Colitis: Causes, Symptoms & Treatment

Significant functions of the human organism are attributed to the large intestine with digestion and immune defense. Therefore, it is all the more problematic when inflammation develops in the colon. This is because inflammation of the colon is characterized by severe symptoms in acute phases, which can result in life-threatening complications if not treated.

What is colitis?

Schmatic diagram showing the anatomy of the colon. Click to enlarge. Colitis is a chronic inflammatory disease of the colon and rectum, also known in medical terminology as ulcerative colitis. The inflammation affects only the uppermost layer of the intestinal mucosa, in which bleeding ulcers can form. In addition, those affected by colitis also have the rectum affected, from which the disease can spread in various directions. A complete cure of the inflammation of the colon is not yet possible, but the symptoms can be limited as far as possible using appropriate treatment methods. Often there is a confusion of the inflammation of the colon with the disease Crohn’s disease. However, this disease only affects the small intestine, in which several layers of the skin become inflamed. Inflammation of the colon usually affects mainly males between 16 and 25 years of age, although only related to Germany, about 20 people per 100,000 inhabitants fall ill each year.

Causes

The exact causes of colitis have not been precisely clarified to date. However, it is assumed that the inflammation is caused by the genetic predisposition of the patient. Thus, specific genes have been discovered which exist in the body in an altered form in the presence of colitis. In addition to hereditary components, certain risk factors can also increase the likelihood of developing the disease. These include, on the one hand, diet, since patients often cannot tolerate certain foods with a high proportion of lactose. On the other hand, a malfunction of the immune system can promote the development of inflammation of the colon. There is also an increased risk of disease after surgical removal of the appendix or after giving up tobacco. Psychosomatic reasons, on the other hand, are excluded as a cause of colitis.

Symptoms, complaints, and signs

Characteristic of an inflammation of the colon is the sudden onset. The affected person usually suffers from severe diarrhea, whereby these are watery to thin. Depending on the individual course of the disease, an inflammation of the colon can bring a different appearance with a varying degree of symptoms. Generally, inflammation of the colon initially manifests itself only insidiously and only shows strong symptoms in later stages. In some cases, the disease also appears quite suddenly without any previous signs. During an acute phase of the disease, severe diarrhea is the defining feature of colitis. These diarrhea episodes can occur up to forty times a day and often have bloody and mucous secretions. Bowel movements are generally very painful and can often result in fecal incontinence, in which affected individuals are unable to control their stool. Patients with colitis also exhibit flatulence, which is usually caused by sugar intolerance. The symptoms described are also accompanied by severe, undulating abdominal pain in the lower abdomen, known in medical terminology as colic. Colic is caused by cramp-like muscle contractions in the muscles of the large intestine and can trigger nausea and vomiting in the patient. Furthermore, a considerable acceleration of the heartbeat to 100 beats per minute is possible, which in extreme cases causes circulatory collapse. In general, acute episodes of the disease also cause a general deterioration in health, with a decrease in performance, energy and weight. In rarer cases, fever episodes and inflammation of the joints, skin, or eyes also occur.

Diagnosis

The diagnosis of colitis is divided into two basic components.The patient’s individual medical history is first taken as part of an anamnesis before a physical examination is performed in the next step. This examination is usually a colonoscopy, during which an examination instrument called an endoscope is inserted through the anus. The condition of the mucous membranes and possible inflammations can then be examined. Pus deposits can also be detected using this method. Furthermore, tissue samples can be taken for microscopic examination in the laboratory, thus providing an exact result. If there is a hardened suspicion of colitis, a second colonoscopy is performed at a later date to confirm the diagnosis. The interval between colonoscopies depends on the patient’s state of health. In addition to a colonoscopy, a blood count is also performed if colitis is suspected. In particular, the hemoglobin value as well as the value of the so-called C-reactive protein are decisive in determining an inflammation. Progressive measurement of the hemoglobin value makes it possible to determine the respective extent of the inflammation and the amount of blood loss. To further ensure the diagnosis, liver values can also be determined, which are usually elevated by two enzyme values in the case of colitis. A stool examination is also performed in the laboratory to rule out bacterial infection as a cause of colitis.

Complications

The conventional symptomatology of inflammation of the colon may be complicated by the development of complications in certain cases. Among other things, the occurrence of severe bleeding is possible during acute episodes, forcing the patient to be monitored as an inpatient. Patients may also develop anemia as a result of bloody diarrhea. A dangerous enlargement of the large intestine is also conceivable, known in medicine as megacolon. Megacolon is caused by a paralysis of the intestine. This in turn results from a steady accumulation of stool in the intestine, as the intestine is unable to move and transport the stool as a result of the inflammation. As a further consequence, the intestine can painfully expand in this context, which in turn can lead to life-threatening threats such as inflammation of the peritoneum or intestinal perforation.

When should you go to the doctor?

At the appearance of the first signs and discomfort in the intestinal region, a visit to the doctor is always advisable to clarify the cause of the discomfort. However, at the latest after a presence of symptoms such as bloody diarrhea or severe abdominal pain, a visit to an expert is essential. This is particularly useful in view of possible complications that may occur if the diagnosis or treatment is too late. If possible, a gastrointestinal specialist such as an internist, proctologist or gastroenterologist should be consulted for advice and examination.

Treatment and therapy

Because the cause of colitis is not adequately understood, existing treatment approaches can only control the symptoms of the disease. Although no complete cure for the disease exists, this allows affected individuals to maintain a completely normal daily life during symptom-free periods of life. Even maintaining a liquid-intensive, low-fiber, high-calorie diet can have a positive effect on the course of the disease. If the affected person is lactose intolerant, lactose-free dairy products can be used. If, on the other hand, fat absorption is affected, products with so-called MCT fats from dietary products should be consumed predominantly. Anti-inflammatory drugs are often used in this context, which enormously prolong the time interval between two relapses. Medicinal treatment may include 5-ASA preparations, the effect of which is supported by the administration of cortisone if necessary. So-called immunosuppressants can also be taken to suppress the immune response. Antibiotics, on the other hand, are rarely prescribed. The respective drugs are usually applied to the site of inflammation where the extent of inflammation is greatest and the risks are lowest. In special cases, the drugs can also be injected via the bloodstream.Significant deficiency symptoms as a result of severe diarrhea can be combated by means of vitamin and mineral supplements if a mere change in diet has not been successful. If the course of the disease is particularly severe or accompanied by complications, surgical intervention is usually indispensable. During the operation, the large intestine is removed and the small intestine is converted so that the affected person can defecate in a conventional manner. In some extreme situations, however, the creation of an artificial bowel outlet can no longer be avoided.

Outlook and prognosis

No definite prognosis can be made in the presence of colitis. In general, however, it can be stated that a complete cure of the disease is impossible to date. However, if the inflammation remains confined to the colon and rectum, a positive course with an average life expectancy can be assumed. Even the measure of administering 5-ASA preparations reduces the risk of cancer by an enormous 75%. Nevertheless, patients with colitis have a significantly increased risk of developing a colorectal cancer tumor. On the other hand, if complications of the inflammation occur, such as cancer, life expectancy is significantly reduced if they are diagnosed and treated relatively late. In turn, with the help of early surgical or drug treatment, patients can usually live a normal everyday life.

Prevention

Specific prevention of colitis is not possible because of the undetermined causes of the disease. However, following certain measures can prolong the quiet phases of the disease, or remission phases, and thereby make everyday life easier for those affected. Important for this is a generally healthy lifestyle, which is primarily characterized by a balanced diet. This means that mainly easily digestible foods with an optimal nutrient composition should be consumed. Sufficient exercise is also crucial for a healthy lifestyle. Psychological stress should also be avoided as far as possible. Due to the increased risk of colorectal cancer, those affected should attend regular preventive medical checkups.

Aftercare

In the case of colitis, there are usually only a few measures and options for aftercare available to the affected person. In this case, the affected person is primarily dependent on the correct and, above all, early treatment of the colitis so that it does not spread to the other organs. If the disease is not treated, in the worst case it can also lead to the death of the affected person. Therefore, early diagnosis is the primary concern with this disease. In most cases, the disease can be treated with the help of medication, mainly antibiotics are used. The treatment lasts for about a week, and care must be taken to ensure that the medication is taken correctly and regularly. In many cases, further follow-up examinations are useful even after the symptoms have subsided, in order to detect further symptoms at an early stage. During the treatment, the affected person should only take gentle food and only after the treatment should the stomach and intestines become accustomed to normal food again. In many cases, tests should also be performed for intolerances and allergies that may have triggered the colitis. This may prevent the colon inflammation from recurring.

What you can do yourself

If colitis is already present, sufferers can also independently bring about a reduction in symptoms in addition to the treatment method they have chosen. Sufferers are particularly recommended to change their diet, which is known as an avoidance diet. As part of this diet, foods that promote inflammation are to be removed from the menu and replaced by anti-inflammatory products. This allows for a reduction in the risk of complications and an attenuation of certain symptoms. Especially during periods of recovery, the focus should be on a predominantly balanced diet rich in fiber. On the other hand, foods such as milk, oats or cereals can often trigger food intolerances. If, on the other hand, there is a relapse phase, a low-fiber diet is of central importance. Ultimately, however, even the implementation of an avoidance diet does not lead to a complete cure of colitis.