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Ileoanal Anastomosis for Ulcerative Colitis

Surgery Overview

This surgery is done to treat ulcerative colitis. The doctor removes all of the large intestine (colon) and the diseased lining of the rectum. This surgery is also called an ileal pouch-anal anastomosis (IPAA).

In an ileoanal procedure, the lining of the rectum is removed, and the lower end of the small intestine (the ileum) is attached to the opening of the anus. The surgeon makes a pouch from the ileum to hold fecal material (stool). The lower end of the pouch is attached to the anus. The muscles around the rectum are left in place. This allows for fairly normal bowel movements.

The ileoanal procedure cures ulcerative colitis by removing all the tissue that the disease could return to.

What To Expect

This surgery is sometimes done in two stages. In the first surgery, the doctor removes the large intestine, makes an opening in the abdomen, and attaches the ileum (part of the small intestine) to the opening. This surgery is called an ileostomy. The opening will be in place until the second surgery. In the first surgery, the doctor also forms a pouch from the end of ileum and attaches it to the anus. When the pouch is healed, there is a second surgery. In the second surgery, the doctor takes the ileum from the abdomen and attaches it to the pouch, and the opening is closed.

Recovery from each surgery may take a few days or longer in the hospital and a few weeks at home. The two stages are sometimes done in the same surgery.

Why It Is Done

This is the most common surgery for ulcerative colitis. It can cure it.

Your doctor might recommend a different surgery if you already have problems controlling your bowel movements or if you are very sick.

Learn more

How Well It Works

This surgery is usually successful. Most people have no problems after surgery. And most people say their quality of life is better after surgery.footnote 1 It is normal to have five to six bowel movements a day after this surgery.


About one fourth of people who have this surgery have a complication. Examples of complications are infection, blockage of the small intestine, and inflammation of the ileal pouch (pouchitis). Some people need one or more surgeries to treat complications. Some people leak stool afterward.

It can be harder to get pregnant after this surgery.

It's not clear if this surgery may cause sexual problems.



  1. Holubar SD, et al. (2021). American Society of Colon and Rectal Surgeons clinical practice guidelines for the surgical management of ulcerative colitis. Diseases of the Colon and Rectum, 64(7): 783–804. DOI: 10.1097/DCR.0000000000002037. Accessed 7/2023.


Current as of: October 19, 2023

Author: Healthwise Staff
Clinical Review Board
All Healthwise education is reviewed by a team that includes physicians, nurses, advanced practitioners, registered dieticians, and other healthcare professionals.


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