Signs of spastic colitis and its other forms, treatment, prevention

Causes of colitis. Types, classification

Treatment for ulcerative colitis in adults and its other forms is different. To differentiate them, a classification has been developed that systematizes colitis.

According to the course of colitis there are:

• acute – the symptoms are vivid, grow quickly, and cannot be confused with the symptoms of other diseases;
• chronic – develops slowly, symptoms are not expressed. Periods of remission (no signs) alternate with periods of exacerbation.

Depending on the cause, the following colitis is distinguished:

• ulcerative - its causes are not clear. This colitis is associated with hereditary factors, autoimmune and infectious lesions;
• infectious - develops under the influence of infectious agents - nonspecific (staphylococci, streptococci) and specific (Koch bacillus, treponema pallidum). The symptoms of nonspecific colitis in a child and an adult are similar;
• ischemic – occurs due to impaired microcirculation in the intestinal wall and its oxygen starvation;
• toxic - formed due to the influence of various toxic substances on the mucous membrane of the large intestine. A variety is medicinal colitis;
• radiation – develops due to the influence of radiation factors on the intestinal mucosa.

More information about the causes of colitis (for example, what are the causes of pseudomembranous colitis) can be found on the pages of our website https://www.dobrobut.com/.

Depending on the location of the lesion, the following colitis is distinguished:

• typhlitis – the cecal mucosa becomes inflamed;
• transversitis - the mucous membrane of the transverse colon suffers;
• sigmoiditis – the mucous membrane of the sigmoid colon becomes inflamed;
• proctitis – inflammation of the rectal mucosa;
• pancolitis - the mucous membrane of all parts of the large intestine is affected (for example, with catarrhal colitis in men or women).

Spastic colitis - what is it?

Spastic colitis is a persistent disorder of the functional state of the intestine. The pathology is accompanied by the occurrence of painful spasms. The disease does not provoke organic disorders in the organ. A characteristic manifestation of this type of colitis is a dystrophic change in the tissues of the digestive tract. The inflammatory process is less pronounced than in other forms of diseases in this category.

In women, spastic colitis is diagnosed more often than in men. The risk group also includes children (from an early age).

Signs of catarrhal colitis in men and women

The clinical picture depends on the form of colitis.

Manifestations of acute colitis:

• periodic sharp pain in the abdomen. Possible back and lower back pain due to colitis;
• constant urge to defecate;
• rumbling in the large intestine;
• bloating;
• severe diarrhea.

Manifestations of chronic colitis:

• feeling of fullness and heaviness in the stomach;
• pain in the form of colic (contractions) - these are mainly signs of spastic colitis;
• urge to defecate;
• diarrhea – when the right half of the large intestine is affected;
• constipation – if the left half is affected;
• fecal stench – observed when putrefactive flora is activated;
• flatulence (bloating) – observed when fermentative flora is activated;
• blood in the stool - detected in erosive or ulcerative colitis. This is a sign that requires a serious approach to treatment - for example, ordinary antibiotics or suppositories for deep erosive colitis simply will not help.

With long-term colitis the following are observed:

• significant weight loss;
• general weakness;
• manifestations of a lack of vitamins - dry skin and mucous membranes, blurred vision, and so on.

Menstruation may also change with colitis in women - they may become painful.

Acute and prolonged chronic colitis requires hospital treatment. Mild forms of chronic colitis can be treated at home.

Treatment

Diet. The main goal of the diet is to limit the consumption of spicy, fatty, salty and other foods that have an irritating effect on the intestines. In addition, you need to include the following foods in your diet: fruits, whole grain bread, beans, vegetables. It is recommended to eat fractional meals 5-6 times a day in small portions. This makes it possible to reduce the intensity of diarrhea, the level of gas formation, and stabilize the patient’s condition.

Drug treatment. Initially, treatment of spastic colitis begins with the prescription of non-steroidal anti-inflammatory drugs (NSAIDs) and antibacterial drugs. Well-known remedies are recommended: analgin, ibuprofen, baralgin, spasmalgon, ketorol. However, it must be remembered that their long-term use can provoke a worsening of the disease and ulceration of the gastrointestinal mucosa. Broad-spectrum antibiotics are also used: ceftriaxone, cefazolin, oxamp. In addition to anti-inflammatory drugs, the doctor prescribes enveloping drugs that help reduce the intensity of the inflammatory process.

To make an appointment at the ABC-Medicine clinic for the treatment of spastic colitis, call +7 (495) 223-38-83.

Diagnostics

The diagnosis is made based on complaints, medical history, and the results of additional research methods.

Physical examination data are as follows:

• on palpation – pain and bloating;
• upon percussion - a dull sound over intestinal loops overflowing with feces;
• on auscultation – increased peristalsis due to diarrhea.

The most informative are the following instrumental diagnostic methods:

• sigmoidoscopy – examination of the rectum and initial parts of the sigmoid colon using a sigmoidoscope;
• colonoscopy – examination of the colonic mucosa using a colonoscope (a flexible probe with an optical system);
• irrigoscopy - X-ray examination after administration of a contrast agent into the intestine.

Laboratory methods used in the diagnosis of colitis:

• bacteriological examination - stool is inoculated on nutrient media, the pathogen is identified by colonies, and its sensitivity to antibacterial drugs is also determined (important for the choice of antibiotics in case of exacerbation of chronic colitis or its acute form);
• bacterioscopic examination of stool - pathogens that cause inflammation of the colon mucosa are identified under a microscope;
• fecal analysis for helminth eggs - it is used to identify helminths in the large intestine;
• general blood analysis. An increase in the number of leukocytes and ESR indicates the presence of inflammation. A decrease in the number of red blood cells and hemoglobin signals intestinal bleeding (mainly with ulcerative colitis).

Forms of the disease

Spastic colitis has several forms of manifestation. Each type of disease differs in provoking factors, additional symptoms and implies a special treatment regimen.

You can identify some forms of pathology yourself, but only a specialist can make an accurate diagnosis through a comprehensive examination of the patient.

Forms of the disease:

• acute type (the main cause of development is an infectious lesion of the digestive tract, or irritation of the intestinal mucous membranes by harmful substances);
• chronic type (is a consequence of the acute form, dysbacteriosis may be a concomitant condition);
• toxic type (the provoking factor is the effect of chemicals on the intestinal mucous membranes);
• allergic type (is a complication of chronic allergic reactions);
• nutritional type (develops due to a lack of fiber in the diet, regular violations of the diet);
• medicinal type (in most cases develops against the background of uncontrolled use of laxatives and antibiotics).

Additionally, in medical practice another classification of spastic colitis is used. There are different forms with a predominance of constipation, diarrhea, or alternation of these conditions. A separate group includes unclassified colitis. This type of pathology is difficult to diagnose. Symptoms can change quickly. It is not possible to identify the predominant symptoms.

What drugs are prescribed for atrophic colitis and its other forms?

In the treatment of colitis, conservative and surgical methods are used.

Conservative treatment

Patients are interested in what medications should be taken for atrophic colitis or its other forms. This is determined by the doctor in each specific case. Based on the appointments:

• diet;
• antibacterial or antiparasitic drugs;
• agents that improve blood flow in the intestinal wall;
• intestinal adsorbents;
• laxatives or antidiarrheals;
• agents that improve the condition of normal intestinal microflora;
• detoxification therapy;
• immunomodulators;
• pain relief. The doctor decides what medications to use to relieve pain in acute colitis of the rectum or other locations.

Surgical treatment

It is used for severe complications such as ulcerative colitis or progressive ischemia of the large intestine.

If the damage is significant, resection (removal) of part of the intestine is performed. This is fraught with deterioration of its functions:

• absorption of vitamins;
• absorption of fluid and formation of feces.

Possible complications and consequences

With spastic colitis there is no tendency for symptoms to increase. The disease significantly reduces the quality of life. The disease is not accompanied by organic disorders of the digestive tract. However, if the symptoms of the pathology are ignored for a long time, serious complications can arise. Diarrhea provokes dehydration, constipation causes intestinal obstruction. The consequences of such conditions are disruptions in the functioning of the entire body. With intestinal obstruction, pathological processes develop that require surgical intervention.

IBS with constipation. The place of non-absorbable molecules in the treatment of various gastroenterological diseases

Oksana Mikhailovna Drapkina , professor, doctor of medical sciences:

– Lecture by Yulia Olegovna Shulpekova, she will talk about IBS with constipation.

Yulia Olegovna Shulpekova , associate professor, candidate of medical sciences:

– Hello, dear colleagues. It's very nice to talk with you now. In my lecture I would like to present the role of various non-absorbable large molecules in the treatment of IBS with constipation and, in particular, focus on the drug Macrogol. Let me start this lecture by briefly recalling the existence of the Rome Third Revision Criteria, according to which we assess the presence of recurrent abdominal pain or discomfort on at least three days per month over the past three months, and which must be associated with two or more of the following: signs: decreased pain during bowel movements, changes in frequency and shape of stool. As you can see, there may also be additional symptoms that sometimes bring very strong anxiety to patients. And the question often arises: how to evaluate the shape of feces? There is a special Bristol scale. Although it is well known to everyone, I would like to emphasize once again that this scale can be used to assess whether a patient’s stool is normal or not, and based on it, make a conclusion about the presence of irritable bowel syndrome. Here are the third and fourth types of stool forms - these are normal types. And the first and second types are more typical of IBS with constipation. The diagnosis of IBS with constipation is based on the patient having difficulty bowel movement, that is, a subjective feeling of incomplete bowel movement, hard or lumpy stools in more than 25% of bowel movements, and loose stools in less than 25% of bowel movements. And I would also like to remind you of the extreme importance of eliminating anxiety symptoms:

1. Loss of body weight, which does not allow us to exclude cancer, colitis or enterocolitis.
2. The appearance of symptoms at night, which is not typical for functional diseases of the gastrointestinal tract.
3. Constant and fairly intense or increasing abdominal pain as the only or leading symptom. This is not typical for functional diseases.
4. Onset of the disease at the age of over 50 years.
5. Family history: colon cancer, inflammatory bowel disease, celiac disease in the patient’s relatives. As well as the high prevalence of these diseases in the area. In such cases, a more targeted examination is necessary to exclude organic pathology.
6. Changes in organs upon examination (hepatomegaly, splenomegaly), palpable mass in the abdomen.
7. Blood in the stool.
8. Signs of malabsorption and osteoporosis.
9. Deviations in the general blood test, biochemical parameters and TSH (thyroid-stimulating hormone) levels.

Thus, for a fairly reliable diagnosis of IBS, it is necessary for the patient to undergo not only detailed physical examinations and anamnesis, but also include a complete blood count, stool occult blood test, biochemical blood test, and thyroid function tests in the minimum examination. IBS with constipation is known to be a fairly common disease. In economically developed countries, the prevalence of irritable bowel syndrome itself can reach 10-20%. And among all these cases, according to various sources, cases of constipation reach half: 34-52% in different studies. And the mixed version of the course, in which constipation is also observed, reaches 33-39%. In IBS with constipation, according to some data, the incidence of depression and anxiety is higher, and the patient’s quality of life is lower. And as an explanation for why constipation predominates in these patients, a violation of cholinergic innervation is assumed. As shown by some researchers, the tone of the cholinergic part of the nervous system seems to be altered. In particular, they explain the influence of psychosocial factors; activation of vagal fibers, which affect intestinal motility, in turn, indirectly affect visceral sensitivity, and it is connected to the central nervous system through sympathetic fibers.

In case of IBS with constipation, to confirm the diagnosis and to objectify the presence of constipation, it is advisable to conduct studies with radiopaque markers, but, unfortunately, this is available in few institutions. In the left image you see a uniform distribution of radiopaque marks five days after their administration along almost the entire colon, more in the left sections. In the middle image you can see the concentration of these tracers by the fifth day after their ingestion in the rectosigmoid junction, which indicates that the constipation appears to be more of a functional proctogenic nature. And in the right picture you see one of the reasons for such proctogenic functional constipation, a violation of the relaxation of the anorectal muscle in the form of a loop covering the rectum. A special study was conducted which showed that many patients suffering from IBS with constipation have a significantly reduced number of large propulsive contractions of the colon per day compared to healthy people. But other studies have shown that in some patients it is not hypotension that predominates, but, on the contrary, spastic activity of the intestine. In particular, on the left side of the slide you see how the sigmoid colon contracts normally after eating; there is a relatively small amplitude and rhythmic contractions. And on the right side of the slide you see chaotically high-amplitude contractions of the sigmoid colon in a patient with IBS, which can lead to impaired evacuation of feces and thickening of its consistency. In the development of both hypersensitivity and motor impairment, great importance is attached to changes in local reflexes. It is well known that the wall of the colon responds reflexively to an increase in intraluminal pressure, this pressure affects the enterochromaffin type cells that are embedded in the mucous membrane; they secrete serotonin, and the secretion of serotonin modulates the flow of impulses into the local enteric and central nervous systems. And in the enteric local system, the central local system, there are whole varieties of groups of nerve endings and nerve cells. Some of them act as sensory cells, others mediate motor reflexes, relaxation or contraction of the intestine. And there are also interneurons. Thus, peristalsis largely depends on the pattern of local reflexes that has developed in a given patient.

The involvement of the central nervous system in the development of manifestations of irritable bowel syndrome has also been proven. You can see on the left side of the slide how the activity of the cerebral cortex and subcortical nuclei changes when the rectum is stretched, with the introduction of a balloon that stretches the rectum. And patients with IBS have altered electrical activity in various parts of the brain. And in response to the expected stretching of the rectum, the response in some areas is reduced, while in others, on the contrary, it is pathologically increased.

And on this slide I wanted to present this amount of knowledge in the form of a diagram. What is known today about the contribution of disturbances in the inflammatory response, about the contribution of inflammatory cells to the pathogenesis of irritable bowel syndrome. In the lower part of the figure we see the data obtained in experimental studies, which relate to the content of various cytokines in the blood of patients, irritable bowel syndrome and in the mucous membrane. And now, in particular, data have been obtained on the high permeability of intercellular contacts, and on the fact that in most cases these patients have increased levels of pro-inflammatory cytokines, interleukin-6, and tumor-necrotizing factor. They are not so significantly increased, but apparently contribute to the pathogenesis. In addition, in the mucous membrane in most patients the content of mastocytes, macrophages and certain populations of lymphocytes is increased. And these cells are thought to influence nerve fibers and modulate pain sensitivity and motor response. While researching material for this presentation and looking for differences between IBS with constipation and IBS with diarrhea, I came across evidence that there is conflicting evidence that mast cells are, in general, elevated in patients with irritable bowel syndrome, as shown on the right parts of the slide, these cells are colored brown. But in one study (shown below right) they found that, on the contrary, in IBS with constipation their number was even reduced compared to healthy individuals. And in IBS with diarrhea, they are significantly increased. Also shown is a change in the production of various hormones that regulate gastrointestinal motility in irritable bowel syndrome: in particular, cholecystokinin, somatostatin, various neuropeptides, and so on.

Next, let me move on to a review of medications currently recommended for relief of the main clinical symptoms of irritable bowel syndrome. These drugs can be divided into groups used:

1. For diarrhea: astringents and adsorbents; motor regulators, predominantly suppressing motor activity.
2. For constipation, preference is given to the use of osmotic laxatives, the most modern of which are “Polyethylene glycol” and “Lactulose”. Bulk laxatives of combined action are a kind of osmotic, bulk, and to some extent stimulating laxatives: Psyllium, Methylcellulose, Calcium Polycarbophil. And motility regulators: “Prucaloprid” (a new prokinetic agent registered in Russia), “Trimebutin”, “Tegaserod” (which is not used in Russia).
3. Antispasmodics and tricyclic antidepressants are used to treat abdominal pain.

Unlike other branches of medicine, non-absorbable molecules are widely used in gastroenterology. Why in gastroenterology? Because the gastrointestinal tract is a container, on the one hand, for diseases; on the other hand, it is a field for the action of drugs. And diseases of the gastrointestinal tract make it possible to prescribe medications locally. Examples include alginates for reflux disease, antacids, sucralfate, bismuth salts, adsorbents, non-absorbable antibiotics, aminosalicylic acid (5-ASA) preparations and modern laxatives. And all these modern means are designed to have as little systemic effects on the body as possible while highly effective in treating diseases. Currently, we try to prescribe drugs that have the highest level of evidence and have undergone large studies. In particular, level 1 evidence includes randomized controlled trials with an adequate sample size that demonstrate the effectiveness of a given drug. And the studies must be of high quality in patient selection and so on. Such studies that show the effectiveness of laxatives include studies on the effectiveness of Polyethylene glycol (PEG) to a greater extent, and to a lesser extent - Lactulose and Tegaserod. All other types of laxatives are categorized as “B” and “C”; there is less research on them, and there is less evidence of their effectiveness and safety.

Let me dwell briefly on “Polyethylene glycol” (“Macrogol”), which is an osmotic laxative. These are linear polymers with a mass of 3000-4000, which are able to attract and retain water molecules. Thus, the stool increases in volume, its consistency softens, it stimulates motility by stretching the wall, and thanks to such a soft consistency, its evacuation is facilitated. Dosage forms of “Polyethylene glycol” with a weight of 4000 in our country are represented by “Forlax” and “Fortrans”. The advantages of these drugs are that they: a) are not absorbed from the gastrointestinal tract; b) are not metabolized; c) do not have (as shown in studies) a significant effect on the level of blood protein, that is, they do not cause protein loss of diarrhea; do not affect the intestinal pH and the composition of the intestinal microflora; d) drug interactions are not described.

The Forlax effect, in particular, has been proven in modern meta-analyses by Belsey and the Cochrane Community. Here are the data from these meta-analyses. In them, in particular, a comparison was made of the effects of “Polyethylene glycol” and another effective and safe modern laxative – “Lactulose”. And according to a meta-analysis by Belsey and the Cochrane group, the advantage was in favor of the use of “Polyethylene glycol”. In the first meta-analysis, it was expressed in the fact that it provided almost one additional free bowel movement per week compared to Lactulose. And in a Cochrane meta-analysis, it was shown to be more effective in relieving abdominal pain and reducing the need for other medications to relieve IBS symptoms. It turned out that when Forlax is prescribed in long courses (from 4 weeks to 3 months), the aftereffect remains for some time, that is, after discontinuation of the drug for about two months or more, independent, soft stools can persist, as if the patient were continuing to take it drug. And this effect of “gut education” is attracting a lot of interest. By the way, it is now beginning to be studied in relation to other laxatives - this has already been shown for Forlax - and it is explained theoretically by the fact that new reflexes can be established at the level of the spinal cord and central nervous system, which contribute to the normalization of stool frequency.

Currently, there are a lot of sites on the Internet where much attention is paid to the issues of neuroplasticity, restructuring, and rapid adaptation of the nervous system to new conditions. As you can see, this excerpt from one of the sites shows that new connections, new axons, are established quite quickly between different nerve cells. The study by Professor Baranskaya, who works in our clinic, was devoted to assessing the softness of the effect of Polyethylene glycol (PEG) 4000. In particular, she assessed how long after the first dose of Forlax the first normal bowel movement would occur in most cases. And she found that in 70% of patients, loosening of the stool, a mild loosening, was observed within 20-35 hours after the first dose of the drug. The normal passage time for contents is 30-48 hours. Thus, as shown by the dark pink bars, in most patients the effect seemed to coincide with the physiological rhythm of the movement of contents through the intestines. Finally, there are other fiber-based bulk laxatives that cannot be mentioned. These are non-cellulosic natural polysaccharides (pectins, gums, mucus, inulin), semi-synthetic (methylcellulose), calcium polycarbophils, which are included in many combined laxatives.

The effect of such dietary fibers is based on the fact that they are partly processed by microflora, contribute to the growth of the microbial population, and the production of short-chain fatty acids. And all this leads to stimulation of motor skills, a decrease in water absorption and the laxative effect of these drugs. Such drugs are highly effective and quite physiological, but one should be careful about the possibility of constipation and fecal impaction in some patients, so they should be prescribed carefully, starting with small doses. Thank you for your attention.

Prevention

Prevention of spastic colitis involves eliminating provoking factors. Intestinal motility can be disrupted by a sedentary lifestyle. If there is insufficient physical activity, it is recommended to do basic exercises in the morning.

The diet must be controlled. Frequent snacking, sudden changes in diet, overeating and other factors have a negative impact on the condition of the digestive system.

Prevention measures:

• prevention of stressful situations and timely treatment of nervous disorders;
• compliance with the rules of a balanced and rational diet;
• timely identification of the causes of gastrointestinal disorders;
• prevention of parasitic and bacterial infections;
• regular examination by a gastroenterologist;
• healthy lifestyle and sufficient physical activity;
• adherence to sleep and rest patterns.

Video - Super food for intestinal motility.

Causes of spastic constipation

Increased muscle tone is often associated with several factors:

• neurological disorders;
• endocrine diseases and changes in hormonal status;
• irritable bowel syndrome with a predominance of constipation;
• stress, inflammatory diseases of the gastrointestinal tract;
• taking certain medications that affect muscle tone, etc.

Spastic constipation can be caused by previous surgeries, dietary habits, etc. They also serve as aggravating factors.

Spasms are provoked by various factors. The intestinal muscles are regulated, among other things, by the characteristics of the transmission of nerve impulses. The health of the intestines is influenced by many processes. Therefore, the causes of spastic constipation are neurological diseases, deficiency of vitamins and minerals, a sedentary lifestyle, psycho-emotional shocks that affect the functioning of the nervous system, etc.

Violate muscle tone and intoxication, unbalanced nutrition, including prolonged fasting and irregular meals.