About 1 in 1,000 hospitalizations is due to some type of condition that affects the blood vessels leading to the intestines, called intestinal vasculopathy. (1) Ischemic colitis is the most common type of intestinal vasculopathy and form of ischemia affecting the bowels. It’s especially a big concern among elderly patients.
The term ischemia (also sometimes spelled ischaemia) refers to a temporary restriction in blood supply reaching tissues in the body. The reason this is so dangerous is because it causes a shortage of oxygen and glucose that are both needed for normal cellular metabolism. In many cases it’s not entirely known why ischemic colitis develops, but risk factors seem to include older age and a history of irritable bowel syndrome or cardiovascular problems, especially abnormal blood clotting, low or high blood pressure, and arteriosclerosis.
Usually ischemic colitis only affects people briefly and resolves within several weeks; however, about 20 percent of people with the condition experience symptoms chronically. Ischemic colitis can cause increased inflammation and damage to the intestines, as well as pain and other symptoms. When severe ischemic colitis develops, it can also cause complications including sepsis, which can sometimes be life-threatening.
What Is Ischemic Colitis?
The definition of ischemic colitis, according to the Merck Manual, is “injury of the large intestine that results from an interruption of its blood supply.” (2) When blood flow is blocked from reaching the inside lining and inner layers of the walls of the large intestine, the bowels become susceptible to problems such as development of ulcers (sores) and internal bleeding.
Cases of ischemic colitis are generally split into two categories, depending on what’s causing them:
- Those that result from a decrease in blood supply but do not involve a blockage (called a non-occlusive disease). This is the more common type of ischemic colitis.
- And those that are caused by an actual blockage, such as a blood clot in an artery or vein (called an occlusive disease).
Signs & Symptoms of Ischemic Colitis
The most common symptoms of ischemic colitis are abdominal pains, especially on the left side of the body, along with bloody stools. Other signs and symptoms can include: (3)
- Loose stools (diarrhea), that usually happen more frequently and are either bright red or darker than normal in color due to blood clots. Blood may be passed with or without stool. Some also experience constipation before other symptoms begin.
- Tenderness, cramping and sensitivity throughout the abdomen. Sometimes pain is so intense that it’s hard to either sit still or stand without hunching over.
- Nausea and loss of appetite.
- Low grade fever, usually below 100 F or 37.7 C. Symptoms of a fever might develop, including fatigue, weakness, headaches, loss of appetite, indigestion or nausea.
- Sometimes pain on the right side of the abdomen, which is a sign of a more serious problem because blood vessels on the right side also supply blood to the small intestine.
- Pain after eating, reduced food intake, problems with nutrient absorption and involuntary weight loss.
How long do ischemic colitis symptoms usually last? When the condition is mild to moderate, symptoms usually resolve within one to two weeks. People who have a more severe case may need longer to recover — at least several weeks or even longer if surgery is needed. In rare cases, if a part of the large intestine becomes very damaged, surgery is sometimes necessary to remove the portion of the intestine. This can sometimes result in scarring and chronic symptoms.
Ischemic Colitis Causes & Risk Factors
The underlying cause of ischemic colitis is reduced blood flow reaching the large intestine, which is also called the colon. The intestine/colon is about 5 feet in length, wrapping throughout the abdomen, and includes the ascending colon, the transverse colon, the descending colon, the sigmoid colon and the rectum. These organs are the “final section” of the gastrointestinal tract and have the important roles of absorbing water and nutrients from digested food (called chyme) as well as turning any waste into stool/feces. (4)
There are two main arteries that supply blood to the large intestines: the superior mesenteric artery and the inferior mesenteric artery. These arteries branch off into many smaller blood vessels that supply the intestine with blood, oxygen and nutrients. However, some of them are prone to inflammation and blocked blood flow for a variety of reasons. (5) If blood supply is also reduced in the small intestine, then a serious problem can occur in intestinal tissue called necrosis. This means the tissue starts to become severely damaged and die off.
Ischemic colitis has been found to be more common among people with the following risk factors:
- Over the age of 60.
- History of irritable bowel syndrome (certain studies have found that the risk increases two- to four-fold in those with irritable bowel syndrome). (6)
- Low blood pressure.
- History of heart and/or blood vessel disease, especially chronic obstructive pulmonary disease.
- History of increased blood clotting.
- History of diabetes.
- Frequent use of constipation-inducing medications.
- Recovering from an illness or incident such as an infection, trauma, surgery, heart attack or stomach virus.
- Taking medications that interfere with blood flow (more on this below) or receiving dialysis treatments.
- Having recently completed a marathon or other very strenuous type of physical activity that contributes to severe dehydration.
- Use of certain recreational drugs, including cocaine and methamphetamines. Some studies have found that up to 27 percent of recreational triathletes, 20 percent of marathon runners, and 87 percent of 100-mile ultramarathon runners test positive for fecal occult blood. (7)
- People who recently had surgery on the aorta, the main artery in the human body that carries blood away from the heart to various organs and tissue.
These types of risky behaviors/habits can lead to ischemic colitis because they contribute to issues such as:
- inflammation of the blood vessels (vasculitis)
- low blood pressure (hypotension)
- arteriosclerosis (or the buildup of fatty deposits on the walls of arteries)
- build up of blood clots
- hernia or development of scar tissue
- formation of tumors
- autoimmune diseases including lupus or sickle cell anemia
- colon cancer (very rarely)
Conventional Treatments for Ischemic Colitis
Your doctor can make a diagnosis of ischemic colitis by performing a physical examination, discussing your symptoms with you, using lab test results, and, usually, performing an endoscopy test to examine the inside of your intestines.
Once a diagnosis has been made, treatment for ischemic colitis will depend on how severe someone’s symptoms are and the suspected underlying causes. Some conventional treatments that are used to manage ischemic colitis include:
- Treating any underlying health issues that are contributing to the problem, such as heart disease, a blood clot or blood pressure problems. This is usually done using a combination of medications and lifestyle changes.
- Intravenous fluids to reverse or prevent dehydration.
- Antibiotics to prevent infections.
- Avoiding use of any medications that reduce blood flow by constricting the blood vessels (including all the drugs mentioned above).
- In some cases, when ischemic colitis is severe, surgery might be needed. Only approximately 20 percent of patients require surgery due to intestinal damage. This is most common in people with underlying health issues, such as heart disease or blood clots. (8) Surgery can be performed to bypass a blockage; remove dead tissue in the intestine; repair any holes that developed in the colon; and remove any scarring that can cause another blockage in the future.
5 Natural Ways to Prevent Ischemic Colitis & Improve Symptoms
1. Reduce Inflammation & Gastrointestinal Damage
Increased inflammation, a history of gastrointestinal problems, and autoimmune diseases can all contribute to ischemic colitis or make it worse. A healthy diet and lifestyle are important for controlling inflammation within the intestines and also for regulating blood pressure/circulation.
Here are changes you can make to your diet in order to keep inflammation and GI distress to a minimum:
- Eat anti-inflammatory foods — These include foods like fresh veggies, fruit, nuts, seeds, wild-caught fish and fermented dairy products. Some of the best choices are:
- leafy green veggies
- cruciferous veggies
- other veggies like carrots, yellow squash, red bell peppers, butternut squash, asparagus and purple eggplant
- berries and apples
- sea vegetables
- chia seeds and flaxseeds
- wild-caught salmon
- plain fermented yogurt
- Avoid eating any food you’re allergic or sensitive to — This can include foods that contain gluten (found in all wheat, barley and rye products), conventional cow’s milk dairy products, nuts, eggs or certain types of fruits or veggies.
- Avoid processed foods — Eliminate or reduce foods made with refined grains, added sugar, processed meats, refined vegetable oils (like sunflower, safflower or corn oil), artificial sweeteners, synthetic additives, diet soda and other diet drinks, trans-fats, fried and fast foods.
- Focus on healthy fats — Aim to eat more monounsaturated fats and polyunsaturated fats (especially omega-3s), plus some natural saturated fat (in moderation depending on your current health). Good sources of healthy fats include oily fish (at least twice a week) that contain omega-3 fatty acids; virgin olive oil or coconut oil; nuts, seeds and avocados.
2. Prevent & Treat Abnormal Blood Pressure
If your blood pressure is too high or too low, you may be at an increased risk for problems like thickening of the arteries or blood clots. Risk factors for having abnormal blood pressure include:
- low nutrient intake
- a poor diet high in sodium
- obesity or being overweight
- lack of physical activity/sedentary lifestyle
- high amounts of chronic stress
- other compounding medical problems
- a family history of high blood pressure
If you have high blood pressure, include more of these foods in your diet:
- fresh fruit
- lean proteins
- beans and legumes
- healthy fats
- 100 percent whole grains that are (ideally) sprouted
- organic, unsweetened dairy products
These foods are part of the “DASH diet,” named the best diet for a sixth year in a row by U.S. News & World Report, especially for those with blood pressure problems. The DASH Diet also aids in weight loss, lowering cholesterol, and preventing or controlling diabetes.
Other tips for regulating blood pressure include:
- managing stress
- cooking more at home
- increasing fiber consumption
- lowering your sodium/salt intake (especially from processed foods)
- getting more potassium in your diet
- staying hydrated
- practicing portion control
3. Eliminate Use of Risky Medications
A number of medications can cause ischemic colitis. So, whenever possible, it’s best to avoid using any prescription (and, of course, recreational) drugs that you don’t need. Talk to your doctor about your risk for ischemic colitis based on your current health and use of medications. Although this only happens rarely, medications to discuss that can contribute to ischemic colitis include:
- NSAID pain killers
- Hormone replacements such as estrogen or birth control pills
- Synthetic steroids including danazol (brand names Danatrol, Danocrine, Danol, and Danoval)
- Migraine medications
- Certain antibiotics
- Drugs used to treat irritable bowel syndrome including teraserod (brand names Zelnorm and Zelmac).
4. Prevent or Treat Blood Clotting Abnormalities
The most significant risk factors for developing venous and arterial blood clots that can block blood flow include:
- being sedentary/immobility
- older age
- genetics/family history
- taking certain medications
- having high blood pressure or high cholesterol
- lack of regular exercise
To help prevent blood clots from forming, it’s important to stay active and eat a healthy diet. Make it a priority to exercise regularly and avoid long periods of prolonged inactivity or immobilization. Aim to be active for at least 30 minutes daily. Also, take breaks regularly when you’ve been sitting for an extended period of time.
If you smoke cigarettes, make every effort to quit as soon as possible since smoking increases the risk for blood clots. Certain medications may also increase your risk for developing blood clots, including hormone replacement drugs (usually used by menopausal or postmenopausal women), birth control pills, medications to control blood pressure, and cancer treatment drugs. Discuss your risk of blood clots with your doctor if you use these medications, especially if you have a history of heart-related problems.
5. Avoid Becoming Dehydrated & Overexertion
Drinking water throughout the day is the best way to stay hydrated, especially whenever you’re losing fluids, such as if you’re doing vigorous exercise. Severe dehydration can cause changes in blood pressure and potential serious problems like heat exhaustion, fainting and cardiac problems. People recovering from surgery, athletes, people who perform manual labor outdoors in the heat, children, the elderly, and people with GI issues are all susceptible to the effects of dehydration.
To protect yourself from dehydration and negative effects of electrolyte loss, drink about eight glasses of water throughout the day (give or take a bit) in addition to consuming hydrating foods such as:
- coconut water or coconut milk
- watermelon and other melon
- bell peppers
- citrus fruits, like oranges and grapefruit
Precautions If You Suspect You Have Ischemic Colitis
Always visit a doctor if you experience bloody stools for more than one day accompanied by abdominal pain and/or a fever. Rather than attempting to treat ischemic colitis on your own, or just waiting it out, get a professional diagnosis to be safe. It’s important to get a proper diagnosis of ischemic colitis in order to distinguish it from other similar conditions that may be chronic (such as other types of inflammatory bowel diseases) or more serious, such as acute mesenteric ischemia, which causes complete blockage of blood flow to part of the intestine that often cannot be reversed.
Final Thoughts on Ischemic Colitis
- Ischemic colitis is an injury to the large intestine/colon as a result of reduced blood flow. It affects people over the age of 65 most often, especially those with a history of cardiovascular problems, but it can also develop in younger people.
- Symptoms of ischemic colitis include: abdominal pain, blood stools, diarrhea, trouble eating, dehydration, fever and weight loss. These are due to inflammation and superficial injury to the intestine, along with damage to intestinal tissue (necrosis).
- Treatments for ischemic colitis include: treating any underlying health issues that are contributing to the problem; changing medications; treating dehydration and electrolyte imbalances; resolving any intestinal infections; reducing inflammation in the GI tract; and in about 20 percent of cases, surgery.
Jillian BabcockDr. AxeOctober 20, 2017