Have you ever had a sudden, severe stomach ache, and had a little blood in your stool? Or does your stomach feel full and painful to the touch? If you have one or two of these symptoms, it could be due to a condition called ischemic colitis, which we are going to talk about today. Don't be afraid, even if the name sounds a bit complicated. Let's talk about this in a simple way that everyone can understand.
What is ischemic colitis? Simply put...
Simply put, ischemic colitis is inflammation of your large intestine, or the part we call the colon, due to reduced blood flow (this is called ischemia). You know, every cell and tissue in our body needs oxygen to live and function. This oxygen is carried to them by the blood. So, when the blood flow to the large intestine decreases for some reason, it doesn't get enough oxygen. That's when the tissues in that intestine become damaged and inflamed, meaning they become swollen, red, and painful. It's like a tree withering away when it doesn't have enough water.
This inflammation is actually our body's way of trying to repair the damage. That's why we get discomfort, abdominal pain, bloating, and sometimes bleeding. Ischemic Colitis mainly affects the delicate lining of your large intestine, called the mucosa . Just like the delicate skin inside our mouths, the inside of the intestine is also covered by the lining. However, if this lack of blood flow (ischemia) is severe or lasts for a long time, it can also damage deeper parts of the intestine.
What is the difference between normal colitis and ischemic colitis?
You've probably heard the word ``colitis.'' ``Colitis'' simply refers to inflammation of the colon. ``Ischemic colitis'' is another type of inflammation, but it's a little less common. When most people hear ``colitis,'' they think of long-term inflammatory bowel diseases (IBDs) like ``Ulcerative Colitis'' or ``Crohn's Disease.'' These conditions start in the lining of the colon.
But, `(Ischemic Colitis)` is something different. It actually starts as a problem with your circulatory system. That is, it could be due to a problem with your heart, blood vessels. It could be due to low blood pressure, or it could be due to some disease of the blood vessels. When the blood flow to the arteries that supply blood to the colon is reduced, the result is inflammation of the colon tissue. Otherwise, it is not a specific disease of the colon.
Who is more likely to develop ischemic colitis (Ischemic Bowel Disease)?
This condition is most common in people over the age of 60. Also, people with arterial disease are at higher risk of developing it.
In addition, there are several other risk factors. Let's see what they are:
- Type 2 Diabetes: Because diabetes can damage blood vessels.
- Kidney failure and those undergoing dialysis treatment: Kidney disease also affects blood circulation.
- Low blood pressure: When blood pressure drops, the amount of blood flowing to the organs also decreases.
- Hypoalbuminemia is a decrease in the protein albumin in the blood.
- Peripheral artery disease: Narrowing or blockage of the arteries that supply blood to the limbs.
- Ischemic cardiomyopathy: Diseases caused by reduced blood supply to the heart muscle.
- Blood clotting disorders: The risk of blood clots forming inside blood vessels increases.
- Chronic constipation with fecal impaction: This can cause pressure on the intestines and obstruct blood flow.
- Use of drugs such as cocaine.
- Having an abdominal aortic aneurysm.
If you have these risk factors, it's better to be a little more careful.
How does ischemic colitis affect your body?
For most people, this is only a temporary problem. That is, it only affects a small part of the colon and heals within a few days. Although the inflammation may cause temporary discomfort and pain, once the cause of the decreased blood flow is properly addressed, this condition will also improve almost automatically.
However, sometimes this can be a more serious problem.
- Some people can get repeated episodes of ``Ischemic Colitis'' in the same area. When this happens, scarring can occur in that area and the intestine can become narrowed (stricture). This makes it difficult for food and drink to pass through easily.
- Furthermore, if the `ischemia`, which is the reduction in blood flow, is severe enough, the intestinal tissue can die (gangrene). This is a very dangerous condition. If that happens,
- A hole (perforation) in the intestine may occur.
- Life-threatening complications such as severe infection and sepsis (blood poisoning) can occur.
- In such a case, emergency surgery must be performed.
What are the symptoms of ischemic colitis?
In this case, you may experience one or more of the following symptoms:
- Abdominal pain and cramping: This is the main symptom. It can start suddenly.
- Abdominal swelling and tenderness: You may feel pain when you touch your abdomen.
- Diarrhea and urgency to poop: Needing to go to the toilet frequently.
- Bloody poop: Blood in the stool, sometimes dark red or black.
- Low fever: You may feel a slight fever.
- Nausea or loss of appetite: A feeling of not wanting to eat or drink .
Imagine, if you suddenly start having severe stomach cramps and passing blood, don't just assume it's just a stomach bug. See a doctor immediately.
What are the causes of ischemic colitis?
In fact, there can be many reasons why the blood flow to the colon is reduced. Most of the time, this is temporary. Sometimes, the cause may have gone away by the time the disease is diagnosed. If you have only had ``ischemic colitis'' once and recovered, your doctor may not be able to tell you the exact cause. However, they can make a guess based on your medical history and other medical conditions.
Mainly, diseases that affect your circulatory system, such as heart disease and blood vessel disease, can reduce blood flow to the arteries that supply blood to the intestines. Sometimes a blood clot can block an artery, or an artery can be compressed by something outside.
There are two main arteries that supply blood to our intestines - the superior and inferior mesenteric arteries . These arteries are very sensitive to anything that causes blood vessels to constrict (vasoconstriction). For example, extreme cold, illnesses that cause low blood pressure, and certain medications (vasoconstrictors) can affect this. These arteries respond to low blood pressure by constricting sharply. Scientists think that this is a defense mechanism of our body. That is, when the body loses blood, it reduces the amount of blood going to places like the intestines to divert blood to vital organs like the brain and heart. When this "emergency response" is triggered, the intestines can lose blood.
Doctors sometimes divide this into two categories of causes:
1. Occlusive causes: This means a blockage from within an artery (e.g. a blood clot).
2. Nonocclusive causes: This means that blood flow is reduced due to another cause (e.g. low blood pressure, narrowing of the arteries) rather than an artery being blocked.
The third cause is injury during surgery. Although this is very rare, there is a risk of an AAA repair during surgery to repair a ruptured abdominal aortic aneurysm (AAA). If this happens, it can be more serious than other temporary causes and can be life-threatening. This condition occurs in about 2% to 3% of AAA surgeries, and about 50% of them die.
How is ischemic colitis diagnosed?
The symptoms of this disease (such as stomach pain and diarrhea) are very common, meaning that these symptoms can also be caused by other stomach diseases. Therefore, doctors need to make sure that there are no other medical conditions before they can definitively say that this is ``Ischemic Colitis''.
- You may have imaging tests (e.g., CT scan) of your colon.
- Blood tests can be done to check for infections and other factors. Typically, colitis causes an elevated white blood cell count.
If your doctor suspects that you have Ischemic Colitis, the best way to confirm the diagnosis is with a colonoscopy. This involves inserting a small, lighted tube through your anus to look inside your colon. If you have Ischemic Colitis, the test can look for signs of the condition. If necessary, a small piece of tissue (biopsy) can be taken from your colon at the same time and sent to a lab for further testing.
How is ischemic colitis treated?
The treatment depends on the severity of the disease and whether you have other complications (e.g., an infection in the abdominal cavity).
- In severe or complicated cases, emergency surgery may be required.
- However, many cases can be managed medically.
- You will be given IV fluids (such as saline) through a vein .
- Broad-spectrum antibiotics will be given to prevent or treat infections.
- Oxygen therapy may also be given to increase heart function and blood flow.
- The doctor will stop any medication that they think is contributing to the condition (Ischemic Colitis).
- The most important thing is to "bowel rest." This means not using your digestive system until your bowels heal. You will be given a liquid diet or IV nutrition .
Other treatments that may be needed:
- Stomach decompression by nasogastric tube: This method is used to remove air, fluid, or food from the stomach if part of the intestine is blocked due to ischemic colitis.
- Blood vessel treatments: If there is a blockage in an artery, the doctor may need to surgically remove it, dissolve a blood clot, or insert a stent into a narrowed blood vessel.
- Colectomy: If the colon tissue has died (gangrene) or the colon wall has ruptured (ruptured), the damaged part will need to be cut out. This surgery may also involve the temporary or permanent placement of a colostomy bag (a separate opening in the skin of the abdomen for the passage of stool).
What should a person with ischemic colitis be careful about eating?
If you are recovering from Ischemic Colitis, your doctor will initially advise you to fast . After that, you can gradually switch to a liquid diet , and then a soft diet .
Avoid high-fiber foods during this time. It's not a good idea to overwork your intestines until they're healed. The area needs more blood flow and oxygen to digest food. Resting your intestines gives your body a chance to restore that blood supply.
If you have a long-term condition called ``chronic'' ``Ischemic Colitis'', or if you have another chronic disease that predisposes you to it, your doctor will give you special dietary guidelines to follow long-term.
Can ischemic colitis be prevented?
Since there are many factors that can contribute to this condition, it may not be possible to completely avoid all of them. However, it is very important to manage any medical conditions you already have (especially heart, blood vessel, and kidney diseases) .
- Avoiding smoking and drug use.
- Eating a heart-healthy diet can prevent these conditions from getting worse or developing complications.
- Ischemic Colitis (also known as "runner's colitis") can sometimes be caused by strenuous exercise . This is because the heart is unable to pump enough blood. If you are an endurance athlete, staying well-hydrated can help prevent this.
What is the outlook for ischemic colitis? (Outlook)
The good news is that most people (about 75%) who develop acute ischemic colitis have a relatively mild, temporary condition. It affects only the mucosa of one part of the intestine and resolves completely with standard treatment.
Only a small percentage of people develop complications that require surgery. Such complications often occur in people who already have other medical conditions, such as heart disease or kidney disease. For these people, surgery is risky and recovery is difficult. According to statistics, this group has a higher risk of adverse outcomes and death (about 40%). But that risk is not only due to the condition `(Ischemic Colitis)`.
This disease called `(Ischemic Colitis)` can sometimes take a while for doctors to recognize, as well as those who experience it. Because, when you say stomach pain, no one immediately thinks that this is a cardiovascular problem. However, once the diagnosis is made correctly, you can expect a complete and quick recovery, even if you have to stay in the hospital for a while. However, `(Ischemic Colitis)` can sometimes be severe, so do not ignore your symptoms. If they do not improve, inform your doctor immediately.
So, what are the most important things we should remember from this story?
Okay, here are a few things to keep in mind from what we've talked about:
- Don't ignore sudden, severe stomach pain, especially if it's accompanied by bloody stools. It could be a sign of a condition called ``Ischemic Colitis''.
- It is very important to seek medical advice early. The sooner the disease is diagnosed, the easier it is to treat and prevent complications.
- If you have risk factors like diabetes, heart disease, or high blood pressure, control them well.
- Adopt a healthy lifestyle. Avoid smoking and unnecessary drugs. Eat a good diet.
- Don't be afraid, but be careful. Ischemic Colitis is a condition that can often be cured. However, it needs to be given the necessary attention.
If you have any further questions about this, be sure to talk to your family doctor. He or she can give you the best advice.
` Ischemic Colitis, Inflammation of the colon, Decreased blood flow, Stomach pain, Bloody stools, Colonoscopy
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