feeling very unwell (possible infection or leak)
- A stoma that produces very large amounts, or signs of dehydration (dizziness, dark urine, cramps)
- A stoma that stops working, turns dark/dusky, or pulls in or bulges suddenly
- Spreading redness, heat, swelling or discharge from a wound
- A swollen, hot or painful calf, or breathlessness or chest pain (possible clot — call 999)
- Heavy bleeding from the back passage, wound or stoma
Who to contact: your surgeon or clinic first (keep their number to hand). For urgent advice when you can't reach them, call NHS 111. In an emergency, call 999.
General guidance — it doesn't replace the specific advice your surgeon gives you.
Results & realistic expectations
For severe or hard-to-treat ulcerative colitis, removing the colon can greatly improve symptoms and quality of life and let many people stop long-term medicines. For inherited polyp conditions, it removes the high future cancer risk from the colon. The trade-off is a major operation and lasting changes in bowel function, often including a stoma at least for a time.
If the operation is for cancer, the aim is to remove the affected bowel with a clear margin and lymph nodes; the laboratory results, discussed by the MDT, guide any further treatment and follow-up, and surgery cannot promise a cure. A good team is clear about the options, what each means day to day, and what monitoring any remaining rectum or pouch will need.
These operations deal with the colon permanently. If the rectum is kept (an ileorectal join) or an internal pouch is built, it still needs long-term monitoring — for inflammation, and for cancer risk in inherited conditions or longstanding colitis. An ileal pouch can work well for years but may develop problems such as pouchitis, and a small number of pouches fail over time and need a permanent stoma. Bowel pattern usually settles into a manageable routine, though it is rarely exactly as it was before.
Combining with other procedures
Total colectomy is often part of a staged plan: an emergency subtotal colectomy with a stoma may be followed later by a decision about the rectum, building a pouch, or reversing a stoma. For inherited conditions, surgery is combined with genetic advice and screening of other family members. For cancer, it is part of MDT-planned care. You should not feel pressured into unrelated add-on procedures.
Follow-up & long-term care
You will be reviewed after surgery to check healing and explain the laboratory (pathology) results. If you have a stoma, you will have ongoing stoma-nurse support and, where relevant, a plan for later surgery. If the rectum is kept or a pouch is built, you will have regular monitoring (for inflammation and, where relevant, cancer surveillance). For cancer, NICE advises follow-up in the first years with blood tests and scans. You should always be told who to contact for problems.
- Attend all follow-up appointments and any monitoring of a remaining rectum or pouch.
- If you have a stoma, keep up stoma care and reviews and manage fluids and salts to avoid dehydration.
- For inherited conditions, keep up recommended surveillance and support family screening where advised.
- Build back up to normal activity and lifting gradually over weeks.
- Report any new bleeding, severe pain, high stoma output or change in symptoms promptly.
- Stop smoking and keep to a healthy weight to support healing and general health.
Revision and secondary surgery reality
- Surgery is often staged: a stoma first, then later decisions about the rectum, a pouch or stoma reversal.
- A leak from a join or pouch may need further surgery, drainage or a stoma.
- An ileal pouch can develop pouchitis or, less often, fail and need conversion to a permanent stoma.
- A hernia at a wound or old stoma site may need repair in the future.
Ask your surgeon for their own revision rate, what counts as a revision, and what is included in the written aftercare policy.
What good aftercare looks like
- An enhanced-recovery plan with clear advice on eating, moving, pain relief and return to activity.
- Stoma-nurse support and clear advice on managing a high-output stoma and avoiding dehydration.
- A named contact and out-of-hours number, with clear warning signs for leak, infection, blockage or dehydration.
- Explanation of the laboratory (pathology) results and a plan for monitoring any remaining rectum or pouch.
- Clear plans for any further staged surgery, and, for inherited conditions, surveillance and family screening.
What affects the cost
Costs vary a great deal between people and providers, and we don't publish prices. What matters is understanding what drives the cost and making sure your quote is complete. The main things that affect it:
- Keyhole versus open approach and the complexity of your case
- The type of reconstruction (stoma, ileorectal join or staged pouch) and how many operations are needed
- Surgeon's and anaesthetist's fees
- Theatre/facility time and length of hospital stay
- Stoma supplies and ongoing stoma-nurse support
- Pre-operative tests, scans, genetic input and explanation of laboratory (pathology) results
- Follow-up appointments, surveillance and the policy if a complication occurs
- The surgeon's fee and the anaesthetist's fee
- The hospital/facility and theatre fee, and the expected length of stay
- Whether further staged operations (such as building a pouch or reversing a stoma) are covered
- Stoma supplies and stoma-nurse support
- Pre-operative tests, scans and explanation of laboratory (pathology) results
- Follow-up appointments and any surveillance of a remaining rectum or pouch
- What happens, and who pays, if there is a complication such as a leak or pouch problem needing more surgery
On the NHS? Total and subtotal colectomy are widely available on the NHS, including as emergency surgery for a severe colitis flare; private care may be chosen for speed or choice of surgeon, but urgent and cancer surgery is normally arranged promptly on the NHS.
You're entitled to your total cost in writing — including aftercare and any revision — before you decide.
Consent traps and marketing red flags
These are not small details. They are often where patients lose choice, time to reflect, or realistic expectations.
Consent traps
- Not clearly explaining the different reconstruction options and what each means day to day.
- Not making clear which stomas are temporary and which permanent, and how many operations may be needed.
- Pouch trade-offs (frequent stools, pouchitis, possible failure) not being discussed.
- Leak risk not being clearly explained when a join or pouch is made.
- For cancer or inherited conditions, not mentioning ongoing surveillance, the MDT and family screening.
Marketing red flags
- Describing major bowel surgery as 'quick', 'simple' or 'routine' without discussing stoma, leak and function trade-offs.
- Promoting a pouch as 'just like normal' without explaining frequent stools and pouchitis.
- Promising no stoma will ever be needed regardless of findings or staging.
- For cancer, language promising a 'cure' rather than honest, MDT-based discussion.
Choosing a surgeon safely
- Check your surgeon is on the GMC Specialist Register for this area.
- Make sure they practise at a CQC-registered location, and look for membership of bodies like BAAPS or BAPRAS.
- You're entitled to a two-stage consent process with time to reflect (a cooling-off period). The surgeon who will operate must consent you — not a salesperson.
- Be wary of pressure: time-limited offers, discounts or deposits taken before you've had time to think are red flags, not bargains.
- You're entitled to your total cost in writing — including aftercare and any revision — before you decide.
Questions to ask your medical professional
Take this to your consultation. A good surgeon will welcome every one of these.
- Why is removing the colon advised for me, and what are my alternatives?
- Which reconstruction is best in my case — a stoma, a join, or a pouch — and why?
- Will any stoma be temporary or permanent, and how many operations might I need overall?
- If a join or pouch is made, what is my risk of a leak or pouch problems, and what would happen then?
- If the rectum is kept, what monitoring will it need afterwards?
- For cancer or inherited conditions, what follow-up and family screening will I need?
- Are you on the GMC Specialist Register for this area, and which Royal College or professional body are you a member of?
- Will you be the surgeon who carries out my operation, and who looks after me afterwards?
- What are the risks for someone like me, and how often do your own patients have a problem or need it repeated or redone?
- What does a realistic result look like — and what can this operation not achieve?
- What are my options, including waiting, doing nothing for now, or choosing a different approach?
- Can I have written information, results and aftercare instructions in a format I can use, including any accessibility or communication support I need?
- What is the total cost in writing, including any follow-ups, and how much time do I have to decide?
Frequently asked questions
Will I have a stoma, and will it be permanent?
What is an ileal pouch (J-pouch)?
Can this be done on the NHS?
How will my bowel work afterwards?
Does removing the colon cure ulcerative colitis?
How long is the recovery?
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How we made this page
Medically reviewed by a GMC-registered consultant. Written in plain English, checked against NHS, NICE, GMC and relevant Royal College / specialist-society guidance, and kept under review. No clinic paid to appear on this page, and we publish no pricing. This is general information to help you prepare — it is not a substitute for advice from your own clinician. How we review our guides →
Source hierarchy: UK regulator and NHS/NICE guidance first, then relevant Royal College or specialist-society guidance, then peer-reviewed evidence for procedure-specific figures where available.
Sources & standards: NICE NG151 — Colorectal cancer (recommendations) Crohn's & Colitis UK — Surgery for ulcerative colitis Ileorectal anastomosis and proctocolectomy with end ileostomy for ulcerative colitis (PMC) Subtotal colectomy in ulcerative colitis — considerations for the rectal stump (PMC) Total colectomy with ileorectal anastomosis vs ileal pouch-anal anastomosis in selected UC patients (PMC) NHS — Ulcerative colitis: treatment
Reviews reflect patients' experience of care, not clinical outcomes. For procedure volumes and outcome data see PHIN.
Last medically reviewed 2026-09-21. Spotted something wrong or out of date? Report an error in this guide.
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