What is colitis?
The term colitis refers to any kind of swelling or inflammation of the large intestine (colon), which is near the end of the digestive tract, after the small intestine and before the rectum and anus. The primary functions of the large intestine are to absorb fluids from food remnants and produce stool, or feces.
Common symptoms of colitis include abdominal bloating, pain or cramping, bloody stools, diarrhea, excessive gas, and a constant urge to have a bowel movement.
Diseases, disorders and conditions that can cause colitis include:
Inflammatory bowel diseases (IBDs), including Crohn’s disease and ulcerative colitis
Insufficient blood flow to the colon
Intestinal infections, such as Salmonella food poisoning
Irritable bowel syndrome (IBS)
Radiation therapy of the colon
The wide variety of causes makes it difficult to estimate how many Americans are affected by colitis. For instance, a Centers for Disease Control and Prevention study estimates 3 million adults in the United States have IBD, but that is just one possible cause of colitis. It is likely that millions of Americans live with some form of colitis.
Treatment of colitis depends on the underlying disease, disorder or condition. The goal of a clinical evaluation is to identify the root cause(s) of the problem. Once doctors diagnose the underlying cause, it is important to follow the treatment plan you and your healthcare professional design specifically for you to reduce the risk of potential complications.
In some cases, colitis can quickly progress from a mild condition to a life-threatening situation. Seek immediate medical care (call 911) for serious symptoms, such as bloody and frequent diarrhea, painful bowel movements, vomiting, and abdominal tenderness, especially when the abdomen is pressed. These symptoms may be combined with pale or blue lips, fast heart rate, shallow breathing, weakness, and anxiety.
Seek prompt medical care for colitis symptoms that recur or are persistent.
What are the different types of 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
What are the symptoms of colitis?
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.
Common symptoms of colitis
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 pain or cramping
Constant urge to have a bowel movement
Excessive gas (flatulence)
Symptoms that might indicate a serious condition
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
Serious symptoms that might indicate a life-threatening condition
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
Change in alertness of level of consciousness, such as lethargy or passing out
Fast or uneven heartbeat or palpitations
Painful bowel movements
What causes colitis?
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.
Infectious causes of colitis
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
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
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
What are the risk factors for colitis?
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
Reducing your risk of colitis
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.
What are the diet and nutrition tips for colitis?
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:
Ask your healthcare provider or a dietitian for guidance before making significant changes to your diet.
What are some conditions related to colitis?
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
How do doctors diagnose colitis?
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
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?
How is colitis treated?
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.
Medications for colitis
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 treatments for colitis
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)
Home remedies for colitis
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.
How does colitis affect quality of life?
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
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.
What are the potential complications of colitis?
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:
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 perforation or rupture of the intestinal wall
Does colitis shorten life expectancy?
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.