Colitis

colitisColitis is a chronic digestive disease characterized by inflammation of the inner lining of the colon.  Infection, loss of blood supply in the colon, Inflammatory Bowel Disease (IBD) and invasion of the colon wall with collagen or lymphocytic white blood cells are all possible causes of an inflamed colon.

Different Types of Colitis

There are many different forms of colitis, including:

  • Ulcerative colitis
  • Crohn’s colitis
  • Diversion colitis
  • Ischemic colitis
  • Infectious colitis
  • Fulminant colitis
  • Collagenous colitis
  • Chemical colitis
  • Microscopic colitis
  • Lymphocytic colitis
  • Atypical colitis

Risk Factors

  • Perforation (rupture) of the bowel: Intestinal perforation occurs when chronic inflammation weakens the intestinal wall ultimately creating a hole.  If a hole forms, a large amount of bacteria can spill into the abdomen and cause infection.  
  • Fulminant colitis: This includes the damage of the thickness of the intestinal wall. The normal contractions of the intestinal wall stop temporarily. Eventually, the colon loses muscle tone and begins to expand. X-rays of the abdomen can show trapped gas inside the paralyzed sections of the intestine.    
  • Toxic megacolon: The colon dilates and loses its ability to contract properly and move intestinal gas along. Resulting abdominal distension can be severe, and patients should seek medical attention immediately. The goal of treatment is to prevent the bowel from rupturing.  
  • Increased risk of colorectal cancer: The risk of colorectal cancer increases with the duration and severity of the disease.     

Signs of Possible Colitis

General signs of colitis can include:

  • Intense pain
  • Tenderness in the abdomen
  • Depression
  • Rapid weight loss
  • Aches and pains in the joints
  • Loss of appetite
  • Fatigue
  • Changes in bowel habits (increased frequency)
  • Fever
  • Swelling of the colon tissue
  • Erythema (redness) of the surface of the colon
  • Ulcers on the colon (in ulcerative colitis) which may bleed
  • Mucus and/or blood in stool and rectal bleeding
  • Diarrhea, which may occur, although some forms of colitis involve constipation so the stool and bowel movements may appear normal.

Other symptoms may include gas, bloating, indigestion, heartburn, gastro esophageal reflux disease, cramps, bowel urgency and many other uncomfortable aches in the gastrointestinal system.

Detection

Common tests for colitis include X-rays of the colon, testing the stool for blood and pus, sigmoidoscopy and colonoscopy. Additional tests include stool cultures and blood tests, including blood chemistry tests. A high erythrocryte sedimentation rate (ESR) – a measure of how long it takes for red blood cells to settle in a blood sample – is typical of acute colitis.

Treatment

The route of treatment depends on what is causing colitis. Many cases require little more than symptomatic care, including clear fluids to rest the bowel and medications to control pain. Patients who have become acutely ill often need intravenous fluids and other intervention.

  • Infection: Infections that cause diarrhea and colitis may potentially require antibiotics, depending on the cause. Viral infections require fluids and time. Some bacterial infections, such as Salmonella, do not need antibiotic therapy; the body is able to get rid of the infection on its own. Other bacterial infections, such as Clostridium difficile, require antibiotic treatment.
  • Inflammatory Bowel Disease (IBD): Medications are often used to control IBD. Anti-inflammatory medications may be used initially. If these are unsuccessful, medications that suppress the immune system can be added. Surgery may be an option in severe cases, including removal of the colon and small intestine.
  • Ischemic colitis: Treatment for ischemic colitis begins with intravenous fluids to rest the bowel and prevent dehydration. If sufficient blood supply is not restored, surgery may be needed to remove parts of the bowel that lost blood supply.
  • Diarrhea and abdominal pain: Diarrhea and abdominal pain are the primary symptoms of colitis. Initial treatment at home may include a clear fluid diet for 24 hours, rest, and Tylenol for pain. If symptoms resolve quickly, no further care is needed.

Prevention

Many people have found that one or more of the following foods have triggered their symptoms:

  • Alcohol
  • Caffeine
  • Carbonated beverages
  • Dairy products (if lactose intolerant)
  • Dried beans, peas, legumes, dried fruits or berries
  • Fruits with pulp or seeds
  • Foods containing sulfur or sulfate
  • Foods high in fiber (including whole-grained products)
  • Hot sauces and spicy foods
  • Meats
  • Nuts and crunchy nut butters
  • Popcorn
  • Products containing sorbitol (sugar-free gum and candies)
  • Raw vegetables
  • Refined sugar
  • Seeds

Avoiding foods that appear to trigger symptoms may help prevent colitis.

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