About Ischemic Colitis

Overview

Ischemic colitis happens when there is decreased blood flow to the colon or large intestine. This reduced blood flow can cause damage to the intestines, which can be mild or, in more severe cases, lead to tissue death. It is the most common type of intestinal blood flow problem and can occur due to blocked blood vessels (from hardened arteries) or other reasons that affect blood flow. Ischemic colitis usually causes symptoms such as abdominal pain, diarrhea, and bleeding from the rectum (the part of your body where stool leaves). While many cases get better on their own, more serious ones may need emergency surgery. Some risk factors that make ischemic colitis more likely include:

  • Congestive heart failure: A condition where the heart can’t pump blood as well as it should
  • Sepsis: A life-threatening infection that spreads through the body
  • Atherosclerosis: hardening of the arteries, which can block blood flow
  • Constipation: Having trouble passing stool

It’s important to get a quick diagnosis and the right treatment prevent problems and help you recover.

Causes and Risk Factors

The root causes of ischemic colitis include:

  • Hardening of the mesenteric arteries: The arteries that supply blood to the intestines becomes stiff or blocked. This can happen to people with conditions like coronary artery disease (narrowing of the heart’s blood vessels) or peripheral vascular disease (narrowing of blood vessels in areas like the legs).
  • Blood clots in the arteries leading to the intestines: Clumps of blood that block blood flow to the intestines
  • Severely low blood pressure (hypotension): When your blood pressure drops too low, it can prevent enough blood from reaching your organs.
  • Atherosclerosis: This is when plaque (a build-up of fats, cholesterol, and other substances) builds up in the arteries, reducing blood flow.
  • Bowel obstructions: Blockages in the intestines caused by scar tissue (from surgeries), tumors (growths that block the intestines), or hernias (when part of an organ pushes through a weak spot in the muscles)
  • Conditions affecting blood: Such as vasculitis (inflammation of blood vessels) and sickle cell anemia (a genetic disorder where red blood cells are not shaped like regular round cells. Instead, they are shaped like a crescent or banana, which can block blood flow)
  • Surgical procedures involving the heart, blood vessels, colon, or surrounding areas: This can sometimes affect blood by stopping the normal flow of blood to other organs, including the intestines.
  • Use of drugs like cocaine or methamphetamines: These can restrict blood flow and increase the risk of ischemic colitis.
  • Rarely, certain medications: Including antibiotics, chemotherapy (cancer treatments), heart medications, hormone therapy, treatments for irritable bowel syndrome (IBS), nonsteroidal anti-inflammatory drugs (NSAIDs), and migraine medications can increase the risk

The non-modifiable risk factors for ischemic colitis cannot be changed or controlled. These include:

  • Age: Increasing age is a major risk factor because, as people get older, their blood vessels become less flexible, which can make it harder for blood to flow easily to the colon.

The modifiable risk factors for ischemic colitis can be influenced or changed. These include:

  • Hypertension (high blood pressure): High blood pressure puts extra force on your blood vessels, which can damage them over time and reduce blood flow to the colon.
  • Hyperlipidemia (high cholesterol): Having too much cholesterol, which is a type of fat in your blood, can cause plaque to build up in your arteries. This plaque build-up makes it harder for blood to flow to your colon.
  • Coronary artery disease: This happens when plaque builds up in the arteries of your heart, reducing blood flow and increasing the risk of blood flow problems in other areas, like the colon.
  • Diabetes mellitus: High blood sugar levels can damage blood vessels, which makes it harder for blood to flow to important areas, like the colon.
  • Atrial fibrillation: This condition causes an irregular heartbeat, which can lead to blood clots that block the blood flow to the colon.
  • Chronic obstructive pulmonary disease (COPD): This lung disease can lower oxygen levels in the blood, which can reduce blood flow to the colon.
  • Smoking: Smoking damages the blood vessels and increases the risk of blockages, which can cause ischemic colitits.
  • Dialysis: People on dialysis for kidney problems may have low blood pressure during treatment, which can reduce blood flow to the intestines, including the colon.

It is recommended to keep a healthy weight, be physically active, and eat a healthy diet. However, it is important to talk with your healthcare professional about your situation before making any changes.

Symptoms

The most common early symptoms of ischemic colitis include:

  • Abdominal pain: Usually, the pain is on the left side of the abdomen and can range from mild to moderate.
  • Tenderness in the stomach
  • Stomach pain after meals

As ischemic colitis progresses or becomes more severe, the following symptoms may occur:

  • Blood in the stool (hematochezia)
  • Urgent need to pass stool
  • Bloating
  • Lightheadedness
  • Fever
  • Nausea or vomiting

It is important to know that ischemic colitis is a medical emergency. If you have any continuing or severe abdominal pain, bloody stools or any other concerns you should get medical help right away.

Diagnosis

To diagnose ischemic colitis, doctors commonly perform the following exams, tests, and procedures:

  • Medical history and physical exam: Doctors will get your medical history to understand your symptoms and risk factors. A physical exam will be done to look for abdominal tenderness, unusual bowel sounds, signs of dehydration, changes in blood pressure or heart rate, abdominal swelling to check reduced blood flow or other intestinal issues, and blood in the stool.
  • Imaging tests: Doctors may use imaging tests to confirm the diagnosis and rule out other conditions. These tests include:
    • Ultrasound or abdominal CT (computed tomography) scan: These tests allow doctors to see the colon and intestines.
    • Mesenteric angiogram: This test uses X-rays to find blockages in the arteries that supply blood to the intestines.
  • Blood test: A blood test can check if there are higher white blood cells or lactic acid, which could suggest a problem with blood flow to the colon.
  • Stool analysis: A stool sample can help identify if there is blood in the stool or if an infection is causing the symptoms.
  • Colonoscopy with biopsy: During this procedure, a small camera is used to look inside the colon, and tissue samples may be taken to help confirm the diagnosis and check how serious the inflammation is and how much damage has been caused by the reduced blood flow.

It's important to note that these exams, tests, and procedures should be performed by healthcare professionals.

Treatment Options

The goals of treatment for ischemic colitis are to relieve symptoms, help the body heal, and prevent problems. Ischemic colitis can be a life-threatening condition and is almost always treated in the hospital. Treatment depends on the cause of the ischemic colitis. Here are the different treatment options and how they work to reach these goals:

  • Medication types:
    • Antibiotics: Used to prevent infection in cases where there is damage to the bowel
    • Blood thinners: Medications to thin the blood may be given if a blood clot is the cause of ischemic colitis.
    • Pain relief medications: Help control the discomfort
  • Therapies:
    • Bowel rest: Resting the bowel and not eating or drinking anything is part of treating ischemic colitis.
    • Hydration: IV (intravenous) fluids are given to keep the body properly hydrated.
    • Supplemental oxygen: Providing oxygen can help improve blood flow to the affected area and support healing.
  • Therapeutic procedures:
    • Surgical intervention: In severe cases that don't respond to other treatments, surgery may be needed. The specific procedure depends on the individual case but may involve repairing damage, removing scar tissue, clearing blockages, or inserting stents to improve blood flow.
  • Health behavior changes:
    • Treating medical conditions: Controlling conditions like diabetes and congestive heart failure can help reduce the risk of ischemic colitis.
    • Avoiding vasoconstrictive medications: Certain medications that narrow blood vessels should be avoided because they can make symptoms worse.

It's important to talk with a healthcare professional for personalized advice and guidance about medication types, therapies, therapeutic procedures, health behavior changes, or other treatments for ischemic colitis.

Medication dosing may be affected by many factors. Check with your health care professional about dosing for your individual situation. Other side effects can occur. Check with your health care professional or read the information provided with your medication for additional side effect information.

What are the common symptoms of ischemic colitis?

What are the treatment options for ischemic colitis?

Are there any lifestyle changes I can make to reduce my risk of developing ischemic colitis?