How to Tell a Case of Colitis
It is easy to tell a victim of colitis, but it is hard to tell him very much! There are few ailments in which the patient is so willing to dispute your diagnosis. “But Doctor,” says one for instance, “how can I have colitis? Actually I am constipated.” Or still another will ask: “Gosh Doc, I eat the simplest food. I couldn’t possibly have irritated my colon.” Others will tell you that they heard that colitis is a tropical disease and they have never been south of Brooklyn. You can gather from the foregoing how difficult it is to tell some of these patients anything at all.
Now:
This state of affairs is partly due to the fact that many people have no very clear idea as to what colitis is, or, what is still worse, have a very mistaken idea. Let’s take a look at a run-of-the-mill case of colitis and see what makes us think that something is wrong with the colon.
The first signal of disorder that the average person is apt to notice is the passage of mucus with the bowel movement. At first this may be disregarded, but later, as the amount increases, the patient frequently becomes very critical of bowel movements and examines them carefully. The mucus may be passed as thin membranous string or may be in the form of a small gelatinous lump.
Sometimes it is clear and slimy, at other times opaque. Occasionally it may be stained with blood.
Naturally at this time the patient becomes conscious of a certain amount of abdominal distress, varying from a vague discomfort in the abdomen to actual pain. This discomfort may merely be an uneasy feeling in the lower abdomen, a sense of weight, and occasionally, cramp-like pains usually described as colic. Such pain is situated most frequently in the left flank or low in the abdomen on the left side. There is marked tendency to gas and flatulence. At times there may be tenderness over this area or even tenderness over the entire course of the large intestine. These symptoms of abdominal discomfort may pass away within a day or two, or intervals between attacks may be even longer.
Many people notice that the attacks are likely to come on when they are emotionally disturbed. The function of the bowel becomes disturbed also. Usually the trouble begins as constipation, but is followed by diarrhea. Early in the development of colitis, stools become hard and small. Later they attain a more pasty consistency, and the caliber of the bowel shows a steady contraction due to spasm. Thin, ribbon like stools result. They are usually unsatisfying and give the impression that something still remains in the bowel.
Accompanying these symptoms is a general feeling of depression and a lack of energy. At times this feeling of weariness may be very marked. The person troubled with colitis is apt to have fits of the “blues,” when nothing seems to cheer him up. Appetite is usually very poor, and an unpleasant taste is noted in the mouth. This steadily progresses to the point where, as one of my patients once expressed it, “My mouth tastes like the bottom of a bird cage.” It is quite understandable that with such a taste in one’s mouth the sufferer is apt to become irritable. Occasionally, however, appetite is precocious and there is a feeling of not being satisfied even immediately after eating.
Sleep seems to lack restful quality; it is frequently disturbed, often impossible. All of this, of course, interferes with efficiency in business and with congeniality at home and among friends. There is a marked effect on blood pressure—an effect that is progressive. Gradually the patient loses weight and looks drawn and pale because of anemia.
During all this time the sufferer from colitis naturally develops marked concern over the state of his intestines. He is disturbed both physically and mentally. But by far the greatest disturbance is the fear which arises in his mind that he is the victim of that dread specter, cancer. Of course, the longer he delays competent medical examination, the more depressed and bewildered he becomes. Worry over a condition of colitis can actually impair both physical and mental efficiency.
Perhaps one obstacle to the early recognition of colitis is the fact that colitis has a marked tendency to become chronic. It develops so slowly and over such a long period of time that many of the early symptoms such as constipation are viewed with tolerance or at least are not appraised at their full significance. Another reason for colitis tending to become chronic is that, because of the mildness and seeming harmlessness of its early symptoms, it is quite likely to be treated by patent medicines touted as being “good for what ails you.” The untold damage prolonged use of such purgatives does can hardly be overestimated.
Still another reason why it is difficult sometimes to “tell” a case of colitis is that people insist on misguided attempts at treating colitis by fantastic flyers at diet. Without rhyme or reason, roughage—bran and raw fruit, for instance—is indulged in. Needless to say, they merely add to the irritated state of the lining of the colon. On the other hand, equally mistaken efforts at reducing the roughage content by living on raw-fruit juices produce another set of disturbances.
Since simple colitis may, over a period of time, turn into the ulcerative type, it stands to reason that the early establishment of an exact diagnosis is very important. Here, particularly, is one instance where you should not tolerate treatment until a thorough examination has been made.
No competent and conscientious physician will attempt to treat you merely by listening to your symptoms. He knows that neither he nor anybody else can be in the complete possession of all the facts in your case without making a rectal examination. This can be done painlessly and quickly by the use of a specially designed speculum. Without such an examination you may be the victim of a poor guess and be treated for some simple ailment such as colitis for months and months, only to learn later on, long past the time when the knowledge can do you any good, that what you were suffering from was something far more serious—namely cancer.
Fortunately the family doctor has at his disposal two procedures which will give the answer in a quick and certain manner. The first of these methods is that of instrumental examination of the lower intestinal tract. This is a procedure which the patient need not look forward to with any dread, since there are available instruments which make possible the thorough examination of the anus, rectum and sigmoid colon, with a minimum of discomfort. One of these is shown in Figure 6.
Fig. 6. Rectosigmoidoscope, used to examine rectum and colon
With the skillful use of these instruments, which are electrically lighted, the interiors of the organs may be viewed directly by the examining physician and an appraisal made of the nature and extent of the disorder. Such an examination, backed by experience in examining these cases, can yield a wealth of information and is far superior both in extent and in accuracy to x-ray examinations or any other.
The only limitation of this method of examination is that imposed by the anatomical structure of the colon. It is possible to examine a little beyond ten inches up into the colon. Beyond this point other methods must be invoked. It is at this point—the point beyond which the instrument can yield him no information—that the doctor uses a method known as a barium enema study of the colon.
In this procedure, barium sulphate solution is allowed to flow into the rectum and colon in the same manner that an enema would be given. The substance, barium, however, being opaque can be detected by the fluroscope and pictures can be taken of the outlines of the colon and rectum. The whole procedure is a good deal simpler than the well-known G.I. Series and, still better, is far less expensive. There need be no extensive preparation such as fasting, etc., and the total time necessary for the series of examinations is about half an hour.
Such an examination can yield much information of a contributory nature and when positive findings are noted, they can be a great guidance. In my own experience, I have not found it sensible to rely upon a negative report since the method has its limitations. However, most fortunately, we have here the possibility of direct visualization by means of a specially designed instrument, known as a rectosigmoidoscope. This instrument, when handled with skill, can be introduced to a distance of 10 inches through the anus and since it contains a small electric light in its interior, it adds a clarifying factor of direct visualization.
As accessories to diagnosis in helping the doctor determine that it is a case of colitis that he is dealing with, there are various methods of taking samples of parasites, mucus, pus or blood during the course of an examination through the instrument just described. Not infrequently, it is desirable to take cultures to determine what bacteria are present. In cases where there is any tissue that looks suspect of being cancerous, a small section can be taken with a punch and this may be examined under the microscope. Such a procedure is known as biopsy.
Before leaving the subject of how to “tell” a case of colitis, I think it would be of value to correct certain misconceptions which I have encountered among my patients. Perhaps the best way to correct these is to state that an x-ray examination of the stomach, intestines and colon without using bismuth or barium is of no value. Many people feel that all that is necessary is to lie down on a table and have the picture taken, but without the use of a contrasting substance in the bowel cavity, the picture will reveal nothing of value.
Another error which I am afraid is all too common is that if a patient has the feces examined, he feels he can by this method obtain a diagnosis of the existence of colitis or its cause. The facts are quite the contrary.
The presence of blood in the bowel movement may, in some cases, only indicate that the patient has eaten meat within the last twenty-four hours. The absence of ameba may only indicate the specimen has not been taken under the proper conditions. The absence of parasites or ova (tape worms) may merely mean that we were not fortunate enough to have taken the specimen at the time that the ova were being passed. You may see, therefore, that only your friend the family doctor can properly evaluate these facts and certainly you should put your faith in his judgment rather than worry yourself to death with half knowledge.
If all cases of colitis were examined as promptly as the symptoms appear, the death rate from cancer of the rectum and colon could be reduced to a minimum. As it is, scarcely a day passes but that I see some poor soul who has been getting “treatment” for a year or two for constipation, diarrhea, or colitis, and who, during that time, never once was afforded the advantage of a simple rectal examination with instruments. All these cases could have been saved by early examination and early diagnosis.
From what has been said so far, perhaps you begin to believe that it is a rather hopeless situation. I am happy to say, however,that this is quite far from the truth. Colitis is definitely curable, but not promptly so. When patients ask me, “But, doctor, exactly how long must I stay on this diet before I am cured?” I always ask them: “Exactly how long have you been away from correct diet?” In other words, it is certainly reasonable to ask as much time for repairing the damage as was taken in its production.
I repeat: Cases of uncomplicated colitis are definitely curable, and this should be immediately appreciated by anyone suffering from it. However, he should also realize that its cure is almost exclusively a matter of diet and hence depends to a very great degree upon the patient himself. How can this be done? Study well the regimen for the control of colitis. Written By: J. F. Montague, M.D., Continue Reading: It Can Happen Anywhere
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