What Is Clostridioides Difficile (C. diff) Colitis?

Inflammation of the colon due to Clostridioides difficile (C. diff.) bacteria is known as C. diff colitis. The C. diff bacteria exists naturally in the environment. But once C. diff enters the body, it can grow and cause an infection affecting the digestive system.

Useful bacteria live in your colon to help with digestion. They work to keep bacteria that cause infection — like C. diff — in check. But when the useful bacteria disappear, C. diff bacteria can take over. Without treatment, it can cause severe infection and lead to C. diff colitis.

Let’s take a closer look at C. diff symptoms, plus how to treat a C. diff infection and its potential complications.

What are the symptoms of C. diff colitis?

Symptoms of C. diff colitis depend on how severe the infection is. The most common symptoms are:

• Watery diarrhea

• Abdominal cramps or pain

• Nausea

• Loss of appetite

• Fever

• Fatigue 

• Elevated white blood cell count

What causes a C. diff colitis infection?

C. difficile infection is more common after antibiotic use. When you take antibiotics to get rid of a bacteria that causes an infection, you may also get rid of the useful bacteria in your colon. This leads to C. diff overgrowth and results in a C. diff infection. Infections can happen while you’re taking the antibiotic and even up to 8 weeks after.

How do you treat a C. diff infection?

The specific treatment for C. diff depends on if you have a mild infection or a more severe case.

For most mild infections, you can safely do the treatment at home. Treatment includes:

• Stopping any antibiotics that may have caused the infection (your prescriber will let you know if it’s safe to do this)

• Taking specific antibiotics by mouth (vancomycin, metronidazole, or fidaxomicin) for 10 to 14 days

• Taking probiotic supplements to help re-establish the good bacteria in your colon — or eating foods rich in probiotics, such as yogurt

If your symptoms are severe, you may need to stay in the hospital for closer monitoring and treatment. You may receive IV antibiotics to treat the infection.

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In recurrent or severe infections, you may need a fecal transplant. A fecal transplant puts stool from a healthy person inside the colon of a person with recurrent C. diff infection. This helps to restore normal bacteria in the colon.

In extreme situations, sometimes people need surgery that removes the colon or part of it. This helps to prevent widespread infection and illness.

What are the most dangerous complications of C. diff colitis?

It’s important to seek medical care early when you have C. diff colitis. The infection can progress quickly and lead to dangerous complications that can lead to death. Complications include:

• Dehydration: Frequent episodes of diarrhea (up to 10 to 15 per day) can cause dehydration. It’s important to drink plenty of fluids during this time to stay hydrated.

• Sepsis: Sepsis is a whole-body reaction to infection. It’s a life-threatening medical emergency, and treatment aims to control the infection.

• Kidney failure: Severe dehydration can cause the kidneys to stop working properly.

• Respiratory failure: This is a common complication of sepsis. This is where the lungs can’t properly provide oxygen for the body.

• Toxic megacolon: When the colon becomes very infected or inflamed, it can’t pass gas and stool. This leads to swelling of the colon and may need surgery to prevent further problems.

• Colon rupture: If the colon swells too much, the colon wall can rupture. This causes stool and bacteria to leak into the belly. It’s a medical emergency that typically needs emergency surgery.

Is a C. diff infection contagious?

Yes, C. diff infection can be very contagious and easily spreads between people. The best way to avoid infection and prevent spread is to wash your hands with soap and water. You should wash your hands after every trip to the restroom and before you eat.

One challenge to stopping the spread is that hand sanitizers don’t kill C. diff bacteria. So, if you have C. diff or are around someone with the infection, be sure to use soap and water instead of hand sanitizer.

Whenever possible, try to avoid contact with others who may have the infection. If you can't avoid contact, people with diarrhea should try to use a separate bathroom, if possible.

When treating C. diff in the hospital, healthcare professionals wear a special gown and gloves. This helps to prevent the spread of the infection to other people.

How can you prevent a C. diff colitis infection?

The most important thing you can do to prevent C. diff is the least obvious: Be careful with antibiotics. Most C. diff infections start when an antibiotic wipes out the good bacteria in your gut that normally keep C. diff in check.

That doesn't mean avoiding antibiotics when you need them. It only means not taking antibiotics that you don’t need. Keep in mind: Antibiotics do nothing for colds, the flu, or most sore throats and sinus infections.

Steps that lower your C. diff risk:

• Ask whether you really need an antibiotic. If a healthcare professional prescribes one, it's fair to ask what it's treating and if it’s really necessary.

• Tell every healthcare professional if you've had C. diff infection before. That includes your dentist and any urgent care you visit. A previous C. diff infection changes which antibiotics they'll choose for you.

• Disinfect the surfaces with the right cleaners. Everyday cleaners won't kill C. diff spores. You need bleach or an EPA-registered disinfectant rated for C. diff.

One thing that won't help are probiotics. They're often suggested for preventing antibiotic-related gut trouble. But the American College of Gastroenterology recommends against using them to prevent C. diff.

When should you see a doctor for C. diff colitis?

Loose stools while you're taking an antibiotic are common, and usually it's just a side effect of the antibiotic. This may show up as just a few episodes of diarrhea, and it’s usually gone in a day or two. C. diff colitis looks different. The stools are more watery, happen more frequently, and don’t settle down.

If you're taking an antibiotic now, or have taken one in the past 2 months, call your prescriber if you notice:

• Three or more watery stools in 24 hours

• Diarrhea that lasts more than a day or two, or keeps getting worse

• Diarrhea along with fever or belly cramps

• Symptoms that come back after you've already been treated for C. diff

Don't wait it out. C. diff is very treatable, and treating it early is what keeps it from becoming serious.

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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.

Reviewed by:

Farzon A. Nahvi, MD

Farzon Nahvi, MD, is an emergency medicine physician and author of “Code Gray: Death, Life, and Uncertainty in the ER.” He works at Concord Hospital in Concord, New Hampshire, and teaches at the Geisel School of Medicine at Dartmouth.

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