Ischemic Colitis

Ischemic colitis is a condition characterized by swelling in the large intestine as a result of limited blood supply to part of the large intestine (colon). Usually, the narrowed or blocked blood vessels cut down the blood supply to the colon and cause depletion in oxygen supply to your digestive system.  Stomach pain is a common symptom which can indicate damage to your colon. Though ischemic colitis can affect any part of the colon, it usually causes pain on the left side of your belly (abdomen). Since symptoms of ischemic colitis are not specific, there is a possibility of misdiagnosis. The condition may heal on its own or require treatment depending upon the severity of the condition. Medications may be used to treat ischemic colitis or prevent infection. In severe conditions where your colon has been damaged, a surgery may be required. 

The signs and symptoms of ischemic colitis include:

• Stomach pain or cramps which can occur suddenly or gradually
• Bright red or maroon-colored blood in your stool or, at times, passage of blood alone without stool
• A feeling of urgency for bowel evacuation
• Diarrhea
• Nausea

Remember that if you have symptoms on the right side of your abdomen, you are more likely have severe complications. The reason is, the right side of your colon and portion of your small intestine are supplied by the same arteries. Pain in the right side means the arteries that supply to your small intestines may also be blocked. You may experience a more severe pain if the supply to your right side is affected. Part of the small intestine that has no supply of blood can die due to oxygen deprivation which can be fatal. In such emergency condition, surgery is needed to open the blockage and to remove the dead portion of the intestine.

When to see a Doctor

Ask for an immediate medical help if you experience sudden, severe pain in your stomach. A medical emergency is signaled by a pain so severe that you are not able to sit still or find a comfortable position. Talk to your doctor if see blood in your stool. As with any other disease, early diagnosis warrants early treatment and hence reduced chances of serious complications.

The precise cause of diminished blood flow to the colon isn't always clear. But there are certain factors that heighten your risk of ischemic colitis:

• Accumulation of fats on the interior of the walls of an artery (atherosclerosis)
• Extremely low blood pressure (hypotension) associated with heart failure, major surgery, trauma or shock
• Obstruction caused by a blood clot in the artery that supplies the colon. Rarely, blood clots may also be present in a vein (venous thrombosis)
• Blockage in the colon caused by a hernia, scar tissue or a tumor
• Surgical procedures that involve your heart or blood vessels, or digestive or gynecological systems
• Certain medical conditions that affect blood flow, such as inflammation of the blood vessels (vasculitis), lupus or sickle cell anemia
• Use of stimulants like cocaine or methamphetamine
• Rarely, a colon cancer

In rare cases, certain medications may cause ischemic colitis. Some medicines that increase your risk of ischemic colitis include:

 Some heart and migraine medications
 Hormonal drugs, such as estrogen
 Antibiotics
 Pseudoephedrine
 Medications for irritable bowel syndrome (IBS)
 Medications used in cancer chemotherapy

Making a diagnosis of ischemic colitis is done by performing several tests.

If you experience an abdominal pain so severe that you cannot sit still, seek immediate medical help. The emergency room doctor may refer you for immediate surgery to diagnose and treat your condition. In case you have moderate and occasional signs and symptoms, talk to your doctor to schedule an appointment. Once an initial evaluation is over, your doctor may refer you to a specialist in digestive disorders (gastroenterologist) or blood vessel disorders (vascular surgeon).

How to prepare yourself for the visit?

Getting prepared for the visit can optimize the therapy and help make the visit more fruitful.

List out all the symptoms.

Write down your key medical information.

Write down the names of all your medications, vitamins or supplements.

• Make a list of the questions to ask your doctor. Some typical questions can be:
• What could be the possible cause of my condition?
• What are the tests that I need?
• Do I need a surgery? If yes, how will be my prognosis?
• Do I need to modify my diet and lifestyle after I have surgery?
• What follow-up care are required?

What your doctor wants to know?

A clear talk with your doctor can optimize the therapy and improve the outcomes. Prepare yourself to answer some essential questions from your doctor. Your doctor might ask you typical questions like:

• When did you first notice your symptoms?
• Do the symptoms occur regularly or in an interval?
• How severe are your symptoms?
• Where are your symptoms localized?
• Does any factor improve or worsen your symptoms?

Ischemic colitis may be confused with inflammatory bowel disease as both the conditions share many of the symptoms.

Following tests might be recommended to confirm the diagnosis of ischemic colitis:

• Ultrasound and abdominal CT scans: These tests help to visualize your colon. The images obtained from ultrasound or CT scans may guide your doctor in determining the exact cause of the symptoms you are experiencing.
• Stool examination can help to exclude infection from the list of probable causes.
• CT or MRI angiography: These tests create detailed images showing blood flow in your small intestine. Blocked arteries can show up in the scans. CT or MRI angiography are recommended only if ischemia has affected both small bowel as well as your colon.
• Colonoscopy: This test also provides detailed images of your colon. Your doctor can analyze these images to diagnose ischemic colitis. Colonoscopy can also be used to check for cancer, and to see how well a treatment worked.

The choice of treatment for ischemic colitis is guided by the severity of your condition. Mild cases of ischemic colitis often improve within two to three days. If you need treatment, your doctor may recommend:

• Antibiotics, to prevent infections
• Intravenous fluids, to maintain fluid and electrolyte balance in the body
• Certain medications to treat underlying medical conditions, such as congestive heart failure or an irregular heartbeat
• Avoiding medications that narrow your blood vessels such as migraine drugs, hormone medications and some heart drugs.
• Surgery: In severe cases where the damage to your colon is massive, your doctor may recommend surgery to:

 Remove dead tissue
 Repair a hole in your colon
 Skip or bypass a blockage in an intestinal artery
 Remove part of the colon that has narrowed because of scarring and is causing a blockage
Your need for surgery may be greater if you have an underlying condition, such as heart disease or low blood pressure.

You may not find a sure shot way to prevent ischemic colitis. Majority of the cases of ischemic colitis heal quickly and occur just once.

To prevent ischemic colitis from returning back, you may be recommended to eliminate any medication that might cause ischemic colitis. You may also need to test for clotting abnormalities if no apparent cause for ischemic colitis is found.

There are several risks and complications associated with ischemic colitis.

Risks

• Age: Most often, ischemic colitis affects adults above 60. If it occurs in a young adult, it may signal conditions like inflammation of the blood vessels (vasculitis) or problems with blood clotting.
• Conditions that alter blood clotting process such as Factor V Leiden, may increase your risk of ischemic colitis.
• High cholesterol level in blood can lead to atherosclerosis.
• Restricted blood flow due to heart failure, low blood pressure and shock.
• Previous abdominal surgery may lead to scar tissue formation which can reduce blood flow.
• Intense exercise, such as marathon running, can restrict blood flow to the colon.
• Surgery of a large artery (aorta) that pumps blood from your heart to the rest of your body.

Complications

Most often, ischemic colitis resolves within two to three days even without treatment. However, severe cases can cause complications like:

• Intestinal tissue death (gangrene) secondary to oxygen deprivation
• Hole (perforation) in your intestine or persistent bleeding
• Bowel inflammation (segmented ulcerating colitis)
• Bowel obstruction (ischemic stricture)