Estimated reading time: 5 minutes
Medically reviewed and verified by Kate Burke, MD, MHA
Living with ulcerative colitis means managing a few potential complications. Some are minor, and easily dealt with due to a combination of medication and lifestyle changes. Others, however, are far more dangerous. Toxic megacolon is one of these. This is a potentially life-threatening complication that can develop in people with severe UC. Curious how UC can lead to toxic megacolon, the symptoms and impact of this condition, and the treatments that can help? PatientsLikeMe has you covered. Let's look at ways to recognize this condition and get prompt treatment.
What is Ulcerative Colitis?
Ulcerative colitis is a type of inflammatory bowel disease (IBD) that affects the large intestine and rectum. In UC, the lining of the colon gets inflamed and forms sores, called ulcers1. This inflammation can cause severe gastrointestinal issues like diarrhea and abdominal pain. While UC is a long-term condition, many treatments can help manage symptoms and reduce inflammation. However, if the inflammation gets too severe, it can lead to toxic megacolon.
How UC Leads to Toxic Megacolon
In some cases of severe UC, the inflammation in the colon can get so intense that the colon swells up and loses its ability to contract and move waste along the digestive tract. This condition is known as toxic megacolon2. It causes the colon to become dangerously enlarged, or dilated. This dilation can cause a buildup of gas, bacteria, and toxins, which can increase the risk of colon rupture or perforation. If this happens, toxins and bacteria can leak into the bloodstream. There are a few factors that can increase the likelihood of developing toxic megacolon.
- Severe Inflammation: Uncontrolled UC inflammation increases the risk.
- Infections: Infections, like Clostridium difficile3, can worsen inflammation and increase the chance of toxic megacolon.
- Medications: Some medications, like opioids, antidiarrheal drugs, and some antidepressants, can increase the risk by slowing down bowel movement.
Effects of Toxic Megacolon
Toxic megacolon can quickly become a medical emergency because of the buildup of toxins in the body. If untreated, this can lead to systemic toxicity. There are a number of different effects this has on the body. Severe abdominal pain and swelling are the most common. Here, the belly might get visibly swollen and very tender to the touch. A fever and rapid heart rate can also happen. When the body is infected, it responds by increasing internal temperature to try and get rid of the infection.
Ulcerative colitis in general has an effect on the digestive system, and with toxic megacolon that is magnified. Frequent severe diarrhea is common, often accompanied by blood in the stool. Nausea and vomiting are also symptoms. In severe cases, it can lead to septic shock4. This is a dangerous drop in blood pressure that can be fatal if untreated. Anyone with UC who has these symptoms should get immediate emergency medical care.
Diagnosis
Diagnosing toxic megacolon usually takes a combination of a few tests. The first step is to understand the patient's history of UC and their symptoms. Doctors will talk to you about the history of your condition, as well as any medications you are taking. A physical exam will help your doctor understand how swollen your abdomen is, whether there are signs of toxic illness, and if there is decreased bowel activity. Vital signs can help them monitor your heart rate, check for a fever, and measure your blood pressure. After the physical, they will take blood tests and perform imaging tests5 to confirm toxic megacolon. Blood tests can measure inflammation by looking at the white and red blood cell counts. X-rays or CT scans can check to see if your colon is dilated.
Treatment
Treating toxic megacolon often takes a combination of medical and supportive care. The goal is to reduce inflammation, relieve pressure in the colon, and prevent further complications.
- Medications: Doctors use anti-inflammatory drugs (like steroids) to reduce inflammation. Antibiotics help prevent or treat infection.
- Rest: Resting the digestive system by avoiding solid foods and placing a tube6 through the nose to the stomach can help remove gas and reduce pressure in the colon.
- Intravenous Fluids: IV fluids restore hydration, replenish lost electrolytes, and give you essential nutrients.
- Surgery: If other treatments do not reduce the colon’s size and relieve symptoms within a few days, you may need surgery7. The usual procedure is a subtotal colectomy, where part or all of the colon is removed to prevent further complications.
Successfully managing toxic megacolon is a group effort. Doctors, nurses, radiologists, and surgeons work closely together to monitor your symptoms, provide supportive care, and decide on the best treatments. This teamwork helps improve outcomes and increases the chances of recovery.
By recognizing the symptoms of toxic megacolon early and seeking prompt medical care, patients with UC can improve their chances of recovery and avoid life-threatening complications.
Seize control of your health with PatientsLikeMe, a platform designed to support your wellness journey. Join a community of people who share their experiences and insights, helping you navigate your health challenges with confidence. Use PatientsLikeMe's tools to track your symptoms, treatments, and outcomes for the full picture of your wellness journey to make informed decisions and effectively communicate with your healthcare team. Evaluate the effectiveness of various treatments through comprehensive patient data, guiding you to the best choices for your health.
- https://www.cdc.gov/inflammatory-bowel-disease/about/ulcerative-colitis-uc-basics.html#:~:text=Inflammation%20from%20UC%20causes%20the,inner%20lining%20of%20the%20colon.
- https://www.ncbi.nlm.nih.gov/books/NBK547679/
- https://www.cdc.gov/c-diff/about/index.html
- https://www.ncbi.nlm.nih.gov/books/NBK430939/
- https://www.sciencedirect.com/science/article/abs/pii/S1078817420302297
- https://www.ncbi.nlm.nih.gov/books/NBK556063/
- https://pmc.ncbi.nlm.nih.gov/articles/PMC2780071/