Colitis: Types, Symptoms, Causes, Treatment and Diet

Colitis is defined as an inflammatory bowel disorder and is characterised by inflammation in the inner lining of the colon (large intestine) and rectum. The inflammation generally begins in the rectum and the lower part of the large intestine and gradually spreads upward to the entire colon. Colitis hardly affects the small intestine except for the lower part, which is known as the ileum.

For a person suffering from colitis, with time as the cells on the surface of the lining of the large intestine die and slough off, ulcers develop resulting in pus, mucous and bleeding. The inflammation of the inner lining of the colon may cause diarrhoea and/or frequent urge for emptying of the colon.

Broadly, colitis is classified into four major types. These include:

1. Ulcerative colitis:

   This is the most common type of colitis. Along with Crohn's disease, Ulcerative colitis (UC) is classified as inflammatory bowel disease. UC usually occurs when the immune system of the body becomes overactive against certain microbes like bacteria present in the digestive tract. It starts in the rectum and eventually spreads to the colon. The condition causes inflammation and painful ulcers within the large intestine's inner tissue lining.

2. Ischemic colitis:

   Ischemic colitis (IC) is a type of colitis that occurs when the colon experiences restricted flow of blood. The flow of blood can be obstructed by blood clots that can result in sudden blockage. Atherosclerosis, a condition that involves the build-up of fatty deposits in the blood vessels, is one of the major culprits that restrict the flow of blood to the colon.

3. Microscopic colitis:

   This condition is diagnosed by a physician after carefully examining a tissue sample of the colon under a microscope. Lymphocytic colitis and collagenous colitis are the two types of microscopic colitis. Lymphocytic colitis is diagnosed if there are too many lymphocytes in the tissue sample. Collagenous colitis is diagnosed when the lining of the colon becomes thick owing to the accumulation of collagen beneath the outermost layer of tissue.

4. Allergic colitis in infants:

   As the name suggests, the condition affects infants. It generally happens within 1 to 2 months after birth. Symptoms of this condition include excessive spitting up, reflux, fussiness, and possible flecks of blood in a baby’s stool. The cause of this condition is not known.

Colitis is caused by:

• Infections caused by bacteria, parasites, and viruses
• IBS such as ulcerative colitis or Crohn disease
• Allergy
• Microscopic colitis
• Ischemic colitis

The symptoms of a person having colitis may vary depending upon how severe the inflammations are and where the inflammation occurs. Some of the common symptoms of such a disorder include:

• Diarrhoea along with blood or pus
• Abdominal pain or Cramping
• Loss of appetite
• Rectal pain
• Bleeding of rectum
• Anaemia due to excess bleeding
• Urgency to defecate
• Inability to defecate despite urgency
• Fever
• Weight loss
• Weakness and lack of growth in children.

A few patients may also experience some indirect symptoms such as:

• Skin lesions
• Inflammation of eyes
• Osteoporosis
• Rashes
• Kidney stones
• liver disorders and Joint pain

A patient having such symptoms should immediately consult a doctor for proper diagnosis and treatment.

The diagnosis of patients suffering from colitis involves obtaining the medical history of the patient, physical examinations, and a few laboratory tests. A few popular ways of diagnosis are laboratory examination of stool sample, abdominal computed tomography, abdominal X-rays and colonoscopy.

Once the severity of the condition and the area of inflammation within the colon is accurately diagnosed, the treatment begins and it includes both either by drug therapy or by surgery (if found necessary by the doctor).

The problem of colitis is usually treated either by drug therapy or by surgery. There are several categories of drugs that may prove effective in the treatment of colitis. The type of drug prescribed by the doctor mainly depends on the severity of the condition that a patient suffers from. Moreover, the response of patients to various drugs may also be different and hence it might take some time for the doctor to find out the appropriate medicine that would be effective for a particular patient.

In addition to this, it is important for physicians to weigh out the benefits as well as the side effects of various medicines before prescribing them to their patient.

However, in severe cases of colitis, where medical treatment has no effect, the doctors may recommend surgical treatment. The surgical treatment involves the removal of the entire colon and rectum (proctocolectomy) of the patient.

This surgical method is followed by another process known as ileoanal anastomosis where the surgeon constructs a pouch from the end of the patient’s small intestine and attaches it to the anus. This pouch functions similar to the rectum and collects the stool of the patient and helps in excreting them out normally.

In cases of ulcerative Colitis when the symptoms are mild or moderate, it need not be consulted with a doctor and can be self-managed with the application of drugs or home remedies. But in some conditions there arises a need for urgent medical attention. These are the complications that are consequences of the disease and seek proper treatment.

Those serious complications include perforated colon, fulminant Colitis, toxic megacolon, liver, disease, colon cancer, heavy rectal bleeding, and severe dehydration.

Although no proven cause of Colitis is known till now neither the prevention methods have been discovered, still, diet is considered to be an effective way to the management of the disease. Some of the diet preferences that need to be considered are such as:

• Consumption of carbonated drinks should be avoided.
• More and more intake of fluids should be preferred.
• Small and frequent meals should be taken.
• High fiber foods like popcorn, nuts, and vegetable skins need to be avoided.
• Nutritional supplements like probiotics and vitamins are advised to be taken.

The drugs prescribed by the doctor for the treatment of colitis mainly include anti-inflammatory drugs, immune system suppressors, antibiotics, anti-diarrhoeal medications, pain relievers (except ibuprofen, naproxen sodium and diclofenac sodium as they tend to worsen the symptoms and increase the severity of the disease) and iron supplements.

The common anti-inflammatory drugs used in the treatment of colitis include amino-salicylates and corticosteroids. The immune system suppressors used for treatment are azathioprine, mercaptopurine, cyclosporine, infliximab, adalimumab, golimumab and vedolizumab.

Diet plays a key role in the management of ulcerative Colitis. Some of the foods which are preferred for easing the symptoms in its case are such as:

• Fruits that are low in fiber content like banana, honeydew melon, cantaloupe, and cooked fruits.
• lean protein such as fish, eggs, soy, and tofu.
• Refined grains include white rice, white pasta, oatmeal, and potato.
• Green vegetables in the form of fully cooked as well as seedless and skinless.
• Nutritional supplements such as protein shake.

• olitis is the inflammation of the colon's inner lining which could happen because of an infection caused by a bacteria, virus, or a parasite.
• While ulcerative colitis is more extreme than colitis and lasts lifelong, however, it is not caused by a pathogenic infection.

Like most other treatments, medications used for treating colitis also have some side effects. It is important for a patient to know how to differentiate between the symptoms of colitis and the possible side effects that may arise from its medications. A doctor, who prescribes the medicines for a patient of colitis, must always weigh out the benefits as well as the possible adverse side effects of the medication.

Some of the common side effects of the treatment of colitis include headache, nausea, vomiting, fever, rash, loss of appetite, decreased white blood cells, decreased sperm production in males, diarrhoea, abdominal pain and cramps, gas, hair loss, dizziness, kidney problems, weakness, pericarditis, pancreatitis, high blood pressure, weight gain, mood swings, acne, osteoporosis, cataracts, high blood sugar levels, insomnia, lymphoma and others. In case a patient suffers from some serious side effects then he/she must immediately consult a doctor for remedial measures.

The time taken for a patient of colitis to recover from this problem usually varies depending on the seriousness of the condition and the physiological response of the patient to the prescribed medications. Usually cases of mild colitis may take about 3 to 4 days to recover for children and about one week for adults. However, patients suffering from severe colitis may even take 3 to 4 weeks to recover from this condition.

The price of the treatment of colitis in India varies depending upon the seriousness of the condition of the patient and the medication that his/her doctor prescribes. Usually mild colitis can be treated with medicines that can cost as low as Rs. 1300 (for full treatment).

However, patients suffering from severe colitis may require costly medications and even surgical treatment (if necessary) and for such treatments, the price range can be between Rs. 57,400 to Rs. 7,87,500 in India. This treatment is available in almost all leading hospitals in India.

It should be remembered that colitis, being an auto-immune disease characteristically has a relapsing-remitting course and this means that there are periods of flare-ups which are then followed by a period of remission. Presently there are no medical treatments for the complete cure of colitis.

The medical treatments only tend to lessen the severity of the condition. However, conditions such as inflammation of the bowel, bloody diarrhoea and abdominal cramping can be stopped with surgical treatments.

A variety of treatment options exist for ulcerative colitis. These include medicine and dietary changes. It must be noted that these are not curative treatments. However, you can opt for surgery to get your colon and rectum removed.

There are natural remedies that are believed to cure colitis. Some of them are:

• Avoiding foods that lead to flare-ups
• Regular exercise
• Stress reduction
• Cognitive behaviour therapy
• Consuming omega 3 rich foods
• Intake of herbs like turmeric, ashwagandha etc.

There are certain simple measures that you can take to stop or reduce the frequency and intensity of colitis flare-ups. These measures include:

1. Keep a food journal: Kindly ensure that you have a record of everything you eat and drink. This will help identify the foods that trigger flare-ups. You can then avoid those foods and reduce your risk of flare-ups.
2. Limit your fibre intake: Too much fibre is associated with colitis flare-ups. Do not consume foods that offer more than 1 gram of fibre per serving. Such foods include white rice, white pasta, eggs, butter, fish etc.
3. Exercise:Regular physical activity can help reduce the risk of colitis flare-ups. Exercise is known to reduce inflammation in the body. However, it is recommended that you opt for low-intensity exercises like walking and swimming.
4. Reduce stress:Reducing stress can reduce the inflammatory response of the body and help overcome flare-up faster. Activities such as meditation, deep breathing exercises, etc can provide relief from stress. Also, ensure that you get adequate rest and sleep every day.
5. Eat smaller meals:Reducing meal size can help people with a history of colitis flare-ups. However, you can increase the frequency of meals but ensure that the meals are smaller than usual.

Although medical and surgical treatments are considered as the best ways to control the conditions of colitis, there are a few alternative treatments as well. The alternative treatments for the conditions of colitis include taking of herbal and nutritional supplements, probiotics, fish oil (although excess consumption of fish oil can cause diarrhoea), Aloe Vera gel, acupuncture therapy and/or turmeric.

In addition to this, the patient should avoid consumption of spicy food, dairy products, alcohol, beverages and fibres in their diet. Eating of small light nutrition-rich meals at regular intervals throughout the day, plenty of water and multivitamin supplement helps to recover from this condition.

Home remedies do not cure colitis but they can help in controlling the flare-ups and symptoms. Some home remedies that can help manage colitis are:

1. Having probiotics such as yogurt to promote the growth of helpful bacteria in the digestive system
2. Having a diet rich in calcium and vitamin D to minimize bone damage
3. Maintaining the electrolyte balance in the body
4. Having a low-fibre diet
5. Exercising regularly to support weight management and maintain energy levels
6. Avoid dairy products as these can trigger colitis flare-ups

Summary: Colitis is a condition which is associated with an inflammation of large intestine parts i.e colon and rectum. Although no proven cause of colitis is known till now neither the prevention methods have been discovered, some diet changes and lifestyle modifications are considered to be an effective way for control and management of the condition. It may be associated with some serious complications such as perforated colon, fulminant colitis, toxic megacolon, liver, disease, colon cancer, heavy rectal bleeding, and severe dehydration.