Definition of Colonic ischemia (Ischemic colitis)
Ischemic colitis occurs when blood flow to part of the large intestine (colon) is reduced due to narrowed or blocked blood vessels (arteries). The diminished blood flow provides insufficient oxygen for the cells in your digestive system. It can cause pain and can damage your colon. Ischemic colitis can affect any part of the colon, but most people experience pain on the left side of the belly area (abdomen).
Ischemic colitis is most common among people older than age 60. It can be misdiagnosed because it can easily be confused with other digestive problems. Ischemic colitis may heal on its own. But you may need medication to treat or prevent infection, or surgery if your colon has been damaged.
Symptoms of Colonic ischemia (Ischemic colitis)
Signs and symptoms of ischemic colitis can include:
- Pain, tenderness or cramping in your belly, 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 to move your bowels
The risk of severe complications is higher when you have symptoms on the right side of your abdomen. That’s because the arteries that feed the right side of your colon also feed part of your small intestine. When blood flow is blocked on the right side of your colon, it’s likely that flow is blocked to part of your small intestine as well. Pain tends to be more severe with this type of ischemic colitis.
Blocked blood flow to the small intestine can quickly lead to death of intestinal tissue (necrosis). If this life-threatening situation occurs, you’ll need surgery to clear the blockage and to remove the portion of the intestine that has been damaged.
When to see a doctor
Seek immediate medical care if you have sudden, severe abdominal pain. Abdominal pain that makes you so uncomfortable that you can’t sit still or find a comfortable position is a medical emergency.
Contact your doctor if you develop worrisome signs and symptoms, such as bloody diarrhea. Early diagnosis and treatment can help prevent serious complications.
The precise cause of diminished blood flow to the colon isn’t always clear. But several factors can increase your risk of colon ischemia:
- Buildup of fatty deposits on the walls of an artery (atherosclerosis)
- Dangerously low blood pressure (hypotension) associated with heart failure, major surgery, trauma or shock
- A blood clot in an artery supplying the colon or, less commonly, in a vein (venous thrombosis)
- Bowel obstruction caused by a hernia, scar tissue or a tumor
- Surgery involving the heart or blood vessels, or the digestive or gynecological systems
- Other medical disorders that affect your blood, such as inflammation of the blood vessels (vasculitis), lupus or sickle cell anemia
- Cocaine or methamphetamine use
- Colon cancer (rare)
The role of medications
Certain medicines also can lead to ischemic colitis, though this is rare. They include:
- Nonsteroidal anti-inflammatory drugs
- Some heart and migraine medications that shrink blood vessels
- Hormone medications, such as estrogen
- Certain medications for irritable bowel syndrome
- Chemotherapy medications
Risk factors for ischemic colitis include:
- Age. The condition occurs mostly frequently in adults older than age 60. Ischemic colitis that occurs in a young adult may be a sign of a blood-clotting abnormality or inflammation of the blood vessels (vasculitis).
- High cholesterol, which can lead to atherosclerosis.
- Certain medical conditions, including previous abdominal surgery, heart failure, low blood pressure and shock.
- Irritable bowel syndrome (IBS). Ischemic colitis is diagnosed three times more frequently in people with IBS than in people without that disorder.
- Heavy exercise, such as marathon running, which can lead to reduced blood flow to the colon.
- Surgery involving the large artery (aorta) that pumps blood from your heart to the rest of your body.
Complications of Colonic ischemia (Ischemic colitis)
Ischemic colitis usually gets better on its own within two to three days. In more-severe cases, complications can include:
- Tissue death (gangrene) resulting from diminished blood flow
- Hole (perforation) in your intestine, or persistent bleeding
- Bowel inflammation (segmented ulcerating colitis)
- Bowel obstruction (ischemic stricture)
Preparing for your appointment
Go to the emergency room if you have severe abdominal pain that makes you so uncomfortable that you can’t sit still. You may be referred for immediate surgery to diagnose and treat your condition.
If your signs and symptoms are moderate and occasional, call your doctor for an appointment. After an initial evaluation, you may be referred to a doctor who specializes in digestive disorders (gastroenterologist) or blood vessel disorders (vascular surgeon).
Here’s some information to help you get ready for your appointment, and what to expect from your doctor.
What you can do
- Be aware of any pre-appointment restrictions, such as not eating after midnight on the night before your appointment.
- Write down your symptoms, including when they started and how they may have changed or worsened over time.
- Write down your key medical information, including other conditions with which you’ve been diagnosed.
- Make a list of all medications, vitamins and supplements that you’re taking.
- Write down questions to ask your doctor.
Questions to ask your doctor
- What is the most likely cause of my condition?
- What kinds of tests do I need?
- If I need surgery, what will my recovery be like?
- How will my diet and lifestyle change after I have surgery?
- What follow-up care will I need?
What to expect from your doctor
Your doctor is likely to ask you questions about your symptoms, such as:
- When did you begin experiencing symptoms?
- Have your symptoms been continuous or occasional?
- How severe are your symptoms?
- Where do you feel your symptoms the most?
- What, if anything, seems to improve your symptoms?
- What, if anything, seems to worsen your symptoms?
Tests and diagnosis
Ischemic colitis can be misdiagnosed because it is often confused with other disorders, especially inflammatory bowel disease (IBD). Based on your signs and symptoms, your doctor may recommend these imaging tests:
- Ultrasound and abdominal CT scans, to provide images of your colon that can be helpful in ruling out other disorders, such as IBD.
- Stool analysis, to rule out infection as a cause of your symptoms.
- CT or MR angiography, to provide detailed images of blood flow in your small intestine and to look for blocked arteries. This test is usually used only if ischemia is suspected in your small bowel as well as in your colon.
Rarely, colon cancer can cause ischemic colitis. Your doctor will recommend colonoscopy to check for cancer, usually after the symptoms of ischemic colitis have eased. It’s important to wait for intestinal inflammation to go down because inflammation can hide cancer.
Treatments and drugs
Treatment for ischemic colitis depends on the severity of your condition.
Signs and symptoms often diminish in two to three days in mild cases. But your doctor may recommend:
- Antibiotics, to prevent infections
- Intravenous fluids, if you are dehydrated
- Treatment for any underlying medical condition, such as congestive heart failure or an irregular heartbeat
- Avoiding medications that constrict your blood vessels, such as migraine drugs, hormone medications and some heart drugs
Your doctor will schedule follow-up colonoscopies to monitor healing and look for complications.
If ischemic colitis is severe or your colon has been damaged, you may need surgery to:
- Remove dead tissue
- Repair a hole in your colon
- Bypass a blockage in an intestinal artery
- Remove part of the colon that has narrowed because of scarring, and is causing a blockage
The likelihood of surgery may be higher if you have an underlying condition, such as heart disease or low blood pressure.
Since the cause of ischemic colitis isn’t always clear, there’s no certain way to prevent the disorder. Most people who have ischemic colitis recover quickly and may never have another episode.
But if you’re at risk of ischemic colitis, your doctor may recommend:
- Avoiding certain medications that can diminish blood flow
- Ongoing treatment for underlying conditions such as heart disease, high blood pressure and diabetes
- Cholesterol-lowering medication
- Regular exercise