It is also available as an enema. Treatment of the more severe cases is usually handled by specialists in inflammatory bowel disease. Colon cancer is a complication of ulcerative colitis. A long duration of disease, continuous as opposed to intermittent activity, and involvement of the entire colon are thought to be risk factors for this complication. Approximate incidences of cancer range from three percent after 15 years of disease to 40 percent after 35 years of disease.
Many experts recommend colonoscopy after eight to ten years of disease, with multiple biopsies.
If borderline or early dysplasia is found, the colonoscopy with biopsies should be repeated annually. If no dysplasia is found on the first colonoscopy, the frequency can be reduced to every two to three years. After 20 years of disease, everyone should have an annual colonoscopy, even if no dysplasia has been found. If severe dysplasia or early cancer is found then the colon must be removed. Although this surgery used to require a permanent ostomy, an opening in the abdomen from which the stool could be drained into a bag, modern procedures have been developed which permit the attachment of the intestine to the rectum, and allow a more normal life without the need to wear an ostomy bag.