Settling Pseudomembranous Colitis
You have a strong case of diarrhea. You have been on antibiotics for another condition. Your doctor says you have pseudomembranous colitis.
According to the Cleveland Clinic, pseudomembranous colitis is an inflammatory process that occurs when your colon lining is being injured. It could be bacteria, toxins or another illness that is injuring the lining. Your colon mucosa develops thickened, scabish plaques over the wounds. Your doctor may refer to these as pseudomembranes.
Pseudomembranes form on mucous membranes, like your colon lining, when cells die. Your immune system responds by sending white blood cells to the site of the injury. Leftover cellular debris combines with white blood cells known as neutrophils to form pseudomembranes. They’re raised areas on the mucosa, up to 2 centimeters (cm) wide, being yellow-white in color.
Pseudomembranous colitis symptoms are abdominal pain, diarrhea, fever, nausea and on rare occasions, you may notice pus or bleeding in your feces but not always.
Pseudomembranous colitis is caused by C. diff (Clostridioides difficile) infection. C. diff is a bacterial infection that produces toxins that injure your colon lining. About 10 percent of C. diff eventually go on to form pseudomembranous colitis. This forms 90 percent of all cases. But other causes of colitis can cause similar damage.
C. difficile forms toxins that injure your colon mucosa, causing cell death. The infection can be unusually severe, unusually fast. The infection usually happens after taking antibiotics. Antibiotics decreases the other bacteria in your gut, but it doesn’t affect C. difficile. This allows C. diff to grow out of control.
Any antibiotic can kill the good bacteria in your gut, but not C. diff can make you susceptible to a C. diff infection and pseudomembranous colitis. But some are considered high risk and they are:
· Clindamycin.
· Cephalosporin.
· Penicillin.
· Fluoroquinolones.
· Aztreonam.
· Carbapenems.
You are more at risk for developing pseudomembranous colitis if you:
· Are in a hospital.
· Recently took antibiotics.
· Recently had surgery.
· Are in a nursing home.
· Are older than 65.
· Have an autoimmune disease.
· Have a weakened immune system.
· Have had a C. diff infection before.
When colitis becomes severe and difficult to control, it may lead to additional complications, some of which can be life-threatening. These complications can include:
· Dehydration and electrolyte losses. Severe pseudomembranous colitis can cause severe diarrhea, between 10 and 15 times a day. Severe fluid and electrolyte losses can have dangerous side effects, including low blood pressure, low blood volume and kidney failure.
· Fluid leakage. Your damaged colon lining can begin to leak fluids into your abdominal cavity (ascites), causing it to swell. You may also lose proteins from your colon, such as albumin. Low albumin can cause your blood vessels to leak, causing edema (swelling in your hands and feet).
· Toxic megacolon. Uncontrolled severe colitis can cause such severe swelling that it disables your colon. First, the muscles stop moving, causing a blockage. As the colon further dilates, it can leak or even tear, spreading infection into your abdominal cavity (peritonitis).
· Gastrointestinal perforation. Your colon wall can get a hole or tear without toxic megacolon, too. It may happen if you have ulcers in your colon that wear all the way through the wall, or if you have significant necrosis (tissue death) in your colon wall. When bacteria from your colon leak into your abdomen (peritonitis), they can spread into your bloodstream (septicemia).
· Sepsis. Septicemia can lead to sepsis—a life-threatening, whole-body reaction to severe infection. Sepsis can lead to septic shock, which can cause multiple organ failure and death.
To diagnose pseudomembranous colitis, your doctor will conduct different types of tests such as blood tests, imaging tests and feces tests. They’ll look for signs of infection or inflammation and other red flags.
They’ll test your feces for evidence of C. diff infection. If they find evidence of such an infection, they will start treatment right away. There will be no reason to look inside of the colon for evidence of pseudomembranes unless you have complications or you aren’t responding to the treatment.
At times, signs of pseudomembranous colitis may show up on an imaging test. Your doctor might see a pattern in the images that suggests severe colitis or damage to the mucosa, like a “thumbprint sign” or the “accordion sign.” This might prompt further investigation.
In order to investigate further, your doctor will have to look inside your colon. This requires a colonoscopy. If your doctor finds pseudomembranes, they will take a tissue sample (biopsy) and send it to the lab for confirmation.
To properly treat your colitis, it depends on the cause. You may need specific antibiotics for a bacterial infection, like C. diff or you may need to discontinue medications that are contributing to your colitis. In some cases, your doctor may prescribe medications to reduce inflammation in your colon.
If C. diff is the cause of your pseudomembranous colitis, there are a few drugs that can treat it. Your doctor will choose the right one for you. Some drugs to treat C. diff are metronidazole, vancomycin and fidaxomicin.
Just remember that you can help stop the spread of C. diff in vulnerable populations like hospitals and nursing homes by washing your hands and disinfecting surfaces with chlorine-based products. With special care, you can heal your colon.
