— Rosanna, Florida The best way to differentiate between irritable bowel syndrome (IBS), ulcerative colitis, and microscopic colitis (inflammation of the colon) is to have a colonoscopy and extensive biopsies done so your doctor can closely look at your colon and the tissues inside it. Colonoscopy findings in people with irritable bowel syndrome are generally completely normal, and antispasmodic treatments, whether herbal or prescription, often help. In ulcerative colitis, there are always visible ulcerations in the colon along with friability (easily broken tissue), scarring, and redness. Biopsies are taken to confirm that a diffuse inflammatory response is present. The initial treatment used for ulcerative colitis is one of the 5-aminosalicylic acid (5-ASA) agents, which are anti-inflammatory drugs used to calm disease activity. Patients with microscopic colitis, either lymphocytic colitis or collagenous colitis, often have normal colonoscopies, but their biopsies show intense inflammation consisting of lymphocytes, a particular type of white blood cell. The best therapies for microscopic colitis are Entocort (budesonide) or bismuth subsalicylate (Pepto-Bismol). Since you are still uncertain about what your particular problem is, I would be sure to see a qualified gastroenterologist who can perform these tests and help you receive a correct diagnosis. Your history is confusing to me. Firstly, patients with ulcerative colitis rarely have small bowel involvement – only the large bowel is involved. Next, a perforated small bowel is a life-threatening emergency that would have required immediate surgery. Finally, if 8 feet of your small bowel were removed, then you would be suffering from short bowel syndrome and have quite a bit of diarrhea. So, your diarrhea could be due to active disease or to short bowel syndrome. Often, identifying the correct diagnosis will lead to the best therapy to help your problems. Q3. Over the years, I have been told by doctors that I have colitis, then irritable bowel syndrome , then Crohn’s. There’s always pain in the abdomen, and sometimes in my back. Sometimes I have diarrhea and other times I am blocked. They recently ran the scope into the anus only to find internal hemorrhoids . I have also been told I had a bacterial infection when my colon was swollen so much it was a little bit outside. There was also some bleeding two times. Years ago when the problem started, there was diarrhea and the passing of little black dots. Ulcerative colitis and irritable bowel syndrome (IBS) are very different diseases, although ulcerative colitis patients can have IBS-like symptoms. For the diagnosis of ulcerative colitis to be made, there should be consistent diarrhea and bleeding, with ulcerations seen on colonoscopy and negative stool cultures. In your case, a normal colonoscopy – except for internal hemorrhoids – mostly excludes ulcerative colitis as a diagnosis. Your bleeding is likely due to the hemorrhoids. IBS is diagnosed with symptoms of diarrhea and/or constipation, abdominal pain, and a normal intestinal evaluation. Your problems appear to be consistent with IBS. Q4. What are the symptoms of IBS and colitis? Are they related in any way? Both irritable bowel syndrome (IBS) patients and ulcerative colitis patients have abnormal bowel habits, usually severe diarrhea and abdominal pain. One distinguishing clinical feature is that patients with ulcerative colitis also have rectal bleeding. Also, colonoscopy results are different: IBS patients will have a normal examination, while patients with ulcerative colitis will show lesions or sores on the lining of the intestine. Of course, the treatments are very different also. IBS patients frequently respond to fiber supplements and anti-spasmodic agents, like Bentyl (dicyclomine) and Levsin (hyoscyamine), while ulcerative colitis patients usually respond to drugs that block inflammation, such as 5-aminosalicylic acid drugs or steroids.
