Colitis: symptoms, treatment and what to eat

By Cristiano Antonino On Mar 6, 2023

Colitis, also called irritable bowel syndrome, is a disorder related to alterations in the peristaltic movement of the colon, due to various causes

The colon is a hollow organ (or viscera), located in the abdominal cavity, about one and a half metres long, which begins at the level of the ileo-cecal valve, the terminal tract of the small intestine, and ends with the rectum and the anal canal.

The disorders related to this organ are very frequent and the triggering causes, as mentioned above, are different

There are in fact different types of this disorder, the one called spastic or irritable bowel syndrome being the most common and the least serious, as it does not cause permanent damage.

However, it is still an annoying disorder that can cause the patient stress and embarrassment, to the point of limiting his or her working and social life.

Generally, this problem can be solved through proper nutrition.

On the other hand, a real inflammatory disease, the causes and treatment of which are partially unknown, is rectocolitis, which affects the large intestine and primarily the rectum, for which there are drugs that can keep it under control.

Symptoms of colitis

Symptoms that can be traced back to an inflammation of the colon are generally as follows

abdominal pain and swelling
pain in the side or back;
retro-sternal burning (i.e. behind the chest);
intestinal discomfort;
diarrhoea and/or constipation;
complaints relieved by evacuation and aggravated after meals.

It is usually women in their 20s and 30s who suffer from irritable bowel syndrome, which manifests itself with constipation and/or diarrhoea.

Constipation is associated with constant pain with burning, flatulence, bowel sounds and nausea.

Cramps in the abdomen and frequent diarrhoea with bloody discharge and intestinal mucus, on the other hand, are attributable to ulcerative colitis.

Causes of colitis

But what are the most frequent causes linked to the onset of this disorder? We list them below:

diet (hypersensitivity or intolerance to certain foods, inadequate nutritional style, low in water or fibre);
menstrual cycle (the intestine is quite sensitive to changes in female sex hormones);
alteration of the normal intestinal flora, with an increase in pathogenic microorganisms. This can give rise to a multitude of intestinal disorders;
stress-related factors of a psychological nature. In this case we speak of irritable bowel syndrome or nervous colitis.

The different types

Depending on the cause, colon-related inflammations can be classified into different types starting with:

A) Autoimmune MICI-chronic inflammatory bowel disease:

chronic inflammatory and autoimmune bowel disease; a group of chronic colitides;
Ulcerative rectocolitis (UCR) – a chronic colitis affecting the large intestine;
Crohn’s disease (CD) – another type of IBD that causes various disorders of the colon.

B) Unknown (not IBD – chronic inflammatory bowel disease):

Microscopic colitis: a colitis diagnosed by microscopic test of the colic tissue; macroscopically (“to the eye”) the mucosa appears normal; this disease comes in two variants:
Lymphocytic colitis, first stage of the disease;
Collagenous colitis, later evolution of the disease;

C) Cause-treatment:

diversion inflammation;
chemical inflammation;
chemotherapy-induced inflammation;
radiation inflammation.

D) Vascular disease:

ischaemic colitis;

E) Infectious:

infectious colitis.

Unclassifiable colitis

There are also those called ‘unclassifiable’ colitis because they cannot be associated with any of the specific symptoms listed above.

Unclassifiable colitis is the classification of colitis presenting features of both Crohn’s disease and ulcerative rectocolitis.

The behaviour of indeterminate colitis is generally closer to ulcerative rectocolitis than to Crohn’s disease.

The behaviour of indeterminate colitis is generally closer to ulcerative colitis than to Crohn’s disease.

Atypical colitis is a name occasionally used by physicians for colitis that does not meet the criteria for the definite types.

It is not an accepted diagnosis per se and, as such, cannot be definitively classified.

Diagnosis of colitis

To verify the presence of colitis, the patient must undergo certain instrumental and laboratory tests (complete blood count with formula, electrolytes, culture and search for parasites in the faeces, etc.), depending of course on his or her clinical history.

The general practitioner may then prescribe further instrumental tests (e.g. ultrasound of the complete abdomen, abdominal computed tomography) and/or endoscopic tests that allow, by means of a video camera inserted into the rectum (sigmoidoscopy, colonoscopy), exploration of the intestinal mucosa and possible biopsies.

A very important test in the evaluation of colitis is the biopsy, which can give important answers as to the cause of the disorder, the extent of the intestinal damage and provide the patient with a diagnosis.

Treatment of colitis

Depending on the severity of the pain, the treatment to improve one’s condition also varies.

Sometimes it is important to initiate steroid anti-inflammatory drug therapy to accelerate colon healing.

Some patients need to be kept hydrated with drips and supplemented with iron, due to possible conspicuous blood loss.

There are also drugs that are administered daily, such as anti-inflammatories or specific immunosuppressants.

If the therapy does not work, the doctor will prescribe new drugs until the most suitable therapy for the patient and his specific ailment is discovered.

Malaise can also be a consequence of disorders related to dairy intake, in which case to reduce the disorder it is advisable to follow an exclusion diet, eliminating the ingestion of dairy foods.

The importance of proper nutrition to alleviate colitis

Each person reacts differently depending on the foods they eat, which is why colitis sufferers should note down the foods that cause them the most discomfort and those that benefit them.

In order to alleviate colitis complaints such as discomfort and constipation, it is good practice to follow a diet set by a specialist.

Below is a list of what foods are generally recommended and not in the diet to reduce colitis complaints:

barley soups, oats, rice, tapioca;
unfermented cheeses;
yoghurt;
vegetable broth;
grilled or steamed white meat;
boiled fish;
puree;
cooked fruit;
boiled potatoes and carrots.

Foods allowed in moderation

Legumes (e.g. beans, peas, lentils, chickpeas, broad beans), due to their flautogenic potential;
Vegetables which produce large amounts of gas during digestion such as cabbage, cauliflower, broccoli;
Fruits with flautogenic potential such as sultanas, bananas, apricots and plums;
Milk to be limited especially in association with lactose intolerance;
Wholewheat foods, assess individual tolerance.

Allowed and recommended foods

Water, drink at least 1.5-2 litres a day (preferably natural mineral water).
Bread, pasta, rice, crackers, rye, barley, oats and whole wheat
gluten-free white wheat;
Fish (fresh or frozen) at least three times a week, preferably grilled or steamed;
Meat (choose lean cuts and avoid frying seasonings): beef, veal, veal, chicken, rabbit, turkey, pork loin and horse.
Fresh dairy products and yoghurt, the latter of which if supplemented with probiotics can act positively on intestinal flora;
Matured cheeses such as Grana Padano PDO, which naturally contains no lactose
Fruit preferably with its skin (if edible and well washed)
Vegetables such as artichokes, lettuce, chard and asparagus, tomatoes, carrots, leeks, chicory;