Ischemic Colitis: Signs and Symptoms of This Common Bowel Problem

All organs in the body need blood to survive, including the colon (large intestine). Ischemic colitis is a condition that happens when blood supply to the colon is decreased. The low blood flow can happen suddenly (acute), or it can happen over time (chronic). Either way, it can lead to serious complications. 

When you don’t have proper blood flow in the colon, the tissue can become inflamed. It can also cause the tissue to decay. Ischemic colitis is common in older adults, but it can happen in anyone. Knowing the signs and symptoms of ischemic colitis can help you know if you need to get medical treatment right away. 

What causes ischemic colitis?

Any condition that decreases blood flow to the colon can lead to ischemic colitis. Common causes of ischemic colitis include:

• A blood clot that prevents blood flow

• Low blood pressure

• Atherosclerosis (clogged arteries)

• Certain medications, like estrogen and nonsteroidal anti-inflammatory drugs (NSAIDs)

• Bowel surgery

• Surgical repair of the aorta (the biggest artery in the body)

What are the symptoms of ischemic colitis?

There is a wide range of symptoms you might have with ischemic colitis. Some of the most common symptoms are:

• Mild, moderate, or severe abdominal pain

• Bloating

• Fever

• Diarrhea

• Bloody stools

• Nausea or vomiting

Contact your healthcare provider right away if you have any combination of these symptoms. They can run tests to see what’s causing your symptoms. 

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Who is most at risk of ischemic colitis?

People at risk of a narrowing or blockage of blood vessels are most at risk of developing ischemic colitis. These risk factors include: 

• High or low blood pressure

• High cholesterol

• Sickle cell anemia

• Blood clotting disorders

• Use of substances like cocaine and methamphetamine

• Smoking

• Atrial fibrillation 

How do you diagnose ischemic colitis?

Diagnosing ischemic colitis can be challenging. This is because the symptoms are often vague. At first, your provider will check your medical history, symptoms, and risk factors. 

Your provider will also do a physical exam, paying special attention to your abdominal area. And they’ll likely request bloodwork and a stool sample to look for signs of infection or inflammation. 

An endoscopy may also be used to confirm a diagnosis of ischemic colitis. This can be either a colonoscopy or flexible sigmoidoscopy. With a flexible sigmoidoscopy, a thin camera looks at just the lower part of the colon and rectum. Meanwhile, a colonoscopy can show every part of the colon and rectum. 

How do you treat ischemic colitis?

Treatments can vary, depending on the cause and severity of your ischemic colitis. Let’s take a closer look at medical and surgical treatments. 

Medical treatment

This noninvasive treatment approach is often used for mild cases. Options include:

• Intravenous (IV) fluids: If you have a mild case of ischemic colitis with no evidence of permanent damage, you might start with IV fluids. These fluids may help increase blood flow to the colon and let the bowel rest.

• Antibiotics: In most cases of ischemic colitis, you’ll begin treatment with oral or IV antibiotics. This is to prevent or treat infection.

• Blood thinners: You may take a medication that will cause your blood to be thinner than usual. Thinner blood can more easily pass through the narrowed vessels.

Surgical treatment

In more serious cases of ischemic colitis, surgical intervention is needed. This may include:

• Angioplasty or stenting: The narrowing of the blood vessels in the colon is sometimes reversible. If so, stenting can help open them. A balloon or stent is placed in the vessel to open the narrowing and allow for better blood flow to the colon.

• Surgery: If there is severe or irreversible damage to the colon, a part of the colon may need to be removed (colon resection). 

What are the complications of ischemic colitis?

Most cases of ischemic colitis will resolve. But in some cases, ischemic colitis can become very serious if left untreated. It can lead to complications like:

• Severe infection

• Sepsis (a widespread infection)

• Bowel perforation (rupture)

• Scar tissue causing bowel obstruction

• Colostomy bag (needing to collect stool in a bag outside of the body)

In some cases, ischemic colitis can result in death if not treated in a timely manner. If you have risk factors and concerning symptoms of ischemic colitis, speak with your healthcare provider right away.

Can dietary changes help with ischemic colitis?

There are no specific foods that you can eat to treat ischemic colitis. But maintaining healthy lifestyle habits can help you to prevent it. Tips for prevention can include: 

• Eating the recommended servings of fruits and vegetables

• Staying physically active 

• Managing your chronic conditions (like high blood pressure or high cholesterol)

• Taking your medications as prescribed

• Quitting smoking (or not starting)

Why trust our experts?

Written by:

Valerie Emuakhagbon, MD

Valerie Emuakhagbon, MD, is a board-certified colorectal surgeon. A native of Dallas, Texas, she completed the six-year BA/MD program at the University of Missouri-Kansas City.

Edited by:

Karla Robinson, MD

Karla Robinson, MD, is a medical editor for GoodRx. She is a licensed, board-certified family physician with almost 20 years of experience in health through varied clinical, administrative, and educational roles.

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