Colitis symptoms: What are the early signs of colitis?

Overview: What does colitis feel like?

Colitis is swelling of the inside lining of the colon. The inflammation can be the result of infections, autoimmune reactions, toxins, drugs, decreased blood flow, radiation therapy, or other problems. No matter what the cause, most people will experience colitis as watery diarrhea. Sometimes it will have blood, but not always. Abdominal pain and cramping are typical. Most people will also experience an urgent need to pass stools. Sometimes, that urgent need to defecate won’t go away even when the large intestine is emptied. Fever and fatigue are also possible, but it depends on the cause. Most of these symptoms have treatments, but in most cases, healthcare providers will target the cause for treatment.

What are the early signs of colitis?

The early signs of colitis typically are:

• Watery diarrhea

• Abdominal pain or discomfort

• Cramping

Other colitis symptoms

While colitis is marked by watery diarrhea, other symptoms are possible, as well. Some may be related to the swelling, but others may be secondary. The symptoms of colitis include:

• Watery diarrhea

• Abdominal pain or discomfort

• Abdominal cramps

• Bloody diarrhea

• Fever

• Bowel movement urgency, sometimes when the colon is empty

• Rectal bleeding

• Fatigue

• Loss of appetite

• Weight loss

Depending on the cause, secondary symptoms might include:

• Joint pain

• Arthritis

• Eye swelling

• Swelling in the mouth

• Mouth sores

Colitis vs. Crohn’s

Colitis has many causes. One possible cause is the immune system. In this case, the body’s immune system attacks healthy colon tissues. Called ulcerative colitis, this type of colitis is grouped with Crohn’s disease as inflammatory bowel disease (IBD). Inflammation due to ulcerative colitis is limited to the large intestine and rectum. On the other hand, Crohn’s disease can affect the entire gastrointestinal system, usually the small intestine. However, the colon can be affected, too. The symptoms are largely identical. Although ulcerative colitis is limited to the colon, the inflammatory response can cause problems throughout the body, so the body-wide symptoms of ulcerative colitis are similar to symptoms of Crohn’s. That’s not true of other types of colitis.

RELATED: Ulcerative colitis vs. Crohn’s: Compare causes, symptoms, & treatments

Types of colitis: How can I tell which one I have? 

Healthcare professionals distinguish between the various types of colitis based on the cause. After all, colitis treatment will be targeted at the cause. Because all types of colitis cause diarrhea and have similar symptoms, it’s hard to tell which type of colitis a person has until a healthcare provider has performed blood tests, stool tests, and examined the colon lining.

The types of colitis are:

• Infectious colitis: inflammation of the colon caused by a bacterial, parasitic, or viral infection

• Ulcerative colitis and ulcerative proctitis: inflammation of the lining of the colon or rectum caused by an immune system attack on the tissues lining the colon

• Ischemic colitis: colon inflammation resulting from reduced or obstructed blood flow to a part of the colon often as a result of a blood clot—common symptoms are extreme abdominal pain and bloody stools

• Allergic colitis (or eosinophilic colitis): most commonly seen in newborns and infants, allergic colitis is caused by white blood cells invading the colon tissues in response to a food allergy such as a milk protein allergy

• Microscopic colitis: inflammation of the colon due to several unrelated causes including drugs, smoking, bacteria, viruses, or autoimmune disorders—the distinguishing feature is chronic, daily diarrhea

Radiation treatment to the abdomen can also cause colitis, but it also usually involves the small intestines. The radiation injures the intestines, resulting in inflammation and diarrhea. The condition is usually temporary, but some people will have chronic or even lifelong intestinal problems after radiation therapy.

When to see a doctor for colitis symptoms

See a doctor if you experience any of these symptoms:

• Watery diarrhea persists for two days or more

• Blood is present in diarrhea

• Abdominal pain is severe or gets worse

• Abdominal pain isolated to the left side or right side of the abdomen

• Fever gets very high

• Dehydration starts causing symptoms like thirst, decreased urination, dark urine, weakness, and lightheadedness

To make a diagnosis, a healthcare professional, physician, or specialist in the digestive system will need to perform a physical examination and take a thorough history. Blood tests and stool tests will be used to identify the cause. An X-ray may be used, but a CT scan is more useful in identifying where the problem is located.

To make a definitive diagnosis, a doctor or gastroenterologist will need to examine the lining of the colon and rectum using an endoscope, a camera attached to a flexible tube. To examine the colon, they will either examine the rectum, anus, and colon above the anus with a short endoscope (flexible sigmoidoscopy) or the entire colon with a longer endoscope (colonoscopy). In some cases, the doctor may need to examine other parts of the digestive tract such as the esophagus or small intestine. Depending on the suspected cause, the doctor may perform a biopsy by removing tissue samples from the colon for microscopic analysis. 

Complications of colitis

Complications of untreated colitis will vary depending on the cause. Possible complications include:

• Dehydration

• Abscess

• Intestinal tears or holes

• Intestinal obstruction

• Incontinence

• Colon leakage

• Colorectal cancer

• Severe complications of bacterial infection, including body-wide nerve damage, kidney damage, brain disease, seizures, and extreme and life-threatening inflammation of the colon (toxic megacolon)

How to treat colitis symptoms

Not all cases of colitis will require treatment, but some types of colitis do require treatment. For the most part, treatment options will focus on the underlying cause. Sometimes medications may be used to reduce inflammation or control diarrhea.

Treatment usually consists of:

• Antibiotics to treat or prevent bacterial infection

• Antiparasitic drugs to eliminate parasite infections

• Antiviral drugs to control some types of virus infections

• Aminosalicylates (5-ASA), immune-modulating drugs, corticosteroids, or biologics to control inflammation due to ulcerative colitis

• Corticosteroids (budesonide), antidiarrheal drugs, or immune-modulating drugs to induce remission in people with microscopic colitis

• Surgical removal of part of the colon in extreme cases of ischemic colitis, inflammatory bowel disease, radiation enteritis

• Lifestyle and dietary changes in people with ulcerative, allergic, or microscopic colitis

In some people, over-the-counter medications might help such as antidiarrheal drugs and pain relievers. However, get medical advice from a healthcare professional before using these drugs.

Living with colitis 

Many people who experience a bout with colitis will get over it. Other people, though, may have chronic colitis conditions such as inflammatory bowel disease or microscopic colitis. For them, living with colitis means preventing flare-ups, effectively managing those flare-ups, and maintaining quality of life. Here are some tips:

• Take all medications as instructed

• Keep a symptom and drug side effects diary to help spot triggers and share with healthcare providers

• Follow all dietary recommendations

• Maintain general health through regular physical checkups, dentist visits, and vaccinations

• Avoid unhealthy habits such as smoking and drinking

• Manage stress

• Avoid certain foods like dairy products

FAQs about colitis symptoms

What are the three most common types of colitis?

Colitis is distinguished by the underlying cause. Infectious colitis is due to a colon infection. Ulcerative colitis is caused by an autoimmune attack on the colon.  Ischemic colitis happens when not enough blood and oxygen flow to the colon tissues and they start to die. Allergic colitis is an allergic reaction in the colon, usually to some food like milk proteins. Finally, microscopic colitis is a chronic condition caused by all sorts of things. It’s called “microscopic” because it can only be diagnosed by microscopic examination of the cells lining the colon.

Does colitis go away?

Colitis symptoms are usually temporary. However, some forms of colitis, particularly ulcerative colitis and microscopic colitis, are chronic conditions. They may oscillate between symptomatic flare-ups and symptom-free remission. 

What is the best treatment for colitis?

The best treatment for colitis will depend on the cause. Infectious colitis is often best treated with drugs that eliminate the infection. Ulcerative colitis and microscopic colitis are best treated with drugs that reduce inflammation and prevent flare-ups. Allergic colitis is best treated by taking certain foods out of the diet. Ischemic colitis is an emergency medical situation that usually requires antibiotics, increasing blood flow in the body, and possibly surgery. 

What’s next? Additional resources for people with colitis symptoms

Test and diagnostics

• Bowel ischemia, StatPearls

• Collagenous and lymphocytic colitis, StatPearls

• Diagnosis of ulcerative colitis, National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK)

• Eosinophilic colitis: epidemiology, clinical features, and current management, Therapeutic Advances in Gastroenterology

• Infectious colitis, StatPearls

Treatments

• Ulcerative colitis, StatPearls

• Ulcerative colitis treatments and medications, SingleCare

Scientific studies and clinical trials

• A population-based study of incidence, risk factors, clinical spectrum, and outcomes of ischemic colitis, Clinical Gastroenterology and Hepatology

More information on related health conditions

• Crohn’s disease treatments and medications, SingleCare

• IBS treatment and medications, SingleCare

• What is lactose intolerance? Causes, symptoms, and treatments, SingleCare