Chronic non-ulcerative colitis - Symptoms

Chronic colitis is characterized by pain localized mainly in the lower abdomen, in the area of the flanks (in the lateral parts of the abdomen), i.e. in the projection of the large intestine, less often - around the navel. The pain can be of various nature, there are dull, aching, sometimes paroxysmal, spastic, bursting. A characteristic feature of the pain is that it decreases after the passage of gases, defecation, after applying heat to the abdomen, and also after taking antispasmodic drugs. Increased pain is noted with the intake of coarse plant fiber (cabbage, apples, cucumbers and other vegetables and fruits), milk, fatty, fried foods, alcohol, champagne, carbonated drinks.

With the development of pericolitis and mesadenitis, the pain becomes constant and intensifies during bumpy driving, jumping, and after a cleansing enema.

In many patients, increased pain is accompanied by the urge to defecate, rumbling and rumbling in the abdomen, a feeling of bloating and distension in the abdomen.

Stool disorders

Chronic colitis is accompanied by stool disorders in almost all patients. The nature of these disorders varies and is caused by a disorder of the intestinal motor function. Often, there is loose liquid or mushy stool with an admixture of mucus. In some patients, the urge to defecate occurs soon after eating (gastrointestinal or gastrocecal reflex). In some cases, there is a syndrome of insufficient bowel emptying. This is manifested by the release of a small amount of mushy or liquid feces during defecation, sometimes with an admixture of formed pieces, often with mucus, such stool occurs several times a day. In this case, patients complain of a feeling of insufficient bowel emptying after defecation.

When the distal part of the colon is predominantly affected, especially when the anus is involved in the pathological process, there are frequent urges to defecate, tenesmus, and the release of small amounts of feces and gases. False urges to defecate are possible, with almost no feces, and only a small amount of gases and mucus being released.

Profuse diarrhea in chronic colitis is rare and is observed mainly in parasitic colitis.

Chronic colitis may also be accompanied by constipation. Long-term retention of feces in the lower sections of the colon causes irritation of the mucous membrane, increased secretion and secondary liquefaction of feces. Constipation may be replaced by frequent defecation for 1-2 days with the separation of initially solid feces ("fecal plug"), and then liquid, foamy, fermenting or foul-smelling putrefactive masses ("constipation diarrhea"). In some patients, constipation alternates with diarrhea.

Dyspeptic syndrome

Dyspeptic syndrome is often observed, especially during periods of exacerbation of chronic colitis, and is manifested by nausea, loss of appetite, and a metallic taste in the mouth.

Asthenoneurotic manifestations

Asthenoneurotic manifestations can be expressed quite vividly, especially in the long-term course of the disease. Patients complain of weakness, rapid fatigue, headache, decreased performance, poor sleep. Some patients are very suspicious, irritable, suffer from cancerophobia.

Data from an objective clinical study of patients

Weight loss is not typical for chronic colitis. However, weight loss may be observed in some patients when they sharply reduce the amount of food they eat due to increased intestinal manifestations of the disease after eating. It is possible for body temperature to increase to subfebrile levels during an exacerbation of the disease, as well as with the development of pericolitis and mesadenitis.

The tongue of patients with chronic colitis is coated with a grayish-white coating and is moist.

Palpation of the abdomen reveals pain and compaction of either the entire large intestine or predominantly one of its sections. Also characteristic is the detection of zones of cutaneous hyperesthesia (Zakharyin-Ged zones). These zones are located in the iliac and lumbar regions (respectively 9-12 lumbar segments) and are easily detected by pricking the skin with a needle or gathering the skin into a fold.

With the development of non-specific mesadenitis, pain upon palpation is quite pronounced, is not limited to the large intestine, but is determined around the navel and in the area of the mesenteric lymph nodes - medially from the cecum and in the middle of the line connecting the navel with the intersection point of the left midclavicular line and the costal arch.

With the development of concomitant ganglionitis (involvement of the solar plexus in the inflammatory process), sharp pain appears with deep palpation in the epigastric region and along the white line of the abdomen.

Quite often, with chronic colitis, palpation reveals alternating spasmodic and dilated areas of the large intestine, sometimes a “splashing sound”.

In so-called secondary colitis caused by other diseases of the digestive organs, an objective examination of the patient reveals clinical signs of these diseases (chronic hepatitis, pancreatitis, diseases of the biliary tract, etc.).

Clinical symptoms of segmental colitis

Segmental colitis is characterized by symptoms of predominant inflammation of one of the sections of the large intestine. A distinction is made between typhlitis, transversitis, sigmoiditis, and proctitis.

Typhlitis is a predominant inflammation of the cecum (right-sided colitis).

The main symptoms of typhlitis are:

• pain in the right half of the abdomen, especially in the right iliac region, radiating to the right leg, groin, and sometimes the lower back;
• bowel movements (usually diarrhea or alternating diarrhea and constipation);
• spasm or dilation and pain on palpation of the cecum;
• limitation of mobility of the cecum during the development of perityphlitis;
• pain inside the cecum and in the umbilical region with the development of nonspecific mesadenitis.

Transversitis is an inflammation of the transverse colon. It is characterized by the following symptoms:

• pain, rumbling and bloating mainly in the middle part of the abdomen, with the pain appearing soon after eating;
• alternating constipation and diarrhea;
• imperative urge to defecate immediately after eating (gastro-transverse reflux);
• pain and dilation of the transverse colon (detected by palpation); in some patients, spasms or alternation of spasmodic and dilated areas may be detected.

Angulitis is an isolated inflammation of the splenic angle of the transverse colon ("left hypochondrium syndrome"). It is characterized by:

• severe pain in the left hypochondrium, often radiating to the left half of the chest (often to the heart area), back;
• reflex pain in the heart area;
• a feeling of distension, pressure in the left hypochondrium or in the left upper quadrant of the abdomen;
• tympanitis on percussion of the left upper quadrant of the abdomen;
• pain on palpation in the area of the splenic flexure of the transverse colon;
• unstable stool pattern (alternating diarrhea and constipation).

Sigmoiditis is an inflammation of the sigmoid colon. It is characterized by the following symptoms:

• pain in the left iliac region or lower abdomen on the left, which intensifies with prolonged walking, bumpy driving, physical exertion. The pain often radiates to the left groin area and perineum;
• a feeling of pressure and distension in the left iliac region;
• spastic contraction and pain in the sigmoid colon upon palpation, sometimes dilation of the sigmoid colon is determined. In some cases, dense fecal masses create a feeling of density and lumpiness of the sigmoid colon upon palpation, which requires differential diagnosis with a tumor. After a cleansing enema, the density and lumpiness disappear.

Proctosigmoiditis is an inflammation in the area of the sigmoid colon and rectum.

Proctosigmoiditis is characterized by:

• pain in the anus during defecation;
• false urge to defecate with the passage of gases, sometimes mucus and blood (in the presence of erosive sphincteritis, anal fissures, hemorrhoids);
• a feeling of unemptied bowels after defecation;
• itching and "weeping" in the anal area;
• "sheep" type feces (segmented) with an admixture of mucus, often blood;
• During digital examination of the rectum, a spasm of the sphincter can be determined (during an exacerbation of proctosigmoiditis).

The diagnosis of proctosigmoiditis is easily verified using a rectoscopy.

Classification of chronic colitis

1. By etiology:
   1. Infectious.
   2. Parasitic.
   3. Alimentary.
   4. Intoxication.
   5. Ischemic.
   6. Radiation.
   7. Allergic.
   8. Colitis of mixed etiology.
2. By preferred localization:
   1. Total (pancolitis).
   2. Segmental (typhlitis, transversitis, sigmoiditis, proctitis).
3. By the nature of morphological changes:
   1. Catarrhal.
   2. Erosive.
   3. Ulcerative.
   4. Atrophic.
   5. Mixed.
4. By severity:
   1. Mild form.
   2. Moderate severity.
   3. Severe form.
5. According to the course of the disease:
   1. Recurrent.
   2. Monotonous, continuous.
   3. Intermittent, alternating.
6. By phases of the disease:
   1. Exacerbation.
   2. Remission:
      1. Partial.
      2. Complete.
7. By the nature of functional disorders:
   1. Motor function:
      1. Hypomotor type disorders.
      2. Hypermotor type disorders.
      3. Without impairment of motor function.
   2. By type of intestinal dyspepsia:
      1. With symptoms of fermentative dyspepsia.
      2. With symptoms of mixed dyspepsia.
      3. With symptoms of putrefactive dyspepsia.
      4. Without intestinal dyspepsia
8. With or without allergic syndrome

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