Surgery for Crohn's Disease

Hole in the bowel, or perforation

If there is severe inflammation, or a blockage, this may lead to a tear in the bowel, making a hole in the bowel wall. This is called a perforation. The contents of the bowel can then leak through. In some cases, the leak may form an abscess.

Many people think surgery is the last option, but that is not true. Surgery is offered when your healthcare professionals think it will help your symptoms. Some people may be offered both medicines and surgery. See our information on treatments to find out more about medicines for Crohn’s.

Your Crohn’s may affect one place in your gut or many places. This will affect your symptoms and what type of surgery you are offered. You can find out about the different types of Crohn’s in our Crohn’s information. Some of the most common reasons for surgery are:

Your choice

You may be given the option to continue taking medicines or to have surgery. Some people choose to have surgery rather than trying to manage unpleasant side effects of medicines. For some types of Crohn’s, surgery can have similar results to medicines. If you have a type of Crohn’s called ileocaecal Crohn’s, you may be offered either medicines or surgery. Your surgeon should give you the information to help you make a decision. This is called shared decision making and is an important part of your care.

If medicines are not working for you

If medicines are not suitable or are not working well for you, your doctor may suggest surgery to help control your symptoms.

Strictures 

Sometimes strictures can be treated with medicines, or balloon dilatation during endoscopy. But if these are not suitable, surgery can help. Blockages due to strictures are a common reason for surgery in the small bowel.

Abscesses or fistulas

If small, abscesses can sometimes be treated using medicines alone. Other abscesses may need drainage. If they cannot be fully treated with medicines or drainage, then surgery may help. If you have a fistula you may benefit from surgery. See our information on fistulas

Slow growth in children and teenagers

For children and teenagers, being poorly and unable to get enough nutrients from food can affect their growth and development. Taking steroids can slow growth even further. Most children and teenagers with Crohn’s will be treated with medicines. But sometimes surgery may be needed to help with growth or development.

Higher risk of bowel cancer

Crohn’s is not cancer. But people with Crohn’s that affects much or all of their colon have a higher risk of getting bowel cancer. Even with this greater risk, the overall risk of getting bowel cancer is still low.

You’ll be offered a colonoscopy about 8 years after your Crohn’s symptoms started. A colonoscopy is a camera test to look closely at the lining of your bowel. It’s used to check for early changes in the colon before cancer develops. This is known as a surveillance colonoscopy. If bowel cancer is found, you may need surgery. See our information on risk of bowel cancer.

Severe complications

Sometimes Crohn’s can cause complications that may need emergency surgery. These complications include:

• Severe bleeding from the gut.
• A hole or tear in the gut, known as a perforation.
• Toxic megacolon. This is when the colon becomes severely inflamed and enlarged, and is at risk of tearing.
• A blockage in part of your gut causing severe symptoms and risk of perforation.

Crohn’s coming back after surgery

Symptoms of Crohn’s can happen anywhere in the gut, including in previously healthy sections of the gut. Surgery cannot cure Crohn’s. It’s possible that Crohn’s may come back after surgery, known as recurrence. This may be close to where the surgery was or in another part of the gut. This means it’s possible you could have another flare-up at some point, even after having surgery.

The risk of Crohn’s coming back after surgery is generally higher for:

• People who smoke
• People with fistulas or abscesses
• People with Crohn’s around their bottom, known as perianal Crohn’s
• People with Crohn’s in the jejunum part of the small bowel
• People who have their first surgery at a young age

Medicines may be able to help symptoms and lower your risk of having another flare-up. If you have a high risk of Crohn’s coming back, you may be advised to take medicines such as a thiopurine or an anti-TNF soon after surgery to lower this risk.

Your treatment options will depend on you and the type and severity of your Crohn’s. Medicines do not work for everyone, and some complications of Crohn’s can be life-threatening without surgery. Speak to your IBD team and decide together which treatment options are best for you.

Your surgical team should go through your individual risk with you. They should tell you how to lower your risk of complications. For example, if you smoke, stopping smoking can help to lower your risk.

It’s important to know what your risks are so you can make an informed decision about your treatment. Do not be afraid to ask your surgical team about your risks. See our Appointment Guide for tips on getting the most from your appointments.

A stoma is an opening made by a surgeon on the wall of your tummy. It brings your bowel to the outside. The contents of your bowel, called your ‘stoma output’ empty straight into a bag. The bag is called a stoma bag. You can get different types of stoma bag in lots of shapes and sizes.

A two-piece stoma bag. One-piece stoma bags are also available.

View a larger image of a two-piece stoma bag

Stomas can be made from part of the small bowel called the ileum. These stomas are called an ileostomy. Or they can be made from part of the large bowel called the colon. These stomas are called a colostomy. Stomas can be permanent or temporary.

An ileostomy showing the stoma opening

View a larger image of an ileostomy with stoma opening

A stoma nurse should support you and give you practical help and information on living with a stoma.

Strictureplasty is a way to repair strictures caused by scarring in the small bowel without having to remove any bowel. Strictures can cause blockages in the bowel. This is sometimes called bowel preserving surgery.

View a larger image of strictureplasty

In a strictureplasty, the surgeon:

1. Cuts open the narrowed section of the bowel, the stricture, along the longest side of the bowel.
2. Opens the cut and reshapes it.
3. Sews the cut back together along the opposite way it was cut open. This makes the narrowed section wider.

There are other more complicated ways the surgeon can sew the bowel back together. Ask your surgeon what type of strictureplasty they plan to use.

Resection

Resection means taking part of the gut out. This is one of the most common surgeries in people with Crohn’s. A resection can be helpful for people who have long strictures, or lots of strictures close together.

In a resection the surgeon removes the damaged part of the gut. They then join the healthy sections of bowel back together. This join is called an anastomosis. Resections are sometimes used for fistulas and abscesses in the small bowel.

View a larger image of resection

Ileocaecal resection, or ileocaecectomy

Ileocaecal resection is also known as an ileocaecectomy. It is when the ileocaecal part of the bowel is removed. The ileocaecal part is where the end of the small bowel, called the terminal ileum, meets the start of the large bowel, called the caecum. Crohn’s commonly affects this section of the gut. Ileocaecal resection may be offered if you have severe inflammation or a stricture in this area. The healthy end of the small bowel is then joined directly to the large bowel.

View a larger image of ileocaecal resection

Segmental colectomy and right hemicolectomy

Segmental colectomy

If your Crohn’s is only affecting a small part of your colon, you may be offered a segmental colectomy. This means taking out just a small section of the colon. The 2 healthy ends of the colon are then joined together.

Right hemicolectomy

Right hemicolectomy is when the first half of the colon is removed. The surgeon also removes the appendix and a very small part of the small bowel. The small bowel is then joined up to the remaining half of the colon. You may be offered this if you have inflammation or a blockage in the first part of the colon.

Subtotal colectomy with ileostomy

During a subtotal colectomy the surgeon removes the colon but leaves the rectum. The colon and rectum together make up the large bowel. The surgeon makes an ileostomy, also called a stoma, by joining a section of the small bowel to the surface of the tummy. Bowel contents pass out of this opening into a stoma bag.

View a larger image of a subtotal colectomy with ileostomy

Colectomy with ileo-rectal anastomosis

In this surgery, the colon is removed and the end of the small bowel, known as the terminal ileum, is attached to the rectum. This means you can poo out of your bottom and do not have a stoma.

For this surgery to work, the rectum has to be healthy and not inflamed or scarred. If your anal muscles are damaged, there’s also a high risk this surgery will not work.

Removing the colon means water cannot be absorbed like usual, so your poo may be quite watery. You may have to go to the toilet many times during the day and night.

View a larger image of a colectomy with ileo-rectal anastomosis

Panproctocolectomy with ileostomy

In this surgery, the whole colon, rectum and anal canal are removed. The surgeon makes an ileostomy, also called a stoma, by joining a section of the small bowel to the surface of the tummy. Bowel contents pass out of this opening into a stoma bag.

Panproctocolectomy with ileostomy surgery is irreversible. This means the ileostomy is permanent. But this also means that there is no colon and rectum to become inflamed or get bowel cancer.

View a larger image of a panproctocolectomy with ileostomy

Small abscesses can sometimes be treated with antibiotics through a drip into your vein. Bigger abscesses in the tummy may need percutaneous drainage. This is when a tube is placed through a small hole in the skin to drain out the abscess. Usually a scanning machine, like an X-ray or ultrasound machine, is used to guide the placement of the tube. Some abscesses may need to be opened surgically and drained, or taken out via resection.

Fistulas connecting the small bowel to other parts of the bowel do not always need surgery if they’re not causing problems. However, if a fistula is causing symptoms, or you’re losing weight, you may be offered surgery to remove that section of the bowel. This is a type of resection.

Fistulas around the bottom, called perianal fistulas, can be more difficult to treat. Surgically removing them can risk damaging the strong muscles in your anus, called anal sphincters. These muscles help you control when you poo.

Perianal fistulas are usually treated using setons. A seton is a loop of thread or rubber band passed through an anal fistula. The seton helps drain away pus and allows the inflamed tissue to heal. You may be advised to have biologic medicines at the same time to help the fistula heal. Fistulas sometimes need more than one surgery.

Examination under anaesthesia, also called EUA, is common for people who have perianal Crohn’s. This is when you’re put to sleep with general anaesthetic medicines so the surgeon can check your bottom for fistulas. It’s done under anaesthetic so you do not feel any pain.

Talking to your surgical team

Before a planned surgery is booked in, you may meet a surgeon to discuss your operation. The surgeon should explain your surgical options in more detail. They should also talk through the benefits and risks of the surgery. They should mention any possible complications that can happen as a result of surgery. Let them know if there’s anything you do not understand. This is your chance to ask questions and find out more information. Our Appointment Guide includes questions you may want to ask in your appointments.

If you decide to have surgery, you’ll be asked to sign a consent form. This is an agreement to say you understand the risks and benefits of the surgery. It is written proof that you give permission for the surgeon to carry out the operation. Even if you sign a consent form, you can change your mind and withdraw consent at any point. If you cannot give consent, for example if you are under 16 years old, there are rules in place to help protect you. The NHS has more information on consent.

At this stage, if you’re going to have a stoma, you may also meet a stoma care nurse. They should be able to help with any questions you have about the surgery or your care after the surgery.

Pre-operative assessment

Before planned surgery, you should have a pre-operative assessment. This helps your surgical team to make your surgery the safest it can be. It will also help the anaesthetist plan the best anaesthetic for you. Even if your surgery is done as an emergency, a surgeon and an anaesthetist should both assess you first.

The pre-operative team is usually made up of doctors and nurses. They may call you to assess you, or invite you to the hospital for an assessment. They should ask about your medical history and home life. They may ask you to do some tests before your surgery. This could include:

• Blood tests
• A heart tracing, known as an ECG
• A chest X-ray

The tests you have will depend on your:

• Age
• Medical history
• The type of surgery you’re going to have

If possible, it’s good to be as fit as you can before surgery. This can help your recovery and lower your risk of complications. Your surgical team can give you advice on how to improve your fitness before surgery. This could include eating well, not smoking and being as active as you can be. If you are underweight, you may be advised to take extra nutrients. This may be in the form of a special liquid feed to have as well as your usual diet. If you are a smoker, your IBD team should support you to stop smoking. It’s important to stop smoking before you have surgery, as smoking increases your risk of complications.

Anaemia is common in people with Crohn’s. Anaemia is when you have fewer red blood cells to carry oxygen around the body. If you have anaemia you should be treated for this before surgery, if possible. There are lots of different causes of anaemia. If you have iron deficiency anaemia, then you may be given a top up with tablets or through a drip. Vitamin B12 and folate are also used to treat some types of anaemia. In more severe cases, a blood transfusion may be needed to treat your anaemia.

Medicines and surgery

Your surgical team may advise you to stop taking certain medicines before surgery. They should give you a plan for when and how you should stop taking them. Medicines that may be stopped or changed include:

·       Steroids

·       The combined oral contraceptive pill

·       Blood thinning medicines

Steroids can increase the risk of infection. Stopping or reducing your steroids can help prevent infection after your operation. If your steroids need to be stopped before your operation, you may need to slowly reduce how many you take. Stopping steroids suddenly can be dangerous if you have taken them for a long period of time. If you stop taking steroids look out for symptoms of steroid withdrawal. These include weakness, fatigue, loss of appetite and vomiting. These symptoms can be difficult to identify, as they are like Crohn’s symptoms. If you have any these symptoms get urgent medical attention.

It’s important to tell your surgical team about all the medicines you are taking, including over-the-counter or herbal medicines. They should tell you which ones you need to stop or change before surgery. They may also advise you to start medicines before surgery. If you have other conditions such as diabetes or high blood pressure, they will want to make sure these are under control before surgery.

In some cases, you may need to take a strong laxative called a bowel preparation the day before surgery. This is used to completely empty your bowel. In other cases, you may be asked to have an enema to clear the last part of your bowel.

Things to think about before having surgery

• Transport. How will you get to and from hospital?
• Next of kin. Who should the hospital contact with updates about your hospital stay? Are they ok with being contacted?
• Work and volunteering. Will you need to take time off and who should you talk to about this?
• Caring responsibilities. Do you care for anyone, such as children, a relative, or a partner? Any pets? Who will be looking after them while you are in hospital and while you recover at home?
• Pre-hospital instructions. Did your surgical team give you any instructions on what to do before coming in, like stopping medicines?
• Going home. Will somebody be able to help you when you go home? Can you get food delivered?
• Hospital visiting policy. When can people come to visit you?

Though most hospitals have Wi-Fi, it is not always reliable. You may want to download music, podcasts, or things to watch before coming into hospital, just in case there is no internet to use.

Before the day of your surgery, your surgical team should tell you:

• Which hospital to go to. This may not be the usual hospital that you have your clinic appointments at.
• What time to arrive.
• When to have your last meal and drink before surgery.

On the day of your surgery, you will see a number of people. This includes a:

• Surgeon. They may speak to you about the surgery and examine you before the operation.
• Nurse. They may check your temperature, blood pressure, pulse, and weight. These should also be checked regularly during your surgery and while you recover in hospital.
• Anaesthetist. They may talk about how you will be given the anaesthetic and how your pain will be controlled after the surgery.
• Stoma care nurse. If you may need a stoma, and have not met your stoma nurse already in earlier appointments.

Ideally, you should not be asked to sign a consent form on the day of your operation. Consent forms should be signed at the point you decided to have surgery. For planned surgery, this is before the day of your operation. An anaesthetist should visit you to talk about how you will be given the anaesthetic and how your pain will be controlled after the operation. Good pain relief helps recovery, so this will be an important part of care after the operation.

You’ll usually be given a pair of compression stockings to wear during your time in hospital. Compression stockings lowers the risk of blood clots. You may also be given daily injections to help thin the blood to prevent blood clots. Your doctor should let you know if you need this or not, and should advise you on how long you will need this for. See the later section on lowering your risk of complications while you recover for more information.

How long your surgery will take

This will depend on the type of surgery you’re having, whether it is keyhole or open surgery and if you have had surgery on your tummy before. If you have had surgery on your tummy before you may have scar tissue called adhesions. Adhesions can sometimes make surgery more complicated, so it can take longer. Your surgical team can tell you how long they expect your surgery to take.

After surgery you’ll be moved to a recovery ward. This is a small ward where nurses will monitor you as you wake up properly. The medicines that put you to sleep take a couple of hours to fully wear off. You may not remember waking up, or the first couple of hours after you wake up.

The medicines used during surgery can make you feel sick. This is known as nausea. You may also have a sore throat. This is usually because of the tube that’s put into your throat to help you breathe during surgery. This tube is taken out when you wake up. If you feel unwell, let the nurses know and they’ll be able to help you.

What are the tubes coming out of my body?

When you wake up, you may find some tubes attached to you. These could include:

• Catheter. This takes pee, also called urine, out of your bladder. This is because you cannot naturally empty your bladder when you are put to sleep during surgery. A catheter is usually removed after a few days when you are able to move around again and go to the toilet by yourself.
• Wound drain. This drains blood and fluid from your wound after surgery. This is taken out when there is no more, or very little, blood or fluid left to drain.
• Rectal tube. This tube is inserted up the bottom and helps removes poo or gas.
• Intravenous (IV) drip. These small tubes are used to give you fluids and medicines, like antibiotics and pain relief. Your IV drip may be changed every few days to lower the risk of infection.
• Nasogastric tube. This tube goes in through your nose, down through your throat and into your stomach. This can be used to give you food directly into your stomach. It can also be used to drain or decompress your stomach to keep it empty. This may happen if you have a blockage in your bowel, or if you feel very sick.

When you are fully awake and recovering well from the anaesthetic medicines you will be moved to a ward. For most people this will be a regular surgical ward. Some people need more monitoring. They will be moved to a specialty ward like a high dependency or intensive care unit. This may include people with other conditions, like heart or lung disease. You may also need more monitoring if your surgery was an emergency, as you may be at higher risk of complications.

Pain relief after surgery

Your tummy will feel sore at first, and it may take a while to feel better. You may also notice some bruising and swelling on your tummy. This is common and it should also get better. If it gets worse or you are worried that it’s not getting better, speak to your healthcare professional.

Your doctors and nurses should talk to you about what pain relief may be best for you. The most common ways of having pain relief are:

• Tablets or liquid to swallow
• Skin patches
• An injection into your vein, known as an IV injection
• An injection into a space in your spine, also called an epidural
• An injection into your tummy, also called an abdominal wall block

Patient controlled analgesia (PCA) is a type of IV drip pain relief. The patient controls when they get their pain relief by pressing a button. This is usually used for a short time after surgery when pain may be more severe.

Pain is expected after surgery, but you should not have to suffer. Being in pain can slow down your recovery and increase your risk of complications. If your pain is not under control let someone know.

Your recovery in hospital

You will be encouraged to move as much as you can. This may mean getting out of bed and into a chair, or walking around as soon as you are able. A physiotherapist may visit you to show you some simple leg and chest exercises.

Having surgery can be a big shock to your body, mentally and physically. Your appetite may change and you may not feel very hungry. It may take some time for your appetite to return, especially if you were unwell before surgery. Depending on the type of surgery, you may be able to start drinking water within 12 hours of your surgery. You’ll then move on to a liquid diet such as soup and jelly.

After surgery, your bowel may temporarily stop moving food and gas as it usually does. This can cause you to feel sick and bloated. Your doctor may suggest that you do not eat during this time, usually around 1 to 2 days.

If you have a stoma, your stoma care nurse will teach you how to look after it and how to manage your stoma bag. If you have any problems, don’t hesitate to ask for help.

Some people find that a few days after the surgery they do not feel as well as they did straight after the surgery. They may also feel low in their mood. If you have feelings of a low mood that are not going away, talk to your healthcare professional.

How long you’ll stay in hospital

How long you’ll need to stay in hospital will depend on your individual situation. For the common surgeries mentioned in this information, it’ll probably be around 7 to 10 days. However, some people may only need to stay in hospital for 3 to 4 days. If you were very unwell before your surgery you may need to stay in longer.

It may be helpful to ask your surgical team when they expect you to go home. Generally, people who have had keyhole surgery are able to leave hospital sooner than people who have had open surgery.   Hospital stays for planned surgery tend to be shorter than for emergency surgery. People who need emergency surgery are usually very unwell and may have a more complicated recovery.

Enhanced recovery programmes

Some hospitals have enhanced recovery programmes in place for some types of surgery. These programmes aim to lower your risk of complications after surgery and get people safely home more quickly. Enhanced recovery programmes focus on being as healthy as possible before surgery, as well as getting moving as soon as possible after surgery.

Feeling better after surgery

When you feel better will be different for each person. When you first get home, you’ll probably feel quite weak and tired. You may not feel like doing much.

You should avoid any strenuous exercise for at least a few weeks after your surgery. This is so your wounds can heal properly. This means avoiding any heavy lifting or housework. You may struggle to go up stairs for a short time after surgery.

As time goes on you’ll notice your strength coming back. After a few weeks, you should be able to gradually introduce exercise into your daily routine. A gentle exercise programme may help speed up your recovery and you will likely be given advice on this by your surgical team.

You should be able to start going back to your usual daily activities. It’s important to listen to your body and only do as much as feels comfortable. Everybody is different, so try not to put too much pressure on yourself to get back to usual life straight away.

Your follow-up plan will depend on your individual situation. You should still be under the care of a gastroenterology team and a surgical team. You may have a nurse come to your home to help with any wounds if this is needed. Make sure you understand your follow-up plan when you are discharged from hospital. If you do not know, make sure to ask someone. It is also worth asking:

• What symptoms should I look out for?
• Who should I contact if I’m concerned?

If you have had stoma surgery, your stoma nurse is there to help. Having a stoma can be a big change and it may take a while to get used to it. Talk to the stoma care nurses if you need more information or have any issues. Many hospitals have stoma clinics or offer a stoma care advice line. See our information on life with a stoma.

Driving

In the long-term, surgery should not affect driving. However, you may have to avoid driving straight after surgery. You should not drive again until you are able to control a car properly, including making an emergency stop if needed. This may take several months. If you still cannot drive safely 3 months after your surgery you need to tell the DVLA. Your car insurance may not cover you if you drive before you are fully recovered, so check the terms of your policy. It may be helpful to ask your surgeon to confirm that you can drive again in writing, at your follow up appointment.

Diet

After your surgery, you may have to change what you eat for a short time. Your surgical team will give you specific advice on what you should eat. For example, they may advise you to eat a diet low in fibre. This will make it easier for your gut to break down and absorb food while it recovers from surgery.

As you recover, you may find that you can eat larger meals and a wider range of foods.

Having a varied diet is particularly important if you have had sections of your small bowel removed. This is because it will be harder for you to absorb nutrients. Some people with Crohn’s have difficulty in absorbing fat from their food, especially after having part of their bowel removed. If you have had the end of your small bowel, called the terminal ileum, removed you may need to have vitamin B12 injections.

Most people with a stoma do not need to stay on a special diet. But there might be some foods or drinks that make your stoma more active or create more gas. This is different for everyone. Your stoma care nurse or the hospital dietitian should be able to advise you.

See our information on food for more on diet and Crohn’s.

Hydration

Your colon is important for absorbing water. If you have your colon taken out you have a higher risk of dehydration. You may find it helps to drink fluids and rehydration drinks, including electrolyte mix. Our information on dehydration has more on staying hydrated after surgery.

Work and finances

If you work, you may be wondering how surgery will affect your job and your income. It can take from 2 to 10 weeks before people feel able to return to work. This depends on the type of surgery you’re having and the type of job you have. If you work in a very physical job, you may need more time off.

If you can, it’s best to let your employer know early on about your medical needs and time off so they can make adjustments. It may help to read our information on employment.

If you are absent for more than a week, you will need to get a ‘fit note’ from the healthcare professional who is caring for you. They can make suggestions for additional support or adjustments when returning to work. This could include building up slowly to your normal hours and duties. This is called a ‘phased’ return to work.

See the ACAS website for more information on returning to work after an absence.

If you’re worried about money, have a look at our information on money and benefits. You may be eligible for support.

Your local Citizens Advice service could be a good place to start. They can help with budgeting or maximising your income, and offer benefits advice:

• England
• Scotland
• Northern Ireland
• Wales

If you care for a child who lives with Crohn’s, you may want to read our information on Disability Living Allowance (DLA) for children.

School and university

You may need to take some time out of studying to recover from surgery. Try to speak to your school, college or university as early as you can so they are aware of the situation. They may be able to give you extended deadlines or adjustments for exams. See CICRA for more information on Crohn’s and schools.

Emotional reactions

Everyone reacts to surgery in their own way. And your emotions may even change during the process. You may feel worried or scared, maybe nervous. You may feel a sense of relief. Or you may feel doubt about whether having surgery was the right decision. Going through lots of different emotions can be exhausting. Emergency surgery can be especially difficult as there is less time to adjust. The people close to you may also find it difficult to cope with the thought of you having surgery.

You may find it helpful to talk to someone about these feelings. IBD nurses, stoma nurses and psychologists can support you. You can also speak to your GP about local psychology services. Our information on mental health and wellbeing has further details about this.

It may be helpful to talk to other people who have had surgery for their Crohn’s or who have a stoma. Check our support for you page for ways you can connect to others living with Crohn’s or Colitis.

Body image

Your body may look different after surgery and you may find this difficult to come to terms with. On the other hand, you may feel that having surgery improves your body confidence. You may feel better and able to do the things you enjoy. Maybe you can start going to the gym. Or maybe you have the energy to be intimate with a partner again. If you’re having worries, talk to your IBD team. Your nurses will likely have spoken to lots of people about their body image worries. It may also be helpful to speak to others like friends, family, or other people who have been through a similar experience. Check our support for you page for ways you can connect to others living with Crohn’s or Colitis. Our information on relationships and dating has more on body image.

Sex and relationships

You may be worried about how surgery will affect your sex life. Your surgical team can give you specific advice about when they think it’s safe for you to have sex after surgery. Going back to sexual activity may mean exploring other ways of being intimate or new positions. It can be difficult to talk about sex, but being open about your needs and concerns can help.

Our sex and sexual health information has more on how surgery may affect sex and suggests other ways you could be intimate with a partner.

Fertility in men

After having pouch surgery, you may have problems getting or keeping an erection. For most men, this improves with time, or with sildenafil medicine. Sildenafil is also known by the brand name Viagra.

The risk of fertility problems is lower with keyhole surgery.

You should still use contraception if you do not want to make someone pregnant after surgery.

Fertility and pregnancy in women

If you’re thinking of having children, it’s important to let your surgical team know. Women having surgery in the lower tummy area, known as the pelvic area, may be at risk of fertility problems. It’s thought that surgery in this area of your tummy can cause scar tissue, called adhesions, around the fallopian tubes and ovaries. This can make it more difficult to get pregnant. Ask your surgeon whether your type of surgery may increase your risk. But if you do not have surgery, active Crohn’s may also make it more difficult to get pregnant.

For some people, it may be possible to delay surgery until they have completed their family. For other people, they may be able to have keyhole surgery. The risk of fertility problems is lower with this type of surgery.

You should still use contraception if you do not want to get pregnant after surgery.

If you do become pregnant, either before or after surgery, your doctors will advise you on what options are safest for you and your baby. For example:

• If you have a stoma, it’s still possible to deliver vaginally, but you may need a caesarean section if any complications arise.
• Vaginal deliveries are not advised if you have active Crohn’s in the area around your bum, known as perianal Crohn’s.

Any surgery in the tummy, including a caesarean section, or surgery for your Crohn’s, can lead to scar tissue forming. These are called adhesions. Adhesions can make any future surgery a bit more complicated. Your surgeon should be able to give you further advice on this.

You may find it helpful to read our information on reproductive health and on pregnancy and birth and postnatal care and breastfeeding.

Travelling

Having surgery should not stop you travelling. You may be advised not to fly in the first few weeks after surgery. Blood clots are more likely to happen when you sit still for a long time, like on long-haul flights. And this risk is higher if you have had surgery recently. Ask your surgical team if they have any specific advice for you about travelling. If you have a stoma, you’ll have to consider packing your supplies. Read more about travelling with Crohn’s in our information on travelling.

Insurance

When declaring your medical conditions, insurance companies will usually ask you if you have had surgery because of your Crohn’s. The cost quoted to you may be affected if you are waiting for surgery, or recently had surgery. Our information on money and finding financial support has more on insurance.

Exercise and physical activity

In the long-term, having surgery should not affect how you exercise. If surgery helps your symptoms, it may mean you can be more active. If you have a stoma, you may have to make sure you have spare bags and other supplies with you.

Having surgery in the tummy area, especially stoma surgery, can put you at higher risk of getting a hernia. A hernia happens when there’s some weakness in the muscle wall, so internal organs, such as the bowel, can push through. You can lower your risk of getting a hernia by working on your core strength and practising tummy exercises. Some people also find wearing support underwear can help. Speak to your surgical team about what could help you.

There is more on how you can exercise with Crohn’s in our video on being active. Colostomy UK and the Ileostomy and Internal Pouch Association also have information on exercising after surgery.

Children and young people

Much of the information here will apply to children as well. However, there are some things to be aware of:

• Surgery on children and young people often takes place in specialist hospitals. This may mean you have to travel further for the surgery.
• Children cannot consent to treatment until they are 16 years old.
• The growth and development of a child or young person will be important in deciding if surgery is suitable for them.
• Children and young people may be given some specific instructions before surgery. For example, avoiding vaccinations in the few weeks before surgery.

CICRA has more information on surgery in children with Crohn’s.

We follow strict processes to make sure our information is based on up-to-date evidence and easy to understand. We produce it with patients, medical advisers and other professionals. It is not intended to replace advice from your own healthcare professional.

We hope that you’ve found this information helpful. Please email us at evidence@crohnsandcolitis.org.uk if:

• You have any comments or suggestions for improvements
• You would like more information about the sources of evidence we use
• You would like details of any conflicts of interest

You can also write to us at Crohn’s & Colitis UK, 1 Bishop Square, Hatfield, AL10 9NE, or contact us through our Helpline by calling 0300 222 5700.

We do not endorse any products mentioned in our information.