Spastic colitis

Generality

Spastic colitis, or irritable bowel syndrome, is a set of enteric disorders that specifically concerns the intestinal tract called the colon.

The causes of spastic colitis still represent a question mark today.

According to the most reliable hypotheses, at the origin of the aforementioned condition, there would be an abnormal communication between encephalon, nerve fibers that innervate the intestine and intestinal muscles.

The typical symptoms of spastic colitis consist of: pain and cramps in the abdomen, constipation, diarrhea, sensation of bloating in the stomach, meteorism and mucus in the stool.

With a chronic character, spastic colitis does not cause alterations to the intestinal anatomy and does not favor the appearance of colon or colorectal cancer.

The treatment consists of remedies - including an effective antistress therapy, an adequate dietary plan etc. - aimed at improving the symptoms.

Brief reference to the anatomy of the colon

The intestine is the portion of the digestive system between the pylorus and the anal orifice.

The anatomists divide it into two main sectors: the small intestine, also called small intestine, and the large intestine, also called large intestine .

The small intestine is the first section; it starts at the level of the pyloric valve, which separates it from the stomach, and ends at the level of the ileocecal valve, located on the border of the large intestine. The small intestine consists of three sections (the duodenum, the fast and the ileum), is about 7 meters long and has an average diameter of 4 centimeters.

The large intestine is the terminal tract of the intestine and of the digestive system. It starts from the ileocecal valve and ends at the anus; consists of 6 sections (cecum, ascending colon, transverse colon, descending colon, sigma and rectum), is about 2 meters long and has an average diameter of 7 centimeters (hence the name of large intestine).

What is spastic colitis?

Spastic colitis, also known as irritable bowel syndrome, is a collection of intestinal symptoms that specifically involve the colon .

Spastic colitis is a chronic condition, which can last for years and require - precisely because of its long duration - a long treatment.

Unlike inflammatory bowel diseases such as, for example, Crohn's disease or ulcerative colitis, spastic colitis is not responsible for any change in intestinal anatomy and in no way favors the appearance of colon cancer or colon cancer rectum.

OTHER NAMES

In addition to the name irritable bowel syndrome, spastic colitis is also known as: irritable bowel syndrome, nervous colitis, irritable bowel, spastic colon and mucous colitis.

Epidemiology

According to some statistical surveys, spastic colitis would affect 10-15% of the population belonging to the so-called "developed countries".

According to other research, the areas of the world with the greatest number of patients would be Central America and South America; by contrast, the areas of the world with the least number of patients would be the geographical areas of South-East Asia.

The female sex is the most affected: women with spastic colitis are at least twice as many as men.

Most individuals with irritable bowels are under 45 years old.

The association between spastic colitis and psychological problems, such as major depression, anxiety and personality disorders, is very frequent.

Causes

Despite numerous studies on the subject, the precise causes of spastic colitis still remain a mystery.

MOST TRUSTED HYPOTHESIS

The brain and the intestine are closely connected to each other, through a wide network of nerves.

According to experts, spastic colitis is due to an abnormal communication between the brain, nerve fibers that innervate the intestine and intestinal muscles.

Among the various theories on the possible triggers of the irritable colon, the one just reported is the most reliable.

Pathophysiology

The layer of muscle cells that forms part of the intestinal wall allows food to pass through the digestive process through rhythmic contractions.

According to what the doctors say, the presence of spastic colitis would be responsible for too strong contractions and for too long a duration or, alternatively, for too weak contractions.

Too strong contractions would lead to the onset of symptoms, such as meteorism, a sense of swelling in the abdomen and diarrhea; the too weak contractions, on the other hand, would be at the origin of a slowing of intestinal transit and of hard or dry stools.

THE STIMULATES OF THE SPASTIC COLITIS

Several clinical studies have shown that the symptoms of spastic colitis often appear as a result of certain circumstances.

These circumstances - also referred to as " triggers " ( triggers, in English) or spastic colitis stimuli - may vary from patient to patient.

The most common "triggers" of the irritable colon include:

Intake of some specific foods. There are people who complain about classic spastic colitis disorders when they take one or more of these foods: chocolate, coffee, tea, spices, fatty foods, fruit, peas, cauliflower, cabbage, broccoli, milk, alcohol, sugary drinks, etc. .
The stress. Many individuals with spastic colitis tend to complain of the worst ailments during times of stress.
Hormonal alterations. Doctors believe that hormones can play a "trigger" role, due to the fact that women, subject to cyclical hormonal changes due to the menstrual cycle, are the most interested subjects.
Some infectious diseases of the gastrointestinal tract. According to some clinical investigations, there seems to be a certain type of consequential link between severe gastroenteritis and spastic colitis.

Probable risk factors of spastic colitis:

Age less than 45 years.
Female sex.
Family history of spastic colitis.
Psychological problems, such as anxiety, major depression, personality disorders, etc.
Past history of sexual abuse.

Symptoms and Complications

To learn more: Spastic Colitis Symptoms

The symptoms of spastic colitis can vary, sometimes even significantly, from patient to patient.

The most common symptomatology consists of:

Abdominal pain;
Abdominal cramps;
Sensation of stomach swelling;
flatulence;
Diarrhea or constipation. It may happen that the patient alternates days of diarrhea with days of constipation;
Presence of mucus in the stool.

In general, spastic colitis tends to be a condition that alternates periods, whose symptoms are very intense, to periods, whose clinical manifestations are almost absent.

WHAT SYMPTOMS DOES NOT CAUSE?

Spastic colitis is not responsible for: rectal bleeding, stool blood, fever, weight loss or particularly intense abdominal pain.

All these symptoms and signs mentioned above are characteristic of more severe intestinal conditions and induce a change in the anatomy of the intestine.

ASSOCIATED CONDITIONS

As mentioned, often sufferers of spastic colitis are also affected by major depression, anxiety and related disorders, and personality disorders .

A scientific explanation for this association is currently under study.

COMPLICATIONS

The prolonged presence of spastic colitis can be a reason for:

Hemorrhoids . Hemorrhoids is the improper term used to indicate a pathological dilation and prolapse (due to a failure of the supporting structures of the anorectal canal) of the hemorrhoidal veins.
Malnutrition . It may depend on the elimination of certain foods from the diet, as they are responsible for the onset of intense symptoms.
Compromised quality of life . It is perhaps the complication of spastic colitis with greater impact. Those suffering from irritable bowel complains of periodic disorders, which make it difficult to lead a peaceful life.

Diagnosis

Since there are no laboratory and diagnostic imaging tests capable of identifying spastic colitis, the only way to ascertain the presence of the problem in question is to rely on the so-called differential diagnosis .

With differential diagnosis, doctors understand that path of tests and diagnostic tests that allows to recognize a disease through the exclusion of diseases with similar symptoms.

WHAT EXAMINATIONS TO APPLY?

After having questioned the patient about the symptoms and having analyzed the general health conditions, the doctor could prescribe:

A stool analysis for occult blood research . It means looking for blood in the patient's stool.
A coproculture, ie a microbiological examination of faeces . It consists of searching for bacteria or parasites in feces. It is indicated in the presence of chronic diarrhea.
A flexible sigmoidoscopy . It is used to analyze the state of health of the rectum and the terminal part of the colon. It involves the use of a flexible tubular instrument, equipped with a camera and a light. The introduction of this instrument into the intestinal tract of interest takes place through the anus.
A colonoscopy . It is used for the complete analysis of the colon. Like flexible sigmoidoscopy, it involves the use of a flexible tubular instrument, equipped with a camera and a light. The introduction of this instrument into the colon occurs through the anus.
A radiograph of the digestive tract with barium sulfate contrast medium. Provides fairly clear images of the colon. It is useful for identifying any tumor masses or anatomical anomalies.
An abdominal and pelvic CT scan . Provides three-dimensional images of organs located in the abdomen and pelvic level. It is useful for identifying any tumor masses or anatomical anomalies.
A breath test for the diagnosis of lactose intolerance . It allows to establish if the patient produces sufficient quantities of lactase, a fundamental enzyme for the digestion of lactose.
It should be remembered that failure to digest lactose due to the absence of lactase leads to symptoms such as abdominal pain, meteorism and diarrhea.
A breath test for the determination of bacterial colonization of the small intestine .
A thorough blood analysis . It allows to assess the presence of a disorder such as celiac disease, which causes symptoms and signs very similar to spastic colitis, but has decidedly more serious complications.

If nothing significant emerges from all these laboratory and imaging tests, the possibility that the current condition is spastic colitis is concrete.

Important: in addition to the negativity of the aforementioned tests, the criteria on which doctors rely to establish a definitive diagnosis of spastic colitis are:

Presence, at least once a month, in the last three months, of an abdominal pain lasting at least three days;
The abdominal pain mentioned above is attenuated with defecation;
The abdominal pain mentioned above is associated with changes in the consistency of the stools;
Abdominal pain mentioned above is associated with alterations in the frequency of defecation.

SYMPTOMS AND DANGEROUS SIGNS THAT EXCLUDE SPASTIC COLITIS

The presence of certain symptoms and signs, including weight loss, rectal bleeding, fever, nausea, vomiting etc., suggests that a different and more serious disease than spastic colitis is underway.

For this reason, in such situations, the doctors decide to subject the patient to further and immediate checks.

Main symptoms and signs that suggest the presence of a more serious irritable bowel disease:

Weight loss
Rectal bleeding
Temperature
Recurrent nausea and vomiting
Severe abdominal pain, even during the night
Persistent or even awakening diarrhea
Iron deficiency anemia

Treatment

To learn more: Drugs for the treatment of Spastic Colitis

The causes of spastic colitis being unclear, the treatment consists only of remedies aimed at reducing the symptoms and improving the quality of life of the patients.

In the less serious cases, the doctors consider it sufficient: the use of an effective antistress therapy, the constant practice of physical exercise, an adequate night rest and the adoption of a dietary plan, which excludes all those foods that stimulate the onset of symptoms typical of spastic colitis.

In moderate-severe cases, on the other hand, they consider it essential to add a pharmacological type of therapy to the aforementioned remedies.

DIETARY PLAN: WHAT DO I DELETE?

To learn more: Diet and Behavior for Irritable Colon

For patients suffering from intense meteorism, doctors advise to eliminate from the diet all those foods that cause a conspicuous production of gas inside the intestine, such as: sugary drinks, cabbage, broccoli, cauliflower, etc.

For patients who frequently suffer from diarrhea, it would seem appropriate to eliminate the consumption of foods containing gluten. In this regard, not all doctors agree: some experts believe that gluten has no responsibility.

Finally, for those patients who do not tolerate foods containing carbohydrates fructose, lactose, fructans, etc., experts advise limiting the consumption of these foods and gradually reintegrating them into the diet.

PHARMACOLOGICAL THERAPY

The pharmaceutical products used for spastic colitis include:

Fiber supplements, such as psyllium or methylcellulose. Compared to the fibers contained in foods, fiber supplements cause, once ingested, a lesser sense of swelling in the abdomen.
Osmotic laxatives, such as milk of magnesia or polyethylene glycol. These products represent an alternative to fiber supplements, if the latter are not very effective.
Antidiarrheal, for controlling episodes of diarrhea. They are drugs used for this purpose: loperamide and bile acid sequestering resins (colestyramine, colestipol and colesevelam).
Anticholinergics and antispasmodics . They are useful for those patients suffering from painful intestinal spasms. The drugs in this category include hyoscyamine and dicyclomine.
Tricyclic antidepressants and antidepressants belonging to the category of selective serotonin reuptake inhibitors (SSRIs). Doctors prescribe these drugs to people with spastic colitis who also suffer from depression or personality disorders.
Among the tricyclic antidepressants, imipramine and nortriptyline are reported; among SSRIs, fluoxetine and paroxetine deserve a mention.

ADVICE ON THE LIFESTYLE

Doctors believe that paying attention to lifestyle significantly improves the symptomatology, induced by spastic colitis.

However, they want to point out that the benefits are not immediate, but in the long run. Consequently, adopting a specific lifestyle must be a definitive and not a temporary choice.

Regarding the feeding style, the main advices are:

Reduce your intake of fiber-containing foods, unless you gradually put them back into the diet over several weeks. In other words, the patient must start taking fiber-rich foods again, starting with small doses and increasing the amount ingested week by week. Such an approach allows the intestine to gradually get used to the "digestion" of the fibers.
Avoid those foods that cause a worsening of symptoms and are not indispensable from a nutritional point of view. These include: alcohol, chocolate, coffee, caffeinated beverages and sorbitol or mannitol based products.
Eat at regular intervals, without skipping meals. This guarantees a certain intestinal regularity.
Increase the number of daily meals, dividing the top three into snacks and snacks. This reduces the amount of food taken during each meal and the possibility of suffering from diarrhea.
Pay attention to the intake of products containing lactose. For example, those who struggle to digest milk can replace this product with yogurt, which is more digestible.
An alternative is also to adopt the same technique described for foods rich in fiber.
Drink a lot of water.

As for the lifestyle in general, the most important advice is:

Practice physical exercise regularly. Physical activity helps reduce stress and depression, promotes normal intestinal motility and, in general, produces a sense of inner well-being.
If the patient is not very active, it is good that he starts to exercise gradually, to avoid muscular or joint problems.
Use antidiarrheal drugs and / or laxatives with caution, without exaggerating.