Description

Ischemic Colitis occurs when blood flow to part of the large intestine, or colon, is temporarily reduced. When the blood flow diminishes, the cells in the colon does not get enough oxygen, which can result in inflammation and damage of the tissues of the colon. Causes of the reduced blood flow can include narrowing of the blood vessels supplying the colon or low blood pressure. Ischemic colitis is also called colon ischemia.

Any part of the colon can be affected, but ischemic colitis most commonly cause pain in the left side of the belly area.

Ischemic colitis can be difficult to diagnose because it can be easily confused with other digestive problems. You may need medicines to treat ischemic colitis or prevent the infection. Or you may need surgery if your colon has been damaged. Most of the times, however, the ischemic colitis is cured on its own.

Symptoms

The symptoms of ischemic colitis may include:

  • Pain, tenderness, or cramps in the belly, which can occur suddenly or happen over time.
  • Red or maroon blood in the stool or, sometimes, the passage of the blood alone, without a stool.
  • A sense of urgency to have a bowel movement.
  • The diarrhea.
  • Nausea.

The risk of serious complications is higher when the symptoms occur in the right side of the belly. This is less commonly seen compared with left-sided colitis. People with right-sided colitis tend to have more underlying medical conditions, such as high blood pressure, atrial fibrillation, and renal disease. We most often have to undergo surgery and also have a higher risk of death.

When to see a doctor

Seek medical attention right away if you have sudden, severe pain in the abdomen area. The pain makes you so uncomfortable that you can't sit still or find a comfortable position is a medical emergency.

Contact with a health care professional if you have symptoms that concern you, such as diarrhea with blood. Early diagnosis and treatment can help prevent serious complications.

Causes

The exact cause of the decrease in blood flow to the colon is not always clear. But there are several factors that can increase the risk of ischemic colitis:

  • The accumulation of fatty deposits in the walls of an artery, also called atherosclerosis.
  • Low blood pressure, also called hypotension, associated with dehydration, heart failure, surgery, trauma, or shock.
  • Bowel obstruction caused by a hernia, scar tissue or a tumor.
  • The surgery with the heart or blood vessels, or the digestive or gynecological systems.
  • Medical conditions that affect the blood, such as lupus, sickle cell anemia or inflammation of the blood vessels, a condition known as vasculitis.
  • Cocaine or methamphetamine.
  • The Colon cancer, which is rare.

The function of drugs

The use of certain medications can also cause ischemic colitis, although this is rare. These include:

  • Some heart medications and migraine headaches.
  • The hormonal medications, such as estrogen and birth control.
  • Antibiotics.
  • The pseudoephedrine.
  • Opioids.
  • Illicit drugs, including cocaine and methamphetamines.
  • Certain drugs for irritable bowel syndrome.
  • The chemotherapy drugs.

Risk factors

Risk factors for ischemic colitis are:

  • Age. The condition mainly occurs in adults over 60 years of age. Ischemic Colitis that happens in a young adult can be a sign of a blood clotting issue. It can also be due to inflammation of the blood vessels, known as vasculitis.
  • Sex. Ischemic colitis is most common in women.
  • Clotting problems. Conditions that affect how the blood clots, such as factor V Leiden or the sickle cell disease, may increase the risk of ischemic colitis.
  • High cholesterol, which can lead to atherosclerosis.
  • The reduction of blood flow, due to heart failure, hypotension, or shock. The blood flow can also be affected by certain conditions, such as diabetes or rheumatoid arthritis.
  • Previous abdominal surgery. Scar tissue that forms after surgery can cause a decrease of blood flow.
  • Intense exercise, such as running a marathon, which can lead to the reduction of blood flow to the colon.
  • The surgery with the heart, the gastrointestinal or gynecologic systems.

Complications

Ischemic Colitis usually improve on its own within 2 to 3 days. In the most severe cases, complications may include:

  • The death of the tissues, also called gangrene, resulting from decreased blood flow.
  • Hole formation, also known as drilling, in the intestine, or the persistence of the bleeding.
  • Bowel obstruction, also called stricture disease.

Prevention

Since the cause of ischemic colitis is not always clear, there is no sure way to prevent this disorder. Most of the people who have ischemic colitis recover quickly and may never have another episode.

To prevent the recurrence of episodes of ischemic colitis, some health professionals recommend that you stop taking any medication that may cause the condition. Be sure to stay hydrated, especially when doing strenuous outdoor activities, it is also important. This is especially true for those who live in warmer climates. A test for clotting problems may be recommended as well, especially if there is no other cause of ischemic colitis is evident.

Diagnosis

Ischemic colitis can often be confused with other conditions due to which their symptoms overlap, especially inflammatory bowel disease (IBD). Based on the symptoms, a healthcare provider may recommend these tests image:

  • AbdominalCTscans, to provide images of the colon that may be useful to rule out other disorders, such as IBD .
  • Colonoscopy. This test, which provides detailed images of the colon, may be useful in the diagnosis of ischemic colitis. Colonoscopy can also be used to check for cancer, and to see how well the treatment worked. A sample of tissue, called a biopsy, can be collected to help make a diagnosis.
  • Stool analysis, to rule out infection as a cause of the symptoms.

Treatment

Treatment of ischemic colitis depends on the severity of the condition.

Often, the symptoms subside in 2 to 3 days in mild cases. A health professional may recommend:

  • Antibiotics to prevent infections.
  • Intravenous fluids, if the person is dehydrated.
  • Treatment for any underlying medical condition, such as congestive heart failure or an irregular heartbeat.
  • Do not take drugs that constrict the blood vessels, such as migraine or hormone medicines, and some medicines for the heart.
  • The rest of the intestine, which may involve temporarily getting nutrients from a feeding tube.

A care professional also may schedule the follow-up colonoscopies to monitor the healing, and to detect complications.

Surgery

If the symptoms are severe, or the colon has been damaged, surgery may be needed to:

  • Remove the dead tissue.
  • Repair a hole in the colon.
  • Remove part of the colon that has been reduced due to scarring and is causing an obstruction.

The probability that the surgery can be higher if the person has an underlying condition, such as heart disease, atrial fibrillation, or kidney failure.

Preparing for your appointment

Go to the emergency room if you have a bad stomach pain that makes you so uncomfortable that you can't sit still. You can be referred for immediate surgery to diagnose and treat your condition.

If your symptoms are mild and occur only once in a while, call your health care team for a quote. After the first evaluation, you may be referred to a doctor who specializes in digestive disorders, called a gastroenterologist or a surgeon who specializes in disorders of the blood vessels, called a vascular surgeon.

Here's some information to help you prepare for your appointment, and what to expect.

What you can do

  • Be aware of any pre-appointment restrictions, such as not to eat after midnight the night before your appointment.
  • Write down your symptoms, including when they started and how they may have changed or worsened with time.
  • Write down your key medical information, including other conditions with which you have been diagnosed.
  • Make a list of all the medicines, vitamins, and supplements you are taking.
  • Write questions during your appointment.

Questions to ask your doctor

  • What is the most likely cause of my condition?
  • What kinds of tests do I need?
  • I have other health problems. How can I best manage these conditions?
  • If I need surgery, what will my recovery be like?
  • How will my diet and life style changes after I have the surgery?
  • What follow-up care will I need?

What to expect from your doctor

Your provider is likely to ask you questions about your symptoms, such as:

  • When did you begin experiencing symptoms?
  • The symptoms been continuous or occasional?
  • How severe are the symptoms?
  • Where do you feel that your symptoms?
  • Nothing seems to improve the symptoms?
  • What, if anything, appears to worsen your symptoms?
Symptoms and treatment of Ischemic colitis