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Colitis sounds mysterious and serious, but it’s something more like fever or swelling. In fact, it is swelling of the colon. Just like the skin or throat swells when irritated, the colon can also swell when it is irritated or injured. Colitis is usually caused by an infection, so it often resolves when the infection goes away. There could, however, be a more serious problem, so whenever the gut acts up for a few days, it’s a good idea to get it checked out.
What is colitis?
Colitis is swelling of the lining of the large intestine, commonly called the colon. Like most swelling, it is a symptom rather than a disease, and, like most swelling, it can be temporary or chronic. When the colon swells up, it is usually accompanied by abdominal pain, diarrhea, an urgent need to defecate, frequent bowel movements, and sometimes watery diarrhea, fever, or bloody stools. Colitis has many causes, and treatment consists of addressing the underlying cause. In some types of colitis, though, the swelling and diarrhea can be alleviated with medications.
Infectious colitis
Infections are the most common cause of colitis, particularly bacterial infections. Campylobacter, salmonella, shigella, Escherichia coli, and tuberculosis infections of the gut are the most common. The most severe and even life-threatening cases of colitis are caused by Clostridium difficile, which causes a severe and life-threatening type of colitis called pseudomembranous colitis, and E. coli, which hospitalizes several thousand people each year in the U.S.
Intestinal infections caused by viruses, such as cytomegalovirus, or parasites, such as amoebas (Entamoeba histolytica), also cause infectious colitis. Amebic dysentery (watery diarrhea) is a major cause of death in developing countries. Persons with HIV/AIDS infections frequently experience colitis resulting from opportunistic infections or side effects of antiretroviral medications.
Infectious colitis usually involves watery and sometimes bloody diarrhea, abdominal pain, and vomiting. The infection may or may not include fever. Infectious colitis is a temporary condition that resolves when the infection has been cleared.
Inflammatory bowel disease
Ulcerative colitis and Crohn’s disease, both called inflammatory bowel disease (IBD), are often debilitating conditions characterized by repeated swelling of the colon and rectum tissues. About 3 million people in the United States live with one of these conditions. Symptoms of ulcerative colitis and Crohn’s disease are severe diarrhea, abdominal pain, and weight loss. Neither are curable, but relapses can be controlled through drugs and lifestyle changes.
Microscopic colitis
Both lymphocytic colitis and collagenous colitis involve microscopic changes to the colon’s lining, so they are called microscopic colitis. They are caused by metabolic or autoimmune disorders such as celiac disease, psoriasis, Type 1 diabetes, and thyroid disorders. About 70,00 Americans are diagnosed with microscopic colitis each year. The primary symptom of microscopic colitis is watery diarrhea.
Certain drugs can cause microscopic colitis including aspirin, statins, beta-blockers, stomach acid reducers, immunosuppressive drugs, and vasopressors. No-one is certain how many people experience drug-induced colitis, but it is almost always a temporary condition that resolves when the drug is discontinued. Symptoms usually include diarrhea, general pain throughout the abdomen, blood in the stools, rectal bleeding, and vomiting.
Ischemic colitis
Ischemic colitis is like a stroke that affects the intestines rather than the brain. It results from injury to colon tissues due to lack of blood flow, usually as a result of a heart attack, congestive heart failure, plaque buildup, or blood clots. Inflammation, sores, and bleeding are a common result of ischemic colitis. About 15,000 to 150,000 people in the U.S. are diagnosed with ischemic colitis annually. Symptoms include diarrhea, abdominal pain, cramping, blood in the stools, and nausea.
Radiation colitis and enteritis
Inflammation of both the colon and the small intestine can be caused by radiation exposure, most commonly from cancer radiation therapy. However, medical procedures such as X-rays or CT scans can also irritate the colon tissues. Radiation colitis is usually temporary and is marked by diarrhea, cramping, nausea, and vomiting. Symptoms are temporary and usually fade in a few weeks. However, chronic radiation colitis can occur months to years following radiation therapy due to radiation damage. It is a progressive and serious complication of radiation therapy.
How is colitis diagnosed?
Colitis is a symptom that is only a piece of a diagnostic puzzle. A physician needs to put all the pieces together to diagnose the underlying condition, so diagnosis may involve a physical exam, medical history, blood tests, stool tests, colonoscopy, biopsy, imaging, or heart tests.
Physical and history
The healthcare provider is looking to piece together the symptoms and signs of an underlying condition. The healthcare provider will be interested in medication history, other conditions, and any previous bout with colitis.
The symptoms of colitis vary depending on the underlying cause. Any particular set of symptoms helps the doctor zero in on the diagnosis. Abdominal pain, cramping, diarrhea, watery diarrhea, bloody diarrhea, bloody stools, urgency to defecate, frequent bowel movements, weight loss, and malnutrition can all be part of the colitis experience. Some associated symptoms such as weight loss, anemia, changes in blood circulation, and heart arrhythmias are warning signs that the underlying condition could be serious.
Blood and stool tests
Infections are the most common cause of colitis, so blood and stool tests are used to rule out microbes as the primary cause. Levels of certain substances in the blood could help identify other forms of colitis such as ischemic colitis, Crohn disease, ulcerative colitis, or microscopic colitis. The sedimentation rate of red blood cells helps to identify inflammatory conditions, such as active ulcerative colitis or Crohn’s disease.
Colonoscopy
For colitis not caused by infection, a gastroenterologist, or digestive system doctor, will want to view the inside of the rectum and colon. A sigmoidoscopy involves inserting a scope up the rectum to view the colon just before the rectum. A colonoscopy involves viewing the length of the colon with a long, flexible scope. Both allow the gastroenterologist to view the inflammation and any sores in the large intestine.
Biopsy
When a patient has microscopic colitis, the surface of the colon looks normal during a colonoscopy. To diagnose collagenous or lymphocytic colitis, the gastroenterologist must remove a sample of the intestinal lining and examine it under a microscope.
Imaging
X-rays, a CT scan, or MRI may be used to rule out other conditions, identify other problems with the colon, or identify possible changes in the colon tissue.
Electrocardiogram
If the doctor suspects ischemic colitis, the culprit may be a heart problem. An electrocardiogram or echocardiogram may be used to determine the heart’s health.
Colitis treatment options
In most cases, colitis is treated by focusing treatment on the underlying condition.
Infectious colitis
Bacterial infections are treated by antibiotics, typically metronidazole, fluoroquinolones, and, in severe cases of C. difficile infections, vancomycin. For colitis caused by certain toxic strains of Escherichia coli, however, antibiotics will not be used because they can make the condition worse. Colon tuberculosis is treated with several months of tuberculosis antibiotics.
Amoebic colitis treatment will be treated with medications that target amoebas that have invaded tissues, as well as organisms living in the lining of the colon. Cytomegalovirus is treated with the antiviral medication valganciclovir.
Inflammatory bowel disease
Inflammatory bowel disease—ulcerative colitis and Crohn’s disease—is primarily treated with anti-inflammatory drugs to reduce swelling. More severe cases may require drugs that block the immune system. The most severe cases may require a part of the colon, or the entire colon, be surgically removed. Lifestyle and dietary changes are the primary ongoing treatment for preventing flare-ups.
Microscopic colitis
Both lymphocytic colitis and collagenous colitis are treated with medications that prevent diarrhea, reduce swelling, or, in severe cases, suppress the immune system. Dietary changes, however, are the central foundation of treating and managing the condition. For drug-induced colitis, the primary treatment is to discontinue the drug causing the problem.
Ischemic colitis
For ischemic colitis, treatment focuses on the underlying problem, such as heart arrhythmias or congestive heart failure. Swelling and ulcers in the colon may be treated with anti-inflammatory medications.
Radiation colitis and enteritis
For temporary colitis caused by radiation, treatment consists of monitoring or, in more severe cases, using feeding tubes. Anti-inflammatory drugs such as aminosalicylates can help relieve the swelling. Chronic radiation colitis is treated with anti-inflammatory drugs, glutathione, antioxidants, and, in serious cases, surgery.
Colitis medications
Medications used to treat colitis will vary depending on the underlying cause. Some drugs commonly used for colitis, such as antibiotics, treat the underlying condition but not colon inflammation. Colitis itself is treated with anti-inflammatory drugs, corticosteroids, antidiarrheal agents, and, in severe cases, immune system suppressants.
Antidiarrheal agents
For most cases of colitis, diarrhea is treated with antidiarrheal medications. Antidiarrheal agents work in one of two ways. They either reduce the amount of water and electrolytes dumped by colon tissues into the colon (bismuth subsalicylate) or they slow down the colon’s movement of waste materials (loperamide). Both methods dry the stool and allow more fecal material to build up in stools before defecation.
Anti-inflammatory agents
The drug of choice to reduce swelling in colon tissues are aminosalicylates, usually sulfasalazine or mesalamine. These drugs block the body’s production of inflammatory substances and so help relieve the colitis symptoms. They are the first-line therapy to treat inflammatory bowel disease, ischemic colitis, radiation colitis, and microscopic colitis.
Corticosteroids
Corticosteroids are used in the short-term to rapidly reduce colitis symptoms and induce remission during active flare-ups of inflammatory bowel disease, microscopic colitis, or radiation colitis. Most patients will be given oral corticosteroids, but steroids can also be delivered as a suppository, rectal foam, or enema. Prednisone and budesonide are drugs of choice.
Immunomodulators and immunotherapy
Both inflammatory bowel disease and microscopic colitis can be chronic conditions with repeated flare-ups. In these conditions, colitis is caused by substances produced by the immune system. When anti-inflammatory drugs or corticosteroids fail to work, doctors will turn to drugs that partly shut down the immune system, called immunosuppressants or immunomodulators.
The first-line therapies are immunosuppressants, usually azathioprine, mercaptopurine, or methotrexate. When these medications fail, doctors will turn to immunotherapy using monoclonal antibody injections, such as Remicade (infliximab), Humira (adalimumab), or Entyvio (vedolizumab), or they will use small molecule immune inhibitors such as Xeljanz (tofacitinib) or Sandimmune (cyclosporine), normally used for cancer treatment or organ transplants.
What is the best medication for colitis?
Medicines that directly treat colitis either reduce diarrhea, reduce swelling, or partly shut down the immune system. There is no “best” medication for colitis, just drugs that are the most appropriate for the patient’s medical situation and tolerance for side effects.
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| Best medications for colitis | ||||
|---|---|---|---|---|
| Drug Name | Drug Class | Administration Route | Standard Dosage | Common Side Effects |
| Pepto-Bismol (bismuth subsalicylate) | Antidiarrheal agent | Oral | Two tablets every half hour or four tablets every hour as needed | Constipation, abdominal pain, black tongue |
| Imodium A-D (loperamide) | Antidiarrheal agent | Oral | Two capsules after first loose stool, followed by one cap after each loose stool, up to max of four caps in 24 hours | Constipation, dry mouth, flatulence |
| Azulfidine (sulfasalazine) | Anti-inflammatory agent | Oral, rectal, or enema | Four 500 mg tablets daily | Stomach upset, nausea, diarrhea |
| Apriso (mesalamine) | Anti-inflammatory agent | Oral, rectal, or enema | Four 0.375 gram capsules once daily in the morning | Headache, diarrhea, abdominal pain |
| Prednisone | Corticosteroid | Oral | 40 to 60 mg per day to be tapered off over one to three months | Fluid retention, increased blood pressure, behavior and mood changes |
| Uceris (budesonide ER) | Corticosteroid | Oral | One 9 mg tablet taken once per day for up to eight weeks | Headache, nausea, upper abdominal pain |
| Imuran (azathioprine) | Immunosuppressant | Oral | Dose depends on weight | Bone marrow suppression, abdominal pain, nausea |
| Purinethol (6-mercaptopurine) | Immunosuppressant | Oral | Dose depends on weight | Bone marrow suppression, abdominal pain, nausea |
| Methotrexate | Immunosuppressant (antimetabolite) | Subcutaneous or intramuscular injection | Up to 1 ml of 50 mg/ml once weekly | Low white blood cell counts, nausea, abdominal pain |
| Remicade (infliximab) | Tumor necrosis factor-alpha inhibitor | Intravenous infusion | Given in weeks zeor, two, and six and then every eight weeks. Dose depends on weight | Infections, headache, abdominal pain |
The standard dosages above are from the U.S. Food and Drug Administration (FDA) and the National Institute of Health (NIH). Dosage is determined by your doctor based on your medical condition, response to treatment, age, and weight. Other possible side effects exist. This is not a complete list.
What are the common side effects of colitis medication?
All medications may have side effects, and different classes of medications have different side effects. However, this is not a complete list, and you should consult with your healthcare professional for possible side effects and drug interactions based on your specific situation.
Antidiarrheal agents either slow down the colon or reduce water secreted into the colon. As expected, the most commonly experienced side effect is constipation. Other side effects will depend on the particular drug, but abdominal pain, nausea, and vomiting are common. Bismuth, perhaps the most popular over-the-counter antidiarrheal medication, is related to aspirin, so it should not be taken by people with an aspirin allergy or by children or teens with a viral infection, due to the risk of Reye’s Syndrome.
Aminosalicylates are the most common anti-inflammatory drug used for colitis because they are both safe and effective. Side effects include headache, abdominal pain, nausea, and loss of appetite. They should not be taken by people who are allergic to aspirin. Sulfasalazine should not be taken by people allergic to sulfa drugs.
Corticosteroid use typically causes mood changes, increased appetite, high blood pressure, weight gain, acne, and cataracts. Steroids may also weaken the immune system and leave patients vulnerable to infections.
Immunosuppressants and immunotherapy antibodies weaken the immune system, so the most serious side effects are increased cancer risk and infections. Other severe side effects might include arthritis, organ damage, and, with monoclonal antibodies, severe allergic reactions.
What is the best home remedy for colitis?
Most cases of colitis go away with nothing more than riding it out. Mild to severe diarrhea is the most common symptom, so the goal of home treatment is to replace fluids and electrolytes. Chronic colitis may require dramatic changes in diet and lifestyle to prevent flare-ups.
Drink plenty of fluids
Drink fluids throughout the day to prevent dehydration, the most dangerous complication of diarrhea. If diarrhea is severe and watery, drink only clear fluids such as water, juice, and broth.
Replace electrolytes
Colitis causes the colon tissue to shed lots of ions (electrolytes), which can throw the body’s electrolyte balance off-kilter. Consume electrolyte-rich foods such as broths, soups, and bananas to replace needed electrolytes. Or make one of many recipes for homemade Oral Rehydration Solution which is a great way to replace lost electrolytes.
Avoid foods that make symptoms worse
Colitis isn’t the right time for chili peppers. Avoid foods that irritate the digestive system such as spicy foods, dairy, high-fiber foods, caffeine, and alcohol.
Lifestyle changes
Chronic colitis caused by inflammatory bowel syndrome, microscopic colitis, or radiation colitis will require dramatic changes in diet and lifestyle. Diet should consist entirely of nutrition-rich foods to avoid malnutrition, anemia, and weight loss. Fatty foods and dairy products are generally avoided or greatly reduced, as are any foods that bulk up stools, such as high-fiber foods. Lifestyle changes should focus on reducing stress, including good sleep hygiene and relaxation techniques.
Frequently asked questions about colitis
How do you stop a colitis flare-up?
Chronic colitis due to inflammatory bowel syndrome (Crohn’s disease and ulcerative colitis), microscopic colitis, or radiation colitis are controlled by medications and diet. Medications of choice are aminosalicylates and corticosteroids.
How long does colitis take to heal?
Colitis can be brief and mild, lasting only days, or chronic with flare-ups that can go on for several months. In general, however, colitis caused by infections typically last about one week before the body clears the infection and the colitis goes away.
How can I treat colitis at home?
The primary goal of treating colitis at home is to replace fluids and electrolytes lost because of diarrhea. Drink fluids throughout the day and include electrolyte-rich foods such as broths or soups. If the colitis is caused by an infection, get plenty of rest to help the body carry on the fight against the pathogen.
Does colitis go away?
Colitis is most often a temporary condition caused by an infection. The body usually fights off the infection in about a week and the colitis goes away. Colitis can, however, be due to injury (ischemic colitis or radiation colitis) or a chronic condition (inflammatory bowel disease or microscopic colitis). Flare-ups happen periodically and may take weeks or months to go away even with treatment.
What foods soothe colitis?
Colitis has many causes, so no food helps with all bouts of colitis. Foods that “soothe” ulcerative colitis, such as foods rich in omega-3 fatty acids or meat, will make infectious colitis feel a lot worse, and patients with ischemic colitis need to stay away from fatty foods altogether. Consult with your doctor or a nutritionist about what diet is most suitable for your condition.
What tea is good for colitis?
Teas high in antioxidants, such as green tea, may help reduce swelling and pain of the intestinal tissues. Colitis is often associated with an increase in substances, called reactive oxygen species (ROS), which easily react with oxygen and can damage tissues and worsen inflammation. Infections, ischemia (lack of blood flow), radiation, and inflammatory conditions all increase the amount of these substances. Antioxidants neutralize reactive oxygen species by reacting with them before they react with molecules in the body’s tissues, minimizing the damage they do. While reactive oxygen species do not cause colitis, they can make the condition more unpleasant.
What herbs are good for colitis?
Colitis can be caused by many conditions including bacterial infections, parasite infections, radiation injury, lack of blood flow, drugs, and autoimmune disorders. There are no herbs that have been scientifically proven to help with any of these colitis conditions.
What can I drink with ulcerative colitis?
No matter what the cause, drink clear fluids to help you through a bout with colitis. Caffeine, alcohol, and dairy are generally to be avoided.
What is the best pain medication for ulcerative colitis?
If you take a pain medication, try using acetaminophen. NSAIDs such as aspirin or ibuprofen can cause colitis, so they are probably not a good idea to take during the throes of a colitis bout.
What is the best medicine for IBD?
Inflammatory bowel disease—ulcerative colitis and Crohn’s disease—are treated with aminosalicylates as first-line therapy. These drugs block the production of inflammatory substances in the colon tissues, helping to prevent or reduce swelling.
What medications should be avoided with ulcerative colitis?
When colitis strikes, medications to avoid will depend on the condition responsible. For instance, patients infected with toxic strains of E. coli need to avoid both antibiotics and antidiarrheal medications, both of which can make the condition significantly worse. There are, however, medications that irritate the bowel and cause or worsen colitis. These include nonsteroidal anti-inflammatory drugs (NSAIDs), beta-blockers, statins, stomach acid reducers, vasopressors, and immune suppressants.
What happens if you don't treat colitis?
Colitis is usually a temporary condition that resolves on its own in a few days to a week. It can, however, be a sign of a more serious condition such as ulcerative colitis, Crohn’s disease, autoimmune disorders, metabolic disorders, circulation problems, heart problems, or radiation injury. It can also be a sign of a serious infection, such as a potentially fatal E. coli gut infection or amoebic dysentery. If the symptoms become severe (watery or bloody diarrhea) or last longer than a week, it’s time to talk to a doctor.
Can ulcerative colitis be cured naturally?
Ulcerative colitis is a chronic condition with repeated flare-ups. It cannot be cured. Natural remedies, such as diet and lifestyle changes, can reduce the number and severity of flare-ups, but do not cure the condition.
Is salt bad for colitis?
High-salt diets have been shown in animals and computer models to worsen colitis symptoms, but it is uncertain how salt affects humans wrestling with colitis symptoms. It’s a trade-off. Diarrhea significantly depletes the body of electrolytes–that includes salt. Electrolyte-rich foods and drinks are advised for people with severe diarrhea, which includes salty foods like broths and soups. Electrolyte imbalance is a serious condition, so it’s a good idea to follow the doctor’s judgment on this matter.