Symptoms

Signs and symptoms of pseudomembranous colitis include:

• Diarrhea that can be watery and sometimes bloody
• Abdominal cramps and pain
• Fever
• Pus or mucus in your stool
• Nausea
• Dehydration

Symptoms of pseudomembranous colitis can begin within one to two days after you begin receiving an antibiotic, or they may not occur until several weeks after you discontinue the antibiotic.

When to see a doctor Contact your doctor if you're taking or have recently taken antibiotics and you develop any of the signs or symptoms associated with pseudomembranous colitis, including constant diarrhea, abdominal pain, and blood or pus in your stool.

Causes

Pseudomembranous colitis occurs when harmful bacteria in your colon — most commonly C. difficile — release potent toxins. These toxins irritate the colon, causing the signs and symptoms of pseudomembranous colitis. Harmful bacteria are normally kept in check by the healthy bacteria in your digestive system, but the balance between healthy and harmful bacteria can be upset by antibiotics and other medications.

Antibiotics are most common cause Virtually any antibiotic can cause pseudomembranous colitis. Antibiotics most commonly associated with pseudomembranous colitis include:

• Quinolones, such as ciprofloxacin (Cipro) and levofloxacin (Levaquin)
• Penicillins, such as amoxicillin and ampicillin
• Clindamycin (Cleocin)
• Cephalosporins, such as cefixime (Suprax) and cefpodoxime (Vantin)

Other causes Although antibiotics are by far the drugs most often associated with the development of pseudomembranous colitis, other medications may be responsible. In addition, in people with cancer, chemotherapy may sometimes disrupt the bacteria within their intestines and trigger the development of pseudomembranous colitis. Pseudomembranous colitis can also develop in people with diseases that affect the colon, such as ulcerative colitis or Crohn's disease.

Risk factors

Factors that may increase your risk of pseudomembranous colitis include:

• Taking antibiotics
• Staying in the hospital or a nursing home
• Increasing age, especially over 65 years
• Having a weakened immune system
• Having a colon disease, such as inflammatory bowel disease and colorectal cancer
• Undergoing intestinal surgery
• Receiving chemotherapy treatment for cancer

Complications

By the time your doctor detects pseudomembranous colitis, you may already be seriously ill. If the condition isn't successfully treated at the time of diagnosis, a number of complications can develop, including:

• Abnormally low levels of potassium in your blood (hypokalemia), due to the loss of potassium during excessive diarrhea
• Dehydration leading to abnormally low blood pressure (hypotension), related to significant loss of fluids and electrolytes due to diarrhea
• Kidney failure, due to severe dehydration resulting from diarrhea
• A hole in your bowel (perforated colon), which can lead to an infection of your abdominal cavity
• Toxic megacolon, a rare but serious distension of the colon, leaving it incapable of expelling gas and stool, which could cause your colon to rupture

Most people respond well to treatment, but pseudomembranous colitis can be fatal without effective treatment.

Appointment

Make an appointment with your family doctor or a general practitioner if you have any signs or symptoms that worry you. If you're thought to have a problem in your digestive system, you may be referred to a gastroenterologist. If your signs and symptoms are severe, you may be directed to the emergency medicine department.

Prepare for your appointment so that you can make the most of your time with your doctor. Here's some information to help you get ready and an overview of what to expect.

What you can do

• Be aware of any pre-appointment restrictions. At the time you make the appointment, be sure to ask if there's anything you need to do in advance. For example, your doctor may ask you to restrict your diet or stop taking certain medications to prepare for tests that are commonly used to diagnose pseudomembranous colitis.
• Write down any symptoms you're experiencing, including any that may seem unrelated to the reason for which you scheduled the appointment.
• Write down key personal information, including any major stresses or recent life changes.
• Make a list of your key medical information, including the names of all medications that you're currently taking or that you've taken in the last month or so. Your doctor will also want to know about other conditions for which you've recently been treated, including any procedures or hospitalizations.
• Take a family member or friend along. Sometimes it can be difficult absorb all the information provided during an appointment. Someone who accompanies you may remember something that you missed or forgot.

Prepare a list of questions to ask your doctor, ordered from most important to least important, in case your time with your doctor is limited. Some basic questions to ask your doctor about pseudomembranous colitis include:

• What is likely causing my symptoms?
• Are there any other possible causes for my condition?
• What kinds of tests do I need?
• Is my condition likely temporary or chronic?
• What is the best course of action?
• I have these other health conditions. How can I best manage them together?
• Are there any restrictions that I need to follow?
• Is there anything I can do to prevent a recurrence of this condition?
• If my symptoms do recur, what treatment options will be available?
• Should I see a specialist? What will that cost, and will my insurance cover it?
• Is there a generic alternative to the medicine you're prescribing me?
• Are there any brochures or other printed material that I can take with me? What websites do you recommend?

In addition to the questions that you've prepared to ask your doctor, don't hesitate to ask questions during your appointment at any time that you don't understand something.

What to expect from your doctor Your doctor is likely to ask you a number of questions. Being ready to answer them may reserve time to go over points you want to spend more time on. Your doctor may ask:

• In the last several weeks, have you taken antibiotics, had a surgical procedure or been hospitalized?
• Is anyone at home sick with diarrhea, or has anyone at home been hospitalized in the last several weeks?
• Have you ever been diagnosed with diarrhea related to C. difficile or antibiotics?
• Do you have ulcerative colitis or Crohn's disease?
• When did you first begin experiencing signs and symptoms?
• Have your symptoms stayed the same or gotten worse?
• Are you having abdominal pain?
• Do you have diarrhea? Is there blood or pus in your stools?
• What, if anything, seems to improve your symptoms?
• What, if anything, appears to worsen your symptoms?
• Are you being treated for any other medical conditions?

What you can do in the meantime While you're waiting for your appointment, drink plenty of fluids and stick to bland foods to help you cope with diarrhea.

Tests and diagnosis

Tests and procedures used to diagnose pseudomembranous colitis include:

• Stool sample. A laboratory evaluation conducted on one or more stool samples can determine whether C. difficile is present in your colon.
• Blood tests. Your doctor may recommend blood tests. For instance, a count of your blood cells may reveal an abnormally high white blood cell count (leukocytosis), which may indicate pseudomembranous colitis.
• Colon examination. In a colonoscopy or sigmoidoscopy, your doctor uses a tube with a miniature camera at its tip. The tube is advanced through your rectum and into your colon, allowing your doctor to examine the interior of your colon for signs of pseudomembranous colitis. If you have pseudomembranous colitis, the exam may show raised, yellow plaques or lesions within your colon, as well as swelling.
• Imaging tests. Your doctor may obtain an abdominal X-ray or an abdominal CT scan if you have severe symptoms to look for complications such as toxic megacolon or colon rupture.

Treatments and drugs

Treatment for pseudomembranous colitis typically involves stopping your current antibiotic and starting an antibiotic that's effective against C. difficile. In rare cases, surgery may be necessary.

Stopping the current antibiotic medication Treatment for pseudomembranous colitis often begins with stopping the antibiotic medication that's thought to be causing your signs and symptoms. Sometimes, this may be enough to resolve your condition or at least ease signs, such as diarrhea.

Switching to a different antibiotic If you still experience signs and symptoms, your doctor may recommend an antibiotic that is effective against C. difficile or other bacteria that are present in your colon. Although it may seem strange to use antibiotics to treat a disorder caused by antibiotics, treatment with different antibiotics to eradicate the C. difficile allows the normal bacteria to grow back, restoring the balance of bacteria in your colon.

The antibiotics used to treat pseudomembranous colitis are usually given by mouth. However, depending on the severity of the inflammation and the medication, you may be treated with these drugs intravenously or through a tube inserted through your nose and threaded into your stomach (nasogastric tube).

Once you begin treatment for pseudomembranous colitis, signs and symptoms may begin to improve within a few days.

Treating recurring signs and symptoms Even in people who are treated successfully, pseudomembranous colitis can return in the weeks to months after treatment has been completed. In these cases, treatment options may include:

• Antibiotics. You may need a second or third round of antibiotics to resolve your condition.
• Surgery. If antibiotics aren't working, your doctor may recommend surgery, though this treatment is rarely necessary for people with pseudomembranous colitis. Surgery may be an option in people who have progressive organ failure, rupture of the colon and inflammation of the lining of the abdominal wall (peritonitis). Surgery typically involves removing a portion of the colon (partial colectomy).

Preventing recurrences of pseudomembranous colitis If you've experienced multiple episodes of pseudomembranous colitis or if you have an increased risk of a recurrence, you may opt to try probiotic treatment. Probiotics are concentrated supplements of good bacteria and yeasts that come in capsule or liquid form. You take these supplements by mouth. It's thought that this allows the bacteria in the supplement to travel to your colon, where they help fight the bad bacteria. Some evidence suggests the yeast Saccharomyces boulardii may reduce the risk of recurrent diarrhea associated with C. difficile infection.

Home remedies

To cope with the diarrhea — and subsequent dehydration — that can occur with pseudomembranous colitis, try to:

• Drink plenty of fluids. Water is best, but fluids with added sodium and potassium (electrolytes) may be beneficial as well. Try drinking broth or watered-down fruit juice. Avoid beverages that are high in sugar or contain alcohol or caffeine, such as coffee, tea and colas, which may aggravate your symptoms.
• Choose soft, easy-to-digest foods. These include applesauce, bananas and rice. Avoid high-fiber foods such as beans, nuts and vegetables. If you feel like your symptoms are improving, slowly add high-fiber foods back to your diet.
• Try eating several small meals, rather than a few large meals. Space meals throughout the day instead of eating two or three large ones.
• Avoid irritating foods. Stay away from spicy, fatty or fried foods and any other foods that make your symptoms worse.