Diarrhea and abdominal cramps are the major symptoms of both irritable bowel syndrome and colitis, but the two conditions are distinctly different diseases. Irritable bowel syndrome, which is also called spastic colon, nervous bowel or irritable colon, is caused by excessive spasms of the large intestine. It is much more common than colitis; indeed, it is probably the most common abdominal complaint brought to the attention of doctors. It usually begins during late adolescence or early adulthood and, for unknown reasons, women are affected twice as often as men.
Colitis is a more rare and potentially serious disorder characterized by an inflammation of the innermost lining of the colon. Sometimes the entire length of the large intestine is involved; but more often, the inflammation occurs in the lower portion, in which case the disease is called proctitis. Colitis tends to come and go, with alternating periods of acute flare-ups and quiescence. In a large number of cases, the disorder progresses to ulcerative colitis, in which the lining of the colon becomes thickened and bleeds, resulting in blood and mucus mixed with diarrhea.
Diagnosis of Irritable Bowel
Diagnosis of the irritable bowel syndrome is often based on a review of the symptoms and a process of elimination of other disorders. The major symptoms--abdominal cramping, gassiness, bloating and diarrhea, sometimes alternating with constipation--are characteristic of a number of other intestinal disorders, such as colitis, diverticulitis (the inflammation of pockets that form in weakened segments of the intestinal wall) or cancer. The diarrhea is somewhat distinctive in that it often occurs shortly after eating and sometimes immediately after getting up in the morning. The excessive intestinal spasms causing this syndrome may be detected during a barium enema--a test in which a chalky liquid substance is infused into the colon and X-ray films are taken--or during a sigmoidoscopic examination--a test in which a hollow tube with fiber-optics is inserted through the anus and into the colon. More often, however, these examinations are performed to rule out other colon disorders that may produce similar symptoms; after these other possibilities are eliminated, a presumptive diagnosis of irritable bowel syndrome is made.
Causes of Irritable Bowel
After the digestion and absorption of nutrients by the small intestine, the waste matter is propelled into the large intestine for eventual elimination. Under normal circumstances, regular muscular contractions (intestinal motility) move this waste matter along the five-foot length of the colon and into the rectum for comfortable evacuation. However, when irritable bowel syndrome is present, the pattern of motility becomes disordered because of excessive muscular contractions, resulting in cramping and diarrhea.
There is no clear explanation for this intestinal overactivity, although a number of factors such as emotional stress, diet and an allergic response to particular foods all have been implicated. Heavy cigarette smoking also seems to aggravate the problem.
Treatment of Irritable Bowel
While psychological factors may play some role in this condition, there is no doubt that the patient is suffering from distresing physical manifestations that may themselves produce anxiety. It is important to understand that the condition, although distressing, is not medically serious. In many instances, consuming a diet that contains adequate fiber, or roughage, will help. Proper functioning of the lower intestine requires a minimal amount of bulk composed of the various kinds of fruit and vegetable fibers that go through the upper intestine virtually intact because they are not digested by humans. This fiber retains water and makes the stool bulky and soft, thus aiding in intestinal motility. Fiber can easily be added to the diet in the form of salads, raw or lightly processed fruits and vegetables and whole-grain cereals and breads.
For patients who do not respond to dietary and other life-style changes, such as reduced stress, drugs may be prescribed. These may include an anticholinergic agent to reduce the intestinal activity, a mild tranquilizer or a sedative.
Diagnosis of Colitis
There are several inflammatory bowel conditions called colitis, and the most common is ulcerative colitis. The major symptom is diarrhea containing blood and mucus, often accompanied by severe abdominal pain and cramping. Fever, loss of appetite, anemia and weight loss may occur, especially if the atack is prolonged or recurrent. The entire colon may be involved, but the disease usually begins in the rectum and lower portion of the colon. Some mild cases may be confined to this area, in which case the stools may be normal or even hard, but contain blood and mucus.
Ulcerative colitis can be readily diagnosed by sigmoidoscopy, an examination allowing visual inspection of the lower portion of the colon. A barium enema and X-ray study also may be performed but usually not during an acute flare-up. Studies also may be indicated to determine whether the colitis is caused by an infection, such as amebiasis or salmonellosis.
Complications of Colitis
Hemorrhage is the most common complication of ulcerative colitis. In some cases, the bowel also may be perforated, leading to severe infections. This is always considered a medical emergency requiring immediate surgery.
Colon cancer is much more frequent in patients with ulcerative colitis, especially those with a family history of the two diseases and in whom the colitis begins in childhood. Cancer is also more common if the entire colon is involved. Therefore, patients with ulcerative colitis should be closely monitored for colon cancer.
Treatment of Colitis
Mild to moderate ulcerative colitis usually can be treated with drugs and a special diet. Medications, such as anticholinergics, may be prescribed to reduce colon motility. A normal diet usually can be consumed, but foods that cause diarrhea or irritate the colon should be avoided. Some patients may be advised to avoid raw fruits and vegetables. Antidiarrheal drugs also may be prescribed. More severe disease may require treatment with corticosteroid drugs. Surgery to remove all or most of the colon may be required in severe cases or those that are considered very likely to progress to cancer.
Summing Up
Irritable bowel syndrome is a common intestinal disorder characterized by diarrhea and abdominal cramps. Ulcerative colitis is a less common and more severe inflammatory disease that may involve the entire large intestine. Colitis tends to recur, but in most cases, a remission can be achieved through drug therapy. Since colon cancer occurs more frenquently in ulcerative colitis patients, periodic cancer screening is recommended.
Hospitalization - Admission Procedures
The procedures you follow on admission to a hospital vary from one hospital to another, but basically the process is the same in most institutions in the United States.
Care of the Dying - Role of Friends
The friend can show appreciation of the work being done by the family and offer to stay with the patient if the family needs a little time away from home.
Care of the Dying - Death of an Older Child or an Adolescent
From the age of three years onward, a child begins to understand the concept of death and dying. The dying child feels protective toward his or her parents. Although the child desperately needs to talk about what is going to happen, he or she may never get close to the subject. The child may attach himself or herself to a nurse or physician while still relying on the parents. By doing this, the child is sharing the emotional responsibility. The parents may find this difficult to accept, but must realize that someone else can perhaps give more help by listening dispassionately to the child's fears and anxieties.
