Colitis (ulcerative, ischemic, distal): symptoms and treatment

Complaints of abdominal pain and intestinal problems, unfortunately, are common.

Often we do not pay attention to the symptoms that our body gives and, thus, we do not take enough care of the intestine, considered our second brain.

With that in mind, it is important to know more about one of the most common inflammatory bowel diseases, colitis.

According to the Brazilian Association of Colitis and Crohn’s Disease , there are about 30 thousand new cases of diseases in the country.

In the following text, we explain all the effects that colitis causes in the body. Read on!

What is colitis?

Colitis is an inflammation that affects one or more layers of the large intestine (or colon) and the rectum, and in most patients it is a chronic disease.

It is one of the most common inflammatory bowel diseases, responsible for causing symptoms such as severe abdominal pain, bloody diarrhea , ulcers in the intestinal wall and reduced appetite.

Despite being a disease with no exact cause, there are several types of colitis, which can affect each patient differently.

The diagnosis is usually made by a coloproctologist or gastroenterologist, who analyzes the symptoms and orders tests to confirm the condition.

Although it is still a disease without a cure, there are treatments to alleviate the condition and make patients’ lives more comfortable.

Treatment usually consists of administering medications to contain the inflammation and cause remission of symptoms. A change in diet may also be necessary, especially during seizures, so as not to aggravate the condition.

In severe cases, it may be necessary for the patient to undergo surgery to remove part of the inflamed tissues that cannot be recovered with other conventional treatments.

Despite not having specific groups or risk factors, the highest occurrence of the disease occurs in people aged 15 to 35 years.

In the International Classification of Diseases ( ICD-10 ), ulcerative colitis is found in code K51 .

What is the difference between colitis and Crohn’s disease?

Crohn’s disease and colitis, despite being different, are always related, as the two conditions are inflammatory bowel diseases (IBD).

The main difference is in the region affected by the inflammation , whereas colitis causes inflammation in the colon and rectum, Crohn’s disease is a syndrome that can affect the entire digestive system.

In Crohn’s disease the patient has a lot of abdominal pain, diarrhea, weight loss, weakness and fever .

This inflammation can cause ulcers and openings (fistulas) in the intestine, with leakage of feces, and there may also be narrowing of the intestine and constant pain.

These symptoms are more characteristic in cases that have not been diagnosed and treated correctly.

Because it affects the digestive system, it can also make the patient’s diet more restricted. Before diagnosis, the disease is also a risk because it prevents the absorption of some essential nutrients.

Like colitis, Crohn’s disease also has unknown causes. It can be caused by an autoimmune reaction, by eating or by infectious agents such as bacteria.

Both conditions can be investigated by a coloproctologist or gastroenterologist.

What is nervous colitis?

Despite being a well-known name, nervous colitis is not a type of colitis , but the way in which Irritable Bowel Syndrome (IBS) is commonly known.

Many people confuse the two diseases and symptoms, understanding nervous colitis as a variation of the disease caused by emotional factors, such as stress .

However, although it is often considered one of the aggravating factors, there is no evidence that stress is capable of causing colitis.

Read more: How to control anxiety? 14 tips to avoid crises

Irritable Bowel Syndrome, therefore, is neither an inflammation nor a type of colitis.

It is a disease caused by abnormal peristaltic movements (reduced or in excess).

What are the types of colitis?

Colitis is divided into some types and can be classified according to the time the disease remains active in the patient. In such cases, it can be considered acute colitis (when it affects the patient for more than a week) and chronic colitis (when the patient has the condition for 4 weeks or more).

Other forms of disease classification are:

Ischemic colitis

Ischemic colitis is the manifestation of the disease caused by a deficiency in blood flow, which ends up preventing the large intestine from receiving adequate circulation, by reducing or restricting blood in the region.

It is a type considered serious, as the mortality rate can be high, not only due to the disease, but also due to other pathologies that affect patients and age.

Diseases such as atherosclerosis in the colon (deposit of fat in the blood vessels), vasculitis (inflammation of the blood vessel wall), diabetes , colon cancer , hernia and other complications that can impair blood circulation can cause this type of colitis.

Pseudomembranous colitis

It is a more common type in people who have some impairment in the immune system, such as patients with autoimmune diseases , undergoing cancer treatment, children and the elderly.

Inflammation, in these cases, happens due to the presence of bacteria that damage the large intestine, which, in some circumstances, are unbalanced in the body.

An example of this is what happens to Clostridium difficile, a harmful and quite common bacteria in the intestine, but which becomes harmful when the good bacteria are destroyed. One of the factors that cause this variation is the use of some medications.

Pseudomembranous colitis is a more common type in people who are being treated with some types of antibiotics , such as Amoxicillin or Azithromycin .

Distal colitis (limited)

Distal colitis is the characteristic inflammation for causing severe pain in the left part of the large intestine.

In it, the inflammation extends from the rectum to the splenic angle, the curve of the colon close to the spleen, in the upper left part of the abdominal region.

In addition to pain, the patient may also experience reduced appetite, weight loss and bloody diarrhea.

Universal colitis (pancolitis)

Also called pancolitis, this is the type in which the disease affects the entire colon region.

As in other cases, symptoms include severe pain in the abdomen, weight loss, bloody diarrhea and poor appetite.

CMV colitis

Colitis caused by viral infection is usually associated with cytomegalovirus (CMV), a virus that belongs to the herpesvirus family.

It is not a common cause of colitis, for some researchers the explanation of the disease and for others it is a coincidence.

Anyway, it is important to know that this virus can be transmitted through unprotected sex, through contact with saliva, feces and breast milk.

Read more: Learn how genital herpes transmission happens

Ulcerative proctitis (retitis)

In proctitis, or retitis, inflammation affects only the rectum and does not affect the large intestine. It is usually an inflammation that extends over a very limited area (less than 15 cm from the rectum), being the mildest type of colitis.

In this condition, patients may experience symptoms such as urge to defecate, bleeding and rectal pain.

Proctosigmoiditis

Proctosigmoiditis is the type of colitis where inflammation occurs in the rectum and sigmoid colon, part of the colon that is located just above the rectum.

Patients with this type of colitis may experience bloody diarrhea, cramps and difficulty defecating.

Enterocolitis

Enterocolitis is a type of inflammation that affects the large and small intestines at the same time.

This type of colitis can be caused by infection (viral or bacterial), food poisoning or medication.

Degrees of colitis

Colitis, in addition to being divided into some types, can also be classified into three different degrees, according to the intensity of the symptoms:

Light

Mild colitis is one in which the patient may experience episodes of diarrhea requiring 3 or fewer bowel movements per day. In such cases, the person may have no blood present in the stool, or change in the functioning of other systems.

In this degree of the disease, some tests that can identify the inflammation can show normal results, even with the active disease.

Moderate

This condition is characterized when the disease causes 4 bowel movements or more per day. In patients with moderate colitis there is also systemic involvement, that is, other systems of the body are affected by the disease.

Serious

The patient needs to go to the bathroom to evacuate more than 6 times a day, with the presence of blood in the stool . As with moderate colitis, there is also systemic involvement, but with more severe symptoms.

Therefore, in severe colitis the patient may experience tachycardia, fever and changes in the speed of globular sedimentation, that is, the rate at which erythrocytes (red blood cells) precipitate within a period of one hour.

This is one of the signs of inflammation located in the body or the presence of some type of cancer.

Causes: how does the disease arise?

Colitis is a disease that does not have a single exact cause. There is some evidence, but there are also many myths surrounding the factors that cause the disease.

What is known is that this is not a contagious disease and that it is not related to factors such as diet or everyday stress.

In this regard, the patient who is diagnosed with colitis may be more relieved, as it is not an isolated behavior or habit that causes the disease.

The explanation most accepted by doctors is that this disease is caused by several factors.

There are three aspects that can together cause the development of colitis: immune system, genetics and environmental factors .

Variation in the immune system

Thus, the patient who develops the disease may have inherited some gene that makes him more vulnerable, or it may also be that some environmental factor has caused an abnormal response in the autoimmune system, causing the organism itself to attack the colon region.

What are the factors that could lead to this autoimmune response, however, is not yet known exactly.

But inflammation is believed to happen from this disorder in the immune system.

Without the correct help of antibodies, the inflammation becomes more severe and damages the wall of the large intestine, causing the characteristic symptoms of the disease.

From the diagnosis of the type of colitis, the factors that may have caused it are identified. In some cases, unfortunately, it is not possible to trace what caused the inflammation.

Genetics

Having a family history of the disease is considered a risk factor for colitis as well. For these people, more frequent follow-up is recommended to investigate the disease.

Environmental factors and other diseases

Other factors that can trigger inflammation are infections caused by viruses and parasites, irritable bowel syndrome, insufficient blood circulation in the colon, exposure to radiation and food poisoning caused by bacteria.

Groups and risk factors

Because it often occurs due to unknown causes or different agents, colitis is not a disease that has well-established groups or risk factors, with age and family history being the main alerts.

It can affect men and women in the same way in any age group, the diagnosis being more common in people aged 15 to 25 years.

However, people between the ages of 60 and 80 who experience the symptoms should also investigate the disease.

Also having a close family member with a history of the disease can increase the chances, so it is necessary to maintain a healthy routine of visits to the doctor to investigate the condition.

What are the symptoms?

 

Colitis is a disease that causes inflammation of the large intestine and, in some cases, the rectum. From this, several symptoms can arise:

Ulcers and bleeding

Colitis can cause ulcers on the wall of the large intestine and the rectum. Thus, the intestine’s ability to absorb water from waste (fecal cake) that passes through the region is impaired.

Therefore, diarrhea is one of the most common symptoms, because the stool becomes very soft.

With the damaged wall, the intestine also starts to produce a lot of mucus, being another symptom of the disease the presence of this secretion in the feces.

Ulcers caused on the wall of the intestine can also cause bleeding, so eventually, patients with colitis report the appearance of blood in the stool.

In cases where there is excess blood loss, there is also a reduction in red blood cells, which can cause anemia .

Diarrhea

Diarrhea is a very common symptom in patients with colitis, due to poor absorption of water by the intestine. Generally, diarrhea episodes cause urgency to defecate in patients, which also causes a lot of discomfort on a daily basis.

Abdominal pain

Patients with this disease may frequently complain of abdominal pain and cramps, which may be accompanied by diarrhea.

Reduced appetite and weight loss

By the sum of all symptoms, the patient may also have a reduction in appetite and consequently this has an impact on weight.

Extraintestinal manifestations

Colitis, in addition to affecting the gastrointestinal system and, from there, causing the symptoms mentioned above, can also manifest signs in other parts of the body.

They are symptoms called extraintestinal manifestations of ulcerative colitis, which may be the first signs of the disease in some patients or may never appear in others. Are they:

  • Redness, pain and itchy eyes;
  • Mouth ulcers;
  • Inflammation and joint pain;
  • Itching and the appearance of painful lumps on the skin;
  • Osteoporosis.

Diagnosis: what is the test to detect colitis?

The diagnosis of inflammatory bowel diseases, as is the case of colitis, is made from several tests, in addition to analysis of symptoms and patient history. The gastroenterologist or coloproctologist is usually the one who makes the diagnosis and orders the exams .

The main exams include:

Blood test

The doctor may order a blood test so that it is possible to identify the presence of specific antibodies and to confirm the presence of any inflammation.

In cases where the patient has blood in the stool as a symptom, this test helps to confirm anemia.

Colonoscopy

colonoscopy is an imaging test done by introducing an endoscope in the patient, so that you can view the rectum and large intestine structures.

The device consists of a thin tube with a camera on the end, which allows you to capture images and observe inflamed or ulcerated tissues. Usually, the patient performs the examination under sedation, so that it is not uncomfortable.

During this procedure, it is also possible that a little of the injured tissue is removed for biopsy, which allows other tests to be done for a more accurate diagnosis.

The biopsy allows highlighting the infection caused by H. pylori and colorectal cancer, for example.

It is also an exam used to differentiate colitis from Crohn’s disease, however, it does not always allow the diagnosis, which requires other exams.

Stool examination

Stool examination may be requested to assess whether the patient has an infection or to identify the presence of blood in the collected material.

Imaging exams

Some non-invasive imaging tests may also be ordered to help confirm the diagnosis of colitis. Typically, the most common are X-rays , MRIs and CT scans .

X-ray, for example, is one of the simplest exams among imaging exams. In it, the patient may need to take a contrast liquid called barium, which helps the doctor to assess the structures of the digestive tract.

Magnetic resonance imaging, in patients investigating colitis, also helps to assess abdominal structures, but it is a much more advanced technology than X-rays.

The images obtained in this exam have greater definition of the organs, without the need for radiation.

Computed tomography, on the other hand, is a more technological procedure than X-ray, which allows images of organs from different angles to be obtained, also forming three-dimensional images.

Is colitis curable?

No , colitis is a disease that has no definitive cure. As it does not have an exact cause, the prognosis of the disease is something very particular, as the symptoms, time until diagnosis (early or late) and treatment can vary.

On the other hand, there are treatments and changes in habits that can bring quality of life to these patients.

What is the treatment?

 

The different types of colitis are treated with a combination of medication use and a change in eating habits, which become a little more restricted.

The main objective of treatment is to seek remission of the disease, so that the symptoms are controlled and the patient can lead a comfortable life.

In less frequent cases, in which the patient does not respond well to drug therapy, surgical intervention may be necessary.

Thus, colitis treatments can be divided between diet, medication and surgery:

Medicines

The action and type of medications used depend on the cause, all of which are used to reduce inflammation in the colon and rectum and also to eliminate diarrhea, abdominal pain, bleeding and other symptoms.

The dosages and remedies prescribed may be different for each patient, as they vary according to the needs of each person.

With the treatment well underway, the remission of the disease can last for months or even years.

It can happen that the disease causes seizures and the inflammation returns, that’s why medical monitoring is so important.

Seizures, in addition, can be an indication that it is necessary to change the treatment, changing the dose, frequency or medication used.

In some cases, where treatment with medication is not enough and dietary change is also sufficient, the patient may have to undergo a surgical procedure.

Anti-inflammatory drugs, corticosteroids, immunomodulators and Anti-TNF (tumor necrosis factor) can be prescribed.

Diet

The diet for patients with colitis should be carried out according to medical guidelines, considering the deficiencies and dietary restrictions of each patient individually.

The biggest restrictions are aimed at the crisis phase, in which certain types of food can worsen symptoms, such as fatty foods, rich in fiber, carbonated drinks, milks and derivatives.

Read more: Why should we eat fiber and what is the ideal daily amount

In more specific conditions, the doctor can also guide the patient to follow some more restricted diets, so that food and drug treatment do not conflict or not to worsen the patient’s condition.

Some examples are diets low in sodium, fiber, fat and the high calorie diet:

  • Low sodium diet : it is more recommended for patients who are on corticosteroid medication, to help decrease fluid retention;
  • Low fat diet : during crises, maintaining a diet with light foods is more recommended, as absorption is slower and digestion of fatty foods becomes more difficult;
  • Hypercaloric diet : can be indicated for patients who are underweight or with developmental delay;
  • Diet low in fiber : during attacks, patients with colitis should avoid foods rich in fiber to prevent further stimulation of bowel movements.

Surgery

It is a resource in patients who present a severe condition of the disease, in which the inflamed part is extremely injured.

In these cases, part of the colon and rectum are removed during surgery, a procedure called proctocolectomy .

Surgery is also a resource for treating patients who have not improved with any drug therapy.

It can also be a way to prevent and treat more serious complications.

Among these complications are cases of bleeding, perforation, deep ulcers in the intestinal mucosa and toxic megacolon.

There are, therefore, two types of surgery for patients with colitis:

  • Ileostomy: the patient is submitted to the use of an external bag, placed through an opening in the patient’s abdomen, through which the feces are released;
  • Ile-anal anastomosis : the patient uses an internal pouch, made at the place where the small intestine adheres to the anal sphincter.

Colitis Medicines

There are some medication options that help in the treatment of colitis and they can be used orally or rectally, depending on the case of each patient.

The doctor can advise you on the use of painkillers and anti-inflammatory drugs to help relieve the inflammation and pain caused by the disease.

When it comes to a type of colitis caused by viral, bacterial or parasitic infection, specific antibiotics may be prescribed.

Colitis patients who have the disease due to an inadequate immune response may need to use immunosuppressants.

When the disease also affects the absorption of nutrients, some dietary supplements can be used to complement the treatment.

The main types of medication are as follows:

Anti-TNF

Anti-TNF (tumor necrosis factor) agents are drugs used in patients who do not respond well to other more conventional therapies.

TNF is a chemical that our own body produces, the drug being a protein produced in the laboratory to destroy this natural chemical in our body and reduce inflammation.

The substance Adalimumab ( Humira ) is an example of this type of therapy, being also prescribed to accelerate the healing of the mucosa of the large intestine and improve the symptoms of colitis.

Anti-inflammatories

The aminosalicylates are medicines commonly used to treat inflammatory bowel diseases. They are used to treat inflammation, but also to prevent seizures. One of the most prescribed is Mesalazine .

Corticosteroids

Corticosteroids are also used to help the patient’s body keep the inflammatory process in check and for complete remission to happen.

They can also be indicated for crisis control, but they should not be used for long periods, due to side effects.

Immunomodulators

These drugs interfere with the immune system’s reaction to inflammation in the body.

They are usually prescribed for patients with colitis who have not responded well with treatment with corticosteroids and aminosalicylates.

Attention!

NEVER self-medicate or stop using a medication without first consulting a doctor. Only he will be able to tell which medication, dosage and duration of treatment is the most suitable for his specific case. The information contained in this website is only intended to inform, not in any way intended to replace the guidance of a specialist or serve as a recommendation for any type of treatment. Always follow the instructions on the package insert and, if symptoms persist, seek medical or pharmaceutical advice.

Colitis Diet and Feeding Tips

 

Along with drug treatment, it is important that the patient takes other precautions, such as maintaining a healthy diet that does not harm the condition, especially during a crisis.

It is important to know that it is not the foods that cause colitis and therefore it is not necessary to cut food out of the diet to prevent the disease.

But, with the disease established, there are foods that can worsen the symptoms , causing greater discomfort and pain.

Therefore, in crises, the patient should avoid foods that form residues, such as foods rich in fiber, milks and by-products, fruits, vegetables, sausages, condiments and fatty foods.

Maintaining a very restricted diet is also not healthy, so it is important to have this support from specialists, who will know how to better guide patients.

Read more: Healthy Eating: what it is, benefits, how to have it, menu, tips

Check out other dietary tips that can help in daily living with the disease:

What to eat during crises?

During a crisis, the patient’s body is much more sensitive and eating can worsen pain and other symptoms.

Therefore, it is most recommended that patients prioritize some foods and avoid others.

Some good options for dieting during these periods include:

  • Vegetables well cooked, without peel and seed;
  • Foods made with refined grains and which have less fiber: white bread, white rice, corn flour, white pasta, oats, etc .;
  • Fruits such as bananas, melons and cooked fruits, which are low in fiber;
  • Leaner proteins. such as chicken, fish, eggs, tofu and soy;
  • Lactose-free milks and derivatives.

What not to eat?

During seizures, patients should avoid certain foods and habits that can make symptoms worse, such as cramps, gas and diarrhea. That includes:

  • Avoid fatty foods and fried foods;
  • Consume less dairy products;
  • Avoid soft drinks and other carbonated drinks;
  • Reduce coffee consumption;
  • Avoid foods rich in fiber, such as seeds, wholegrains, fruits, popcorn, nuts, etc .;
  • Moderate consumption of spicy foods.

What to eat when the disease is in remission?

When symptoms improve, the patient can gradually return to a diet rich in fiber and varied foods, with medical and nutritional monitoring to maintain the best possible diet for the case.

With the remission of the disease, the patient should be concerned with maintaining good hydration of the body, consuming plenty of water, broths, juices and vitamins .

Foods rich in fiber should also be part of the diet when the doctor understands that there is no problem in introducing these foods.

Vegetables, fruits, vegetables, lean proteins and probiotic foods can also be consumed. for the patient to have a diet rich in essential nutrients.

Food diary and periodic consultations with a nutritionist

There is no exact model of feeding that works for all patients with colitis in the same way.

Therefore, having a follow-up from a nutritionist is essential.

To help with consultations, the patient can keep a food diary, to record the daily foods and whether they help or worsen symptoms.

Thus, during the consultation, the nutritionist will be able to better evaluate and adjust the patient’s menu according to the experiences he has already had and described.

Prognosis

Colitis is, in most patients, a chronic disease. Therefore, it requires that the patient be careful to avoid recurrences and complications throughout his life.

Even with the treatment started, it can happen that the patient has seizures and presents the symptoms again.

In such cases, the doctor must evaluate a change in the doses or in the prescribed medications.

It is also known that it is possible that colitis causes severe complications and accelerated progression in the initial crisis in about up to 10% of patients with the condition, and may have complete recovery from symptoms and complications with early diagnosis.

In proctitis, the mildest type of the disease, serious complications are uncommon. However, it is possible that, in these cases, the disease spreads and also reaches the large intestine.

Complications

When colitis is not properly treated or when the diagnosis is delayed, the patient may have some more serious complications, such as the following:

  • Toxic megacolon (colon dilation);
  • Perforation of the intestinal wall;
  • Injuries;
  • Acute anemia;
  • Severe bleeding;
  • Severe dehydration;
  • Osteoporosis.

Can colitis patients develop colon cancer?

Colon cancer, or colorectal cancer, is a common type of cancer that can affect everyone in general.

However, patients who have an inflammatory bowel disease, such as colitis, are described as one of the risk groups for the development of the neoplasia.

Read more: 11 tips to prevent cancer and fight risk factors

For this reason, they could be more likely to develop the condition than healthy people, especially those who have a more severe type, which affects the entire colon region and for periods longer than 8 to 10 years.

On the other hand, there are also studies that show that patients who have colitis with early diagnosis and correct treatment may have the same risk of developing colon cancer as the general population.

In any case, these patients should be instructed to have a routine of visits to the doctor and periodic examinations to be able to identify the presence of polyps (abnormal tissue in the mucosa) or cancer at an early stage.

How to prevent it?

There is no specific prevention for colitis, as this is a disease that can happen due to several factors. However, it is possible for people to adopt some habits that can help, at a minimum, in early diagnosis and control of the condition.

First, it is essential to carry out consultations and periodic examinations to monitor health. When diagnosis is early, symptom control and remission is much easier.

Faced with symptoms, people should also seek a specialist as soon as possible, especially those with a family history.

In addition, care with food and healthy habits such as exercise, moderate alcohol consumption and stress control are also recommended.


Colitis, along with Crohn’s disease, is one of the most common inflammatory bowel diseases. Unfortunately, it is still a condition without a cure and without an exact cause, which makes prevention difficult.

But, despite the negative sides, it is a disease that has treatment and that allows patients to lead a comfortable and quality life.

If you have a family history or have any symptoms, see a doctor to be able to diagnose. Thanks for reading!

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