Colitis is the inflammation or swelling of the inner lining of the large intestine i.e. colon. A number of reasons can contribute to colitis which includes infection caused by bacteria, virus or parasite; inflammatory bowel disease (Ulcerative Colitis or Crohn's disease); allergic reactions; ischemic colitis; and microscopic colitis. Colitis can be acute and chronic, i.e. persistent and broadly fits into the category of digestive diseases.
In a medical context, the term colitis is used if:
- The cause of inflammation in the colon is undetermined or,
- The cause is clear.
What is Colitis?
Colitis basically describes inflammation of the innermost lining of the colon. It can be associated with diarrhea, abdominal pain, bloating, and stool having blood in it. This inflammation of the colon can be due to many other reasons also, which includes:
- Loss of blood supply to the colon which is called ischemia
- Inflammatory bowel disease (Crohn's disease, ulcerative colitis)
- Allergic reactions
- Invasion of the colon wall by collagen or the lymphocytic white blood cell.
What are the Symptoms of Colitis?
The symptoms of colitis are quite variable and dependent upon its cause. It also depends on the factors which modify its course and severity. The common symptoms of colitis may include the following:
- Mild to severe abdominal pain and tenderness (depending on the stage of the disease)
- Recurring bloody diarrhea with/without pus in the stools
- Fecal incontinence
- Flatulence is also one of the symptoms of colitis
- Loss of appetite
- Unexplained weight loss
- Blood in stool, which is the hallmark symptom of colitis
- Constant urge to have a bowel movement
There are also some associated symptoms that can be seen as per the cause of colitis. They are:
- Eye inflammation
- Joint swelling
- Canker sores
- Skin inflammation.
When the disease become severe, it can show the following symptoms:
- Shortness of breath
- Fast or irregular heartbeat
There are also some less or rare non-specific symptoms which many accompany colitis. These are:
- Mouth ulcers
- Painful, red and swollen skin
- Irritated and red eyes.
Types of Colitis
Different types of colitis can be seen. They are:
- Autoimmune Colitis: The immune response of an organism against its own cells and tissues is called Autoimmunity and any disease that results from such response is called autoimmune disease. Inflammatory Bowel Disease (IBD) is a group of colitis that falls in this category. There are two major types of IBD and they are:
- Ulcerative Colitis: It is a form of IBD which causes inflammation and ulcers in the colon.
- Crohn's Disease: It is a form of IBD which not only affect the colon, but also affect anywhere from mouth to anus.
- Idiopathic Colitis: When the pathogenesis of a disease is unknown i.e. the disease can be from any spontaneous origin, then that is called idiopathic disease. Microscopic colitis is a type of idiopathic colitis that is diagnosed by microscopic examination of colonic tissue. It has two types:
- Lymphocytic Colitis: It is a type of colitis which is characterized by watery and non- bloody diarrhea. In this case the colonoscopy appears normal.
- Collagenous Colitis: It is a type of IBD which affects the colon and can be seen among women mostly.
- Iatrogenic Colitis: When a person is affected by colitis due to some external procedures is called latrogenic disease.
- Diversion Colitis: It is a type of colitis which can occur as a complication of colostomy, it often occurs within the year following the surgery.
- Chemical Colitis: It is a type of colitis, which can be caused due to the introduction of harsh chemicals into the colon by some procedure or an enema. Endoscopically this can resemble ulcerative colitis, pseudomembranous colitis and infectious colitis.
- Vascular Disease Related Colitis: It is the abnormal condition of the blood vessels i.e. arteries and veins that leads to colitis. Ischemic colitis is a type of colitis that results from inadequate blood supply. Although, it is rare to be found in general population, yet the frequency of its occurrence is high in elderly people.
- Infectious Colitis: When a disease is caused by bacteria, viruses, fungi or parasites, is called infectious disease. Infectious colitis is a type of colitis that is caused by bacteria or viruses. Some common bacteria which cause colitis are E. Coli, Salmonella etc. This colitis may cause bloody diarrhea.
What are the Causes of Colitis?
Based on the physical examination and the history, the doctor might ask for further tests to find the cause of colitis. These include blood tests viz., Complete blood count, electrolyte levels, inflammatory markers and kidney function; urine and stool tests; barium enema and colonoscopy.
After many tests and experiments, it can be said that the causes of colitis include:
- Colitis can be caused due to infections that are caused by parasite, virus or food poisoning due to bacteria.
- Ischemic Colitis or Colitis due to poor blood flow
- Crohn's Disease and Ulcerative Colitis
- Previous radiation therapy to the large bowel may also cause colitis.
- Newborns suffering from Necrotizing enterocolitis
- Pseudomembranous colitis.
- Bacterial Infections that Cause Colitis: There are many bacteria which live inside the colon; they live in the body maintaining the harmony and produce no symptoms. However, there could be onset of some infections if a bacteria, virus, or parasite enter into the large and/or small intestine. Some common bacteria that cause colitis are:
- E. Coli
- Clostridium difficile, generally referred to as C. diff, is a bacterium which also causes colitis. It occurs after a person is treated with antibiotics or had been hospitalized due to the bacterial infection. C. diff coexists in the colon of a healthy person with other normal bacteria. However, when the antibiotics are taken, the susceptibility of the bacteria can be destroyed, which can cause colitis. This bacteria is also found in the hospital in surfaces like toilets, bedrails and also stethoscopes if they aren't disinfected properly and can spread from person to person as it is highly contagious.
- Parasite Infections that Cause Colitis: The commonest parasite infection worldwide that can cause colitis is Entamoeba histolytica. It is mostly acquired when a person drinks infected water and can also spread from one person to another if proper sanitation and hygiene is not maintained.
- Age as a Cause of Colitis: Age can be a cause of colitis. The arteries that supply blood to the colon gradually become narrow with age, which can cause ischemic colitis. The risk factor increases due to diabetes, high blood pressure, high cholesterol, and smoking.
- Blood Pressure and Anemia as a Cause for Colitis: Low blood pressure or anemia (low red blood cell count) can decrease oxygen delivery to the colon which can be a cause of colitis.
- Atrial Fibrillation and Colitis: Patients having atrial fibrillation (AFib) are at risk for developing ischemic colitis.
- Vascular Problems and Colitis: If the blood supply to the colon may be compromised due to the mechanical obstruction of blood vessels may lead to colitis.
How is Colitis Diagnosed?
As the symptoms of colitis are mostly related to abdominal pain and diarrhea, the diagnosis starts with taking a thorough history of the patient by the medical professional. They are also asked if they have any of the above mentioned causes. Blood stained stool is one of the important concerns of having colitis. Some questions asked to the patient during diagnosis are:
- Time of onset of symptoms
- Duration of pain
- Frequency of diarrhea, and
- Whether there are any other associated complaints.
The patient can also be asked about his lifestyle, having any infectious disease, recent travel, unusual diet, or the use of noncommercial water. The medical history of the patient is also important for the diagnosis.
After getting the answers from the patient, if there is any doubt found to have colitis, the following tests are done:
Laboratory Tests for Diagnosis of Colitis
- A complete blood count (CBC) is necessary for diagnosis of colitis. The RBC count helps to know about the amount of bleeding. WBC count helps to know whether the body is undergoing any stress of infection. Platelets count helps in identifying whether there is any blood clot or not.
- Low sodium and potassium levels can be seen during diarrhea and it may lead to colitis.
- The measurement of BUN i.e. blood urea-nitrogen level helps to assess the kidney function.
- To look for infection, which is a cause of colitis, stool samples may be collected.
Colonoscopy for Diagnosis of Colitis
When there is no specific cause of colitis found, then colonoscopy needs to be considered. During this process, a gastroenterologist inserts a long flexible camera into the anus and examines the full length of the colon. In case of microscopic colitis, biopsy of the affected area must be done for the diagnosis.
Imaging Tests for Colitis Diagnosis
To get the image of the colon and the rest of the abdomen CT scan may be done. Different types of colitis shows distinctive patterns which helps a radiologist to recognize the specific diagnosis. On occasion a barium enema or other imaging tests may be used to evaluate the anatomy of the colon.
How is Colitis Treated?
The treatment of colitis depends upon the cause:
- Infections: To treat infections that cause colitis, antibiotics might not be required always. Viral infections causing colitis only need time and fluids to get treated. Even for infections caused by Salmonella, antibiotic treatment is not required. However, if the infection is due to Clostridium difficile, antibiotics treatment is always needed.
- Inflammatory Bowel Disease (IBD): In case of inflammatory bowel diseases like Crohn's disease and ulcerative colitis, a combination of medications is often prescribed to treat the condition step-by-step.
- Ischemic Colitis: The treatment plan for ischemic colitis is supportive in the initial phase by introducing intravenous fluids to provide rest to the bowel and also prevent dehydration. In case essential blood supply to the bowel is not restored, surgery is planned to remove the parts of bowel where blood supply is lost. Surgery may be required for Crohn's disease and ulcerative colitis, depending upon the severity of the illness.
- Diarrhea and Abdominal Pain: Initial treatment for diarrhea at home includes clear fluid diet for 24 hours and adequate rest. Loperamide is an effective medicine to control diarrhea.
- Diet: A clear fluid/liquid diet helps the colon to heal and rest and is also helpful to control stool.
- Hydration: Adequate hydration is important in colitis as an individual loses huge amount of fluid in every diarrheal bowel movement. Adequate hydration is a key element in treatment of colitis sometimes.
- Intravenous (IV) fluids: In case of some colitis, the patient becomes unable to drink enough fluids. In these cases, intravenous (IV) fluid might be required.
For most individuals, no additional care is needed for infectious colitis, when the symptoms have been cleared.
Ways to Prevent Colitis
Some of the common preventive measures for Colitis include:
- Worldwide, infectious colitis affects millions of people daily. The prevention of colitis lies in cleanliness as unavailability of clean drinking water and improper sanitation are the main causes of colitis.
- The cause of inflammatory bowel diseases is hereditary and hence it is very difficult to prevent in the current scenario.
- No smoking and control of high blood pressure, high cholesterol levels, and diabetes can prevent the risk of ischemic colitis.
- Strict hygiene and sanitation measures when handling food and cooking items can prevent colitis associated with infection from germs. Apart from this, healthy lifestyle and dietary changes helps to make the body free from not just colitis but also from other diseases by strengthening and boosting the immunity. Incorporating moderate exercise along with healthy diet comprising of whole grains, lentils, fresh fruits and vegetables, plenty of fluid, and a moderate amount of animal-origin foods can help in preventing colitis.
Although not a life-threatening problem, colitis can be really painful and also serious due to extreme dehydration and blood loss through stool. A proper diet, hygiene and sanitary measure can effectively keep the problem of colitis at bay.