Colitis

Colitis may be acute, with a sudden onset of short-lived symptoms, or chronic, with symptoms that come and go over a lifetime. Different types of colitis may be acute or chronic, including:

• Drug- and radiation-induced colitis, typically an acute form of colitis

• Infectious colitis, typically an acute form of colitis caused by a pathogenic germ. (Bacteria, viruses and parasites are the most common causes.)

• Ulcerative colitis, a chronic inflammatory bowel disease affecting the large intestine

Symptoms of colitis depend on the specific type of colitis and its cause. Symptoms generally affect the digestive tract, but can also include fever, chills and dehydration.

Depending on the cause of colitis, you may experience colitis symptoms daily or just once in a while. At times, any of these colitis symptoms can be severe:

• Abdominal bloating

• Abdominal pain or cramping

• Constant urge to have a bowel movement

• Diarrhea

• Excessive gas (flatulence)

• Weight loss

In some cases, the symptoms of colitis may indicate a serious condition. Seek prompt medical care if you have any of these symptoms:

• Diarrhea lasting longer than 2 to 3 days

• Mild to moderate abdominal pain

• Nausea and vomiting that prevent you from keeping down liquids

• Recurring bouts of diarrhea

Some cases of colitis can quickly progress from a minor condition to a life-threatening situation, such as toxic megacolon (rapid, extreme widening of the colon) and shock. If you have colitis, seek immediate medical care (call 911) for any of the following symptoms:

• Abdominal tenderness when the abdomen is pressed

• Bloody diarrhea or bloody stool. (The blood may be red, black or tarry in texture.)

• Change in alertness of level of consciousness, such as lethargy or passing out

• Fast or uneven heartbeat or palpitations

• Frequent diarrhea

• Muscle weakness

• Painful bowel movements

• Shallow breathing

• Symptoms of dehydration (loss of body fluids that can cause excessive thirst, dry mouth, light-headedness, dizziness, little or dark-colored urine, and weakness)

Many different diseases, disorders and conditions can cause colitis. Colitis can be a sign of inflammatory disorders, intestinal infections, lack of blood flow to the colon, and side effects of radiation or medication treatment. Because of the range of possible causes of colitis, a correct diagnosis of the underlying disease, disorder or condition is very important. Contact your healthcare provider for a physical exam.

Doctors categorize colitis based on the underlying disease, disorder or condition.

Colitis may arise from acute (sudden) or chronic (long-lasting) intestinal infections by viruses, bacteria and parasites including:

• CMV colitis (infection caused by cytomegalovirus)
  
• Cryptosporidium enterocolitis (parasitic infection)
  
• Food poisoning from a wide variety of pathogens, such as botulism, cholera, E. coli, Listeria, Salmonella, Shigella, and viruses
  
• Pseudomembranous colitis (overgrowth of Clostridium difficile [C. diff] caused by antibiotic therapy)
  

Inflammatory causes of colitis include:

• Crohn’s disease (inflammatory bowel disease that can affect any part of the digestive tract)
  
• Microscopic colitis (inflammatory condition that must be diagnosed by looking at cells with a microscope; sometimes called collagenous colitis and lymphocytic colitis)
  
• Ulcerative colitis (inflammatory bowel disease that only affects the colon)
  

Other causes of colitis can include:

• Antibiotic-associated colitis
  
• Irritable bowel syndrome (IBS, digestive discomfort that does not cause intestinal damage or serious disease)
  
• Ischemic colitis (insufficient flow of blood to the colon)
  
• Necrotizing enterocolitis (disorder that primarily affects premature or sick infants and results in death of large intestine tissue)
  
• Radiation of the colon
  

Depending on the underlying disease, disorder or condition, several factors may increase your chances of developing colitis. Similarly, preventing colitis depends on the specific type and cause of colitis. Some common risk factors include:

• Exposure to food, water, soil, or other substances contaminated by viruses, bacteria or parasites that cause intestinal infections

• Family history of irritable bowel syndrome, Crohn’s disease, ulcerative colitis, or other type of colitis

• Premature birth

• Smoking

You may be able to lower your risk of colitis by:

• Cooking perishable food to a safe temperature to kill any germs that may be present

• Drinking clean water

• Not smoking or quitting smoking if you smoke

Talk with your healthcare provider if you have frequent bouts of colitis or colitis-like symptoms. Your doctor may request additional tests to confirm the diagnosis or change your treatment plan.

Nutrition is very important when you have colitis. Food itself does not cause colitis, but it can worsen or reduce symptoms. At the same time, you need to replace vitamins and minerals lost from diarrhea and other effects of disease, especially with chronic colitis.

There is no single diet for colitis. The best foods to include or avoid depend on the individual and what works (or does not work) for them.

In some cases, your doctor may prescribe “resting” the colon to allow it to fully heal. Resting the colon could involve a specialized diet that is very easy to digest, and possibly tube feeding.

For acute colitis and during flares of long-term colitis, altering your diet may help reduce symptoms. During these times, food and waste moving through the digestive tract can be painful, so consuming a diet that will not stimulate the bowel is key.

General diet and nutrition tips for colitis include:

• Bland foods: Avoid spicy foods.

• Low caffeine: Caffeine stimulates the bowel

• Low salt:  Sodium increases water retention

• Low fat: Avoid greasy, fried and “fast” foods

• Low fiber: Avoid raw vegetables, beans, nuts and seeds

• Low-lactose dairy products if you have lactose intolerance. If you can tolerate dairy products, they are beneficial to your diet because they are a good source of calcium and high in calories.

• High calories, to maintain nutrition and prevent weight loss. Depending on your situation, your doctor may prescribe a special nutritional formulation. 

• Small, but frequent meals

Specific diets that may help prevent symptoms include:

• Low FODMAP diet

• Mediterranean diet

Ask your healthcare provider or a dietitian for guidance before making significant changes to your diet.

Many different health conditions involve inflammation of the colon or symptoms similar to colitis. Some are more common than others. Conditions related to colitis include:

• Celiac disease, an inflammatory digestive disorder caused by an intolerance to gluten

• Crohn’s disease, a form of inflammatory bowel disease that can affect any part of the digestive tract

• Diverticulitis, inflammation of small pouches (diverticula) that can develop in the lining of the colon

• Irritable bowel syndrome, a common gastrointestinal condition with symptoms similar to colitis

• Ulcerative colitis, a type of inflammatory bowel disease that causes sores and tissue damage in the colon

In some cases, doctors diagnose colitis based on symptoms and a physical exam of the abdomen. To help diagnose the underlying cause and prescribe the most appropriate treatment for colitis, your doctor will need to order tests in addition to taking your symptom and medical history.

Tests you may need include:

• Stool tests, to identify a possible cause of infectious colitis, such as C. diff, or markers of inflammatory causes of colitis

• Blood tests, to look for inflammatory markers of disease, signs of anemia, or vitamin and mineral deficiencies

• Sigmoidoscopy, a visual exam of the rectum and latter part of the colon with an endoscope

   

• Colonoscopy, a visual exam of the entire colon (large intestine) and first part of the small intestine with an endoscope

Your doctor may biopsy some of the tissue lining your colon during the endoscopy procedure. A specialist will analyze it and send the results to your doctor.

To help diagnose your condition, your doctor or licensed healthcare practitioner will ask you several questions related to your symptoms including:

• How long have you experienced these symptoms?

• How severe is your pain on a scale of 0 to 10, with 10 being the worst?

• Have you experienced these types of symptoms before?

• How frequently do you have diarrhea?

• Do you have a family history of gastrointestinal problems or diagnosis of colitis?

• When do your symptoms occur?

• Have you noticed any particular foods that worsen or improve your symptoms?

• Have you traveled recently? 

Treatment of colitis depends on the underlying disease, disorder or condition. The goals of treatment are to relieve symptoms and correct the underlying problem if possible.

Infectious colitis treatment depends on the organism (bacteria, virus or parasite) that is known or likely to be causing the infection. Healthcare providers prescribe antibiotics for bacterial infections.

Some causes of infectious colitis require no medication because the body will clear the infection in a short time. Supportive treatments and treatments aimed at preventing dehydration and relieving symptoms may also be part of the treatment plan for infectious colitis.

Doctors generally treat inflammatory causes of colitis with anti-inflammatory medications, such as mesalamine and sulfasalazine.

Other classes of medications used to treat inflammatory colitis include:

• Antibiotics, which may be oral or administered intravenously (IV)

• Biologic therapies, such as infliximab (Remicade)

• Corticosteroids, such as prednisone

• Immune modifiers, such as azathioprine (Imuran)

• Pain relievers, both over the counter and prescription. Your doctor may advise against nonsteroidal anti-inflammatory drugs (NSAIDs) because these can irritate the digestive tract. Acetaminophen (Tylenol) is a good alternative for pain relief (and fever reduction), unless your doctor advises otherwise or prescribes you a pain reliever.  

Doctors treat other types of colitis based on the underlying disease, disorder or condition. For example, gastroenterologists may prescribe treatment to relieve symptoms of acute colitis or flare-ups of ulcerative colitis. For ischemic colitis, treatment includes medications to relieve symptoms and procedures to restore blood flow, including surgery if necessary.

Other medical treatments for colitis include:

• Intravenous nutrition to ensure adequate nutrition if you are unable to eat because you need to rest your gastrointestinal tract

• Intravenous rehydration and electrolyte replacement if frequent diarrhea has resulted in the loss of excessive fluid and electrolytes, causing severe dehydration and electrolyte imbalances

• Regular medical care to monitor symptoms, modify treatment plans if necessary, and watch for possible complications

• Smoking cessation program if you smoke

• Surgery to remove a damaged colon and rectum. This major surgery, called a proctocolectomy, involves joining your remaining small intestine to the abdominal wall and connecting an external pouch to collect intestinal waste. Restorative proctocolectomy, or ileoanal pouch-anal anastomosis (IPAA), is a newer procedure that involves connecting the end of the small intestine directly to the anus, thus preserving your ability to pass feces through the anus.

• Vitamin and mineral supplements to prevent or treat deficiencies (intravenous nutrition is another method of treating deficiencies your doctor diagnoses)

A variety of therapies and lifestyle and dietary interventions may help relieve some colitis symptoms, including:

• Curcumin, which has anti-inflammatory properties

• Drinking extra fluids to prevent dehydration from diarrhea 

• Eating a low-fat diet 

• Getting regular exercise, including weight-bearing and aerobic exercises

• Limiting dairy products and any other foods that seem to aggravate your symptoms

• Omega-3 fatty acids, which have anti-inflammatory properties

• Probiotics, which can help maintain or replace bacteria that are beneficial to the body

• Reducing stress through exercise, counseling, meditation, and other proven techniques

• Restful sleep about 8 hours a day

Ask your healthcare provider about additional home remedies and alternative treatments for relief of symptoms from colitis or treatment side effects.

Managing a chronic type of colitis, such as ulcerative colitis (UC), involves many steps to control and relieve symptoms and reduce the risk of colitis complications, such as permanent damage to the colon. This may require frequent doctor visits, lifelong medicine, and major surgery in some cases.

People with chronic colitis are more likely than those without UC to have other chronic health conditions, such as heart or lung disease. People with chronic colitis or recurrent bouts of colitis are also more likely to report a reduced quality of life. As expected, colitis pain is a significant factor in quality of life.

Preventive care is key for people living with any chronic form of colitis. This is ongoing or regularly scheduled care you receive at your doctor’s office or other health clinic like your local hospital. It can also include a healthy lifestyle. Recommendations for colitis include:

• Dietary counseling to plan nutritious meals

• Medical counseling to stop smoking

• Screening for colon cancer and other forms of cancer, such as skin cancer and breast cancer

• Vaccination for such diseases as pneumococcal pneumonia, flu, COVID-19, human papillomavirus, and tetanus

The following tips may make living with colitis easier:

• Ask for help from family and friends when symptoms flare.

• Eat nutritious meals low in salt, sugar and fat.

• Explain your situation to loved ones so they understand your unique needs, such as the importance of nutritious food, access to healthcare, and available toilets.

• Engage in social outings, including travel with friends and family.

• Learn about your condition and available treatment options. Ask your doctor what treatment options he or she recommends and why it would help you.

• Meet with a colitis support group. Many people find that talking with others who have the same condition is a good source of coping tips and resources, as well as friendship. The Crohn’s and Colitis Foundation is a good resource for online communities.

• Practice stress reduction techniques, which may include individual counseling (talk therapy), daily meditation and exercise, and work or school modifications.

• Stay positive. Inflammatory bowel disease is an active area of research, so new therapies could provide even more effective prevention and symptom relief. 

Complications of untreated or poorly controlled colitis can be serious and life-threatening. You can best treat colitis and lower your risk of complications, or delay the development of complications, by following the treatment plan you and your healthcare professional design specifically for you.

Colitis can lead to serious complications including:

• Dehydration

• Fistulas (abnormal holes between the gastrointestinal tract and other areas of the body, such as the vagina, bladder and skin). Fistulas can become infected and cause other serious problems.

• Intestinal bleeding

• Intestinal perforation or rupture of the intestinal wall

• Intestinal ulceration

• Malnutrition

• Peritonitis

• Shock

• Toxic megacolon

The prognosis of colitis depends on many factors, including the cause and prescribed treatment plan. The age, overall health, and other characteristics of the person with colitis also play a role in someone’s individual outlook.

In most cases, colitis treatment is successful and the prognosis is excellent. However, even within a specific type or form of colitis, there is variability. Some types of colitis require more complicated treatment, but the prognosis is still good. With ulcerative colitis, complications may develop soon after the disease starts. For others, complications may never develop or develop much later in life. Most complications are highly treatable with an early diagnosis.

Colitis includes many different types, some which are short-lived and some long-lasting. Studies on life expectancy typically relate to chronic forms, such as ulcerative colitis, a type of inflammatory bowel disease (IBD). There is no cure for IBD, but medications can reduce symptoms and help prevent complications.

Studies of populations of people with IBD show that life expectancy is no shorter than someone without the disease; others show a reduction of about six years. These types of studies involve people diagnosed many years, or even decades, ago. As a result, the gap in life expectancy, if any, is most likely shorter if you were recently diagnosed.

If you have concerns about your long-term health with colitis, talk with your doctor about your prognosis and the steps you can take to reduce any long-term effects of the disease.