What is Ischemic Colitis

Ischemic colitis is damage to the large intestine due to reduced blood flow (ischemia) to the colon. The colon is the last section of the large intestine, where stool is formed.

The reduced blood flow may lead to the death of cells (necrosis) in the lining of the colon, damaging the colon and often causing bleeding.

Most cases of ischemic colitis clear up in a few days with treatment. In other cases, blood flow does not improve, and parts of the colon start to die. This is extremely serious and even life-threatening. If this happens, surgery may be required. In some cases, parts of the colon may need to be removed.

What are the causes?

Ischemic colitis results from a decrease in the blood supply to the colon. Many conditions can cause this, such as:

• Heart problems that reduce blood flow to the arteries that supply the colon. These include problems such as coronary heart disease, peripheral vascular disease, atrial fibrillation, and congestive heart failure.
• Low blood pressure from:
  • An infection that spreads to the blood (sepsis).
  • Dehydration or bleeding (shock).
• Drugs that narrow blood vessels (vasoconstrictors).

Sometimes the cause is not known.

What increases the risk?

You are more likely to develop this condition if:

• You are 60 years of age or older.
• You are female.
• You have another medical condition, such as:
  • Heart disease.
  • Diabetes.
  • Kidney disease that requires you to be on dialysis.
  • A disease that causes blood clots.
• You are frequently constipated.
• You have had surgery on the heart, blood vessels (such as the aorta), or colon.
• You take certain medicines or drugs, such as:
  • Medicines that suppress your immune system (immunomodulators).
  • Medicines that cause constipation.
  • Illegal drugs, such as cocaine or methamphetamines.
• You get an extreme amount of exercise from long-distance bike riding or running.

What are the signs or symptoms?

Symptoms of this condition start suddenly and may include:

• Dull pain, usually on the left side of the abdomen.
• Tenderness of the abdomen.
• Abdomen (abdominal) cramps.
• An urgent need to have a bowel movement.
• Loose, bloody stools with clots of dark or bright red blood.
• Nausea and vomiting.
• Fever.
• Weakness, fatigue, and confusion.

How is this diagnosed?

This condition may be diagnosed based on:

• Your symptoms, your medical history, and a physical exam.
• Tests to find out more about your condition and to rule out other causes of pain and bleeding. These tests may include:
  • Blood tests to check for clotting, blood loss, and low proteins in your blood.
  • CT scan of the colon.
  • A procedure to examine the inside of your colon using a scope that is passed through the rectum (colonoscopy). Colonoscopy is the most important diagnostic test. During this test, your health care provider may take a small piece of tissue from your colon to be examined under a microscope (biopsy).

How is this treated?

You may be hospitalized for treatment. Treatment usually includes:

• Not eating or drinking anything. This allows the colon to rest.
• IV fluids to maintain blood pressure, regulate blood minerals (electrolytes), and provide nutrition.
• Having a tube inserted into your stomach through your nose (nasogastric tube) to drain your stomach.
• IV antibiotic medicines. These may be used if an infection is suspected.
• Stopping or changing medicines that may be causing the condition.

You may need surgery if your condition is severe or if it gets worse or does not get better after a few days. Parts of the colon that will not recover may need to be removed. In some cases, a procedure is also done to attach the healthy part of the colon to the outer wall of the abdomen to drain stool (colostomy).

Follow these instructions at home:

• Follow instructions from your health care provider about eating or drinking restrictions.
• Drink enough fluid to keep your urine clear or pale yellow.
• Take over-the-counter and prescription medicines only as told by your health care provider.
• Return to your normal activities as told by your health care provider. Ask your health care provider what activities are safe for you.
• Do not use any products that contain nicotine or tobacco, such as cigarettes and e-cigarettes. If you need help quitting, ask your health care provider.
• Keep all follow-up visits as told by your health care provider. This is important.

Contact a health care provider if:

• You have blood in your stool.
• You have abdominal pain or cramps.
• You have constipation.
• You have nausea or vomiting.

Get help right away if:

• You have a moderate to large amount of loose, bloody stools with clots of dark or bright red blood.
• You have severe abdominal pain.
• Your abdominal pain has not improved after 24 hours.
• You have a fever.
• You have not been able to have a bowel movement, and you are in pain and vomiting.
• You have shortness of breath.
• You are very tired (lethargic) or have confusion.

Summary

• Ischemic colitis is damage to the large intestine due to reduced blood flow (ischemia) to the colon.
• Some of the symptoms of this condition include abdominal pain or tenderness, bloody stools, and an urgent need to have a bowel movement.
• Diagnosis usually includes a procedure to examine the inside of the colon using a scope that is passed through the rectum (colonoscopy).