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Common signs and symptoms of ischemic colitis include:

• Abdominal pain, tenderness or cramping, usually localized to the lower left side of your abdomen; the onset can be sudden or gradual
• Bright red or maroon-colored blood in your stool or, at times, passage of blood alone without stool
• A feeling of urgency to move your bowels
• Diarrhea
• Nausea
• Vomiting

The risk of severe complications from ischemic colitis increases when signs and symptoms affect the right side of your abdomen. That's because the arteries that feed the right side of your colon also feed part of your small intestine. When blood flow is blocked on the right side of your colon, it's likely that part of your small intestine also isn't receiving adequate blood supply.

Pain tends to be more severe with this type of ischemic colitis.

Blocked blood flow to the small intestine may quickly lead to death of intestinal tissue (infarction or necrosis). If this life-threatening situation occurs, you'll need surgery to clear the blockage and to remove the portion of the intestine that has been destroyed.

When to see a doctor
Contact your doctor if you develop signs and symptoms of ischemic colitis, such as bloody diarrhea and abdominal pain. Early diagnosis and treatment can help prevent serious complications from this condition.

©1998-2012 Mayo Foundation for Medical Education and Research (MFMER). Terms of use.
Read this article on Mayoclinic.com.

Ischemic colitis involves inadequate blood supply reaching your colon. In acute cases, the most frequent cause is blood clots in the arteries supplying blood to your colon. Chronic cases are usually associated with the buildup of fatty deposits (atherosclerosis) in the blood vessels leading to your colon.

In some people, ischemic colitis may be caused by or related to other medical conditions, including:

• Inflammation of the blood vessels (vasculitis)
• Protrusion of an organ or tissue into the surrounding tissue (hernia), interfering with the arterial as well as the venous blood supply to the intestine
• Elevated sugar (glucose) levels in the blood (diabetes)
• Easy blood clotting (hypercoagulable state)
• Radiation treatment to the abdomen
• Colon cancer
• Recent abdominal surgery, particularly when it involves repair of a bulging arterial wall (aneurysm) in the region
• Infections, such as shigella, Escherichia coli 0157:H7 and Clostridium difficile
• Dehydration

The role of medications
Certain medicines also rarely cause ischemic colitis as a side effect. These include:

• Nonsteroidal anti-inflammatory drugs
• Estrogen replacement medications
• Migraine medications in the triptan or ergot class
• Blood pressure lowering drugs
• Certain antipsychotic drugs
• Pseudoephedrine (a decongestant found in many cold and allergy medications)
• The irritable bowel syndrome medication alosetron (Lotronex)

©1998-2012 Mayo Foundation for Medical Education and Research (MFMER). Terms of use.
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Risk factors for ischemic colitis include:

• Age. The condition occurs with greatest frequency in older adults. If it occurs in a young adult, it may be a sign of a blood-clotting abnormality or an inflammation of the blood vessels (vasculitis).
• Heart disease risk factors. The reduced blood flow responsible for ischemic colitis is more likely to occur in people who have traits or conditions commonly associated with heart disease, such as tobacco use and elevated cholesterol levels.
• Certain medical conditions. Some disorders are considered predisposing factors that place you at greater risk of developing ischemic colitis, or they can aggravate it when it occurs. These include previous abdominal operations, heart failure, low blood pressure and shock.

©1998-2012 Mayo Foundation for Medical Education and Research (MFMER). Terms of use.
Read this article on Mayoclinic.com.

In most cases, ischemic colitis resolves on its own within one to two days. In more advanced cases of ischemic colitis, complications may include:

• Gangrene. Untreated ischemic colitis could lead to tissue death (gangrene) in your colon. Gangrene may develop after the initial reduction of blood flow to your colon and can result in death if you don't receive timely treatment.
• Rupture and bleeding. Ischemic colitis can also cause a hole (perforation) in your intestine or persistent bleeding.
• Pain and blockage. Even as healing occurs, ischemic colitis can lead to colon scarring and narrowing. This can cause chronic abdominal pain and blockage.

©1998-2012 Mayo Foundation for Medical Education and Research (MFMER). Terms of use.
Read this article on Mayoclinic.com.

You'll probably first see your primary care doctor if you have abdominal symptoms. However, in some cases when you call to set up an appointment, you may be referred immediately to a digestive disorders specialist (gastroenterologist) or to an emergency department if your symptoms are severe.

Because appointments can be brief and there's often a lot of ground to cover, it's a good idea to be well prepared. Here's some information to help you get ready for your appointment, and what to expect from your doctor.

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, if you're going to have a colonoscopy, you'll need to avoid solid foods and certain medications the day before your appointment.
• 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. Also include your diet and exercise habits.
• Make a list of your key medical information, including other conditions you're being treated for and the names of the medications that you're taking. Include every prescription and over-the-counter drug, vitamin or supplement you use, as well as dosage information.
• Take a family member or friend along. Sometimes it can be difficult to remember all the information provided to you during an appointment. Someone who accompanies you may remember something that you missed or forgot.
• Write down questions to ask your doctor.

Preparing a list of questions can help you ensure that you cover all of the points that are important to you. For ischemic colitis, some basic questions to ask your doctor include:

• What's the most likely cause of symptoms?
• Are there any other possible causes?
• Why did this happen?
• Is ischemic colitis usually temporary or will it last a long time?
• What kinds of tests do I need? Do these tests require any special preparation?
• How is ischemic colitis treated?
• I have other health conditions. How can I best manage these conditions together?
• Are there any dietary restrictions that I need to follow?
• Can I prevent this from happening again?
• Are there any brochures or other printed material that I can take home with me? What websites do you recommend visiting?

In addition to the questions that you've prepared to ask your doctor, don't hesitate to ask additional questions during your appointment.

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 any points you want to talk about in-depth. Your doctor may ask:

• When did you first begin experiencing symptoms?
• Have your symptoms stayed the same or gotten worse?
• How severe are your symptoms?
• Have you had any change in your bowel habits or has there been blood in your stools?
• Where is your pain located?
• Do you have any personal history of blood clots in your legs, lungs or anywhere else?
• What, if anything, seems to improve your symptoms?
• What, if anything, appears to worsen your symptoms?
• Have you had any recent medical procedures?
• What medications are you currently taking?
• Do you or did you smoke? How much?

What you can do in the meantime
Ask your doctor if you should drink more fluids or switch to a liquid diet before your appointment.

©1998-2012 Mayo Foundation for Medical Education and Research (MFMER). Terms of use.
Read this article on Mayoclinic.com.

Diagnosing the cause of your symptoms may include a:

• Physical exam and medical history. Your doctor begins by taking a medical history and conducting a thorough physical examination. During the exam, he or she will check your abdomen for areas of tenderness.
• Colonoscopy. A colonoscopy is considered the definitive test for diagnosing ischemic colitis. In this procedure, a flexible lighted tube is inserted into your rectum and guided into the colon. A tiny camera at the tip of the scope sends images of your colon to a video screen. Your doctor can then view the interior lining of your colon and detect any inflammatory tissue and ulcers.
• Biopsy. Sometimes, as part of a colonoscopy, your doctor may remove a small tissue sample (biopsy) from your colon for laboratory analysis. In ischemic colitis, swelling and bleeding may be present under the colon's lining (mucosal layers), and can be detected in the laboratory.

A colonoscopy can rule out other causes of inflammation in your colon, including certain infections, inflammatory bowel disease, inflammation of the walls of the intestines (diverticulitis) and colon cancer. If the inflammation is severe, your doctor may not be able to see your entire colon well or obtain adequate biopsies.

If this happens, you may need to have a repeat colonoscopy once the inflammation has subsided. This allows your doctor to be sure that nothing of concern is present, such as persistent inflammation, scarring or colon cancer.

Other diagnostic tests
Your doctor may also suggest these other procedures to make a diagnosis:

• X-rays of the abdomen and pelvis. These may be conducted in combination with a barium enema. In this process, a contrast material (liquid barium) is introduced into your colon through your rectum. Once your colon is coated with barium, a radiologist takes X-ray pictures of your intestines. These images, which can be viewed on a video monitor, can detect abnormalities within your colon and help distinguish ischemic colitis from other inflammatory conditions. Images that indicate ischemic colitis may show thickening (thumbprinting) of the wall of your colon.
• Abdominal arteriogram. This is an X-ray of the arteries in your abdomen. It can show narrowing or blockages in these vessels, which may indicate ischemic colitis. A contrast dye is injected into your arteries before the X-rays are taken to help produce clear images.
• Ultrasound. This imaging test uses sound waves to provide images of your colon. It can be helpful in ruling out other disorders, such as inflammatory bowel disease. For the procedure, a device called a transducer that emits sound waves is rolled over your abdomen. Information captured by the transducer is sent to a computer that produces the images.
• Abdominal computerized tomography (CT) scans. Doctors sometimes use these scans to rule out other conditions that can cause symptoms similar to ischemic colitis. This test uses sophisticated X-ray technology to produce detailed cross-sectional images of your colon. Your doctor may be able to detect thickening of the colon wall on the scans.
• Blood tests. People with ischemic colitis may have an elevated white blood cell count (WBC) that occurs when there's inflammation or the body is fighting an infection. If your doctor suspects you have a blood-clotting problem, you may be referred to a blood specialist (hematologist) for more-specific blood tests.
• Stool sample. Analysis of a sample of your stool in the laboratory may reveal bacteria and other infectious microorganisms associated or confused with ischemic colitis.

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The choice of treatment for ischemic colitis depends on the severity of your condition.

When ischemic colitis is mild, your doctor may prescribe medications to keep your blood pressure at normal levels, which will help facilitate blood flow to your colon. You may also need to take antibiotics to prevent infections from developing. Your doctor will treat any underlying health problems, such as heart failure.

With such conservative measures, symptoms often diminish in 24 to 48 hours in mild cases, without the need for hospitalization.

However, if you're dehydrated, you may need hospitalization to provide fluids and nutrients through your veins (intravenously). You may also need restrictions on food intake for a few days to let your intestines rest.

Your doctor will continue to monitor you regularly with follow-up colonoscopies to determine whether your colon has healed or the disease has progressed, and whether complications have developed. In mild cases, healing may occur in two weeks or less. In more-severe cases, recovery can take longer, and relapses can occur.

If you develop ischemic colitis before the age of 50 or have a history of blood clots, you could have a disorder that increases the tendency of your blood to clot (factor V Leiden). Your doctor may treat this disorder with a blood thinner such as warfarin (Coumadin), which could help prevent the likelihood of future ischemic colitis episodes.

Surgery
Some people with severe or prolonged ischemic colitis need surgical treatment to remove (resect) the affected part of the colon.

You may need surgery for ischemic colitis if your condition is associated with:

• Abdominal tenderness and fever that are severe and persistent, even after initial treatment with fluids and medications.
• A hole (perforation) in your colon.
• Gangrene and blood infection (sepsis). Treatment for this severe complication also includes broad-spectrum antibiotics and blood replacement.

©1998-2012 Mayo Foundation for Medical Education and Research (MFMER). Terms of use.
Read this article on Mayoclinic.com.

Since the cause of ischemic colitis isn't always clear, there's no definitive way to prevent the disorder. But the good news is that the majority of those who have it recovers quickly and never has another episode.

Still, it makes sense to avoid a medication that may have caused ischemic colitis in the past. And if you have underlying conditions associated with a risk of ischemic colitis — including heart disease and high blood pressure — make sure you're receiving ongoing treatment. Your doctor may recommend that you:

• Stop smoking
• Take cholesterol-lowering medication
• Control chronic illnesses, such as diabetes
• Exercise regularly

©1998-2012 Mayo Foundation for Medical Education and Research (MFMER). Terms of use.
Read this article on Mayoclinic.com.