Chronic non-ulcer colitis: symptoms

Chronic colitis is characterized by pain localized mainly in the lower abdomen, in the flank region (in the lateral parts of the abdomen), i.e. In the projection of the large intestine, less often around the navel. Pain can be of a varied nature, stupid, aching, sometimes paroxysmal, spastic type, bursting. A characteristic feature of pains is that they decrease after the gases escape, defecation, after applying heat to the abdominal region, and also after taking antispasmodics. Pain intensification is noted when taking rough vegetable fiber (cabbage, apples, cucumbers and other vegetables and fruits), milk, fatty, fried foods, alcohol, champagne, carbonated drinks.

With the development of pericolitis and mezadenitis, the pain becomes constant, increases with jerking, jumping, after cleansing enema.

In many patients the intensification of pain is accompanied by urge for defecation, rumbling and pouring in the abdomen, a sensation of bloating, and bursting of the abdomen.

Stool disorders

Chronic colitis is accompanied by stool disorders in almost all patients. The nature of these disorders is different and is caused by a disorder of the motor function of the intestine. Often there is an unformulated liquid or mushy stool with an admixture of mucus. In some patients, urge to defecate soon after eating (gastrointestinal or gastro-intestinal reflex). In a number of cases there is a syndrome of insufficient bowel evacuation. This is manifested by the release during the defecation of a small amount of mushy or liquid feces, sometimes with an admixture of decorated slices, often with mucus, such a stool can be several times a day. Thus patients complain of sensation of insufficient emptying of an intestine after a defecation.

When the predominantly distal part of the colon is affected, especially when involved in the pathological process of the anus, frequent urge to defecate, tenesmus, the release of small amounts of stool and gases. There may be false desires for defecation, with almost no stools, only a small amount of gases and mucus are released.

Profuse diarrheas with chronic colitis are rare and are observed mainly with parasitic colitis.

Chronic colitis can also be accompanied by constipation. Prolonged stool retention in the lower parts of the colon causes irritation of the mucosa, increased secretion and secondary dilution of feces. Constipation can be replaced by frequent defecation for 1-2 days with the separation of the original solid feces ("feces"), and then liquid, foamy, fermenting or fetid putrefactive masses ("stop diarrhea"). In some patients, constipation alternates with diarrhea.

Dyspeptic Syndrome

Dyspeptic syndrome is often observed, especially in the period of exacerbation of chronic colitis, and manifests itself by nausea, a decrease in appetite, a sense of metallic taste in the mouth.

Asthenoneurotic manifestations

Asthenoneurotic manifestations can be expressed quite brightly, especially with prolonged course of the disease. Patients complain of weakness, rapid fatigue, headache, decreased performance, poor sleep. Some patients are very suspicious, irritable, suffer from carcinophobia.

Data from an objective clinical study of patients

Weight loss is not characteristic of chronic colitis. Losing weight, however, can be observed in some patients, when they dramatically decrease the amount of food taken due to the increased intestinal manifestations of the disease after eating. It is possible to raise the body temperature to subfebrile digits during exacerbation of the disease, as well as the development of pericolitis, mesadenitis.

The tongue in patients with chronic colitis is covered with a greyish-white coating, moist.

When palpation of the abdomen reveals soreness and densification of either the entire large intestine, or mainly one of its department. Characteristic is also the detection of zones of cutaneous hyperesthesia (the Zakharyin-Ged zone). These zones are located in the iliac and lumbar regions (respectively, 9-12 lumbar segments) and are easily identified by pricking the skin with a needle or picking the skin in a fold.

With the development of nonspecific mezadenitis, pain during palpation is quite pronounced, not limited to the colon, but is determined around the navel and in the mesenteric lymph nodes - inside the cecum and in the middle of the line connecting the navel with the point of intersection of the left mid-incision line and the costal arch.

With the development of concomitant ganglionitis (involvement in the inflammatory process of the solar plexus) there is a sharp soreness with deep palpation in the epigastric region and along the white line of the abdomen.

Quite often in chronic colitis, palpation reveals the alternation of spasms and dilated portions of the large intestine, sometimes "splash noise".

With the so-called secondary colitis caused by other diseases of the digestive system, an objective examination of the patient reveals the clinical signs of these diseases (chronic hepatitis, pancreatitis, bile duct diseases, etc.).

Clinical Symptoms of Segmental Colitis

Segmental colitis is characterized by the symptoms of predominant inflammation of any of the large intestine. There are tiflit, traversis, sigmoidite, proctitis.

Tiflit is the primary inflammation of the cecum (right-sided colitis).

The main symptoms of tiflitis are:

• pain in the right side of the abdomen, especially in the right ileal region, radiating to the right leg, groin, sometimes lower back;
• stool disorder (often diarrhea or alternation of diarrhea and constipation);
• spasm or enlargement and tenderness in palpation of the cecum;
• limitation of motility of the cecum with development of peritiflita;
• soreness to the inside of the cecum and in the peripodal region when nonspecific mezadenitis develops.

Transversitis - 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 pain appearing soon after eating;
• alternation of constipation and diarrhea;
• imperative urges for defecation right after eating (gastro-transversal reflux);
• tenderness and widening of the transverse colon (revealed by palpation), in some patients spasms or alternation of spasms and enlarged areas can be determined.

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

• severe pain in the left hypochondrium, often radiating to the left half of the chest (often in the heart), back;
• reflex pain in the heart;
• sensation of raspiraniya, pressure in the left hypochondrium or in the left upper quadrant of the abdomen;
• tympanitis with percussion of the left upper quadrant of the abdomen;
• soreness in palpation in the area of splenic flexure of the transverse colon;
• unstable character of the stool (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, increasing with prolonged walking, jolting, physical activity. The pain often radiates into the left inguinal region and perineum;
• sensation of pressure and dilating in the left ileal region;
• spastic contraction and soreness of the sigmoid colon during palpation, and sometimes the expansion of the sigmoid colon is determined. In some cases, dense fecal masses create a sensation of density and tuberosity of the sigmoid colon during palpation, which requires differential diagnosis with the tumor. After the cleansing enema, the density and tuberosity disappear.

Proctosigmoiditis is inflammation in the sigmoid and rectum areas.

Proctosigmoiditis is characterized by:

• pain in the anus during defecation;
• false desires for defecation with the escape of gases, sometimes mucus and blood (in the presence of erosive sphincteritis, cracks in the anus, hemorrhoids);
• sensation of unopened intestines after defecation;
• itching and "wetting" in the anal area;
• feces such as "sheep" (segmented) with an admixture of mucus, often blood;
• when finger examination of the rectum, spasm of the sphincter (in the period of exacerbation of the proctosigmoiditis) can be determined.

The diagnosis of proctosigmoiditis is easily verified using a sigmoidoscopy.

Classification of chronic colitis

1. On the etiology:
   1. Infectious.
   2. Parasitic.
   3. Alimentary.
   4. Intoxicating.
   5. Ischemic.
   6. Radiation.
   7. Allergic.
   8. Colitis of mixed etiology.
2. By primary localization:
   1. Total (pancolite).
   2. Segmental (tiflit, transversitis, sigmoiditis, proctitis).
3. By the nature of the morphological changes:
   1. Catarrhal.
   2. Erosive.
   3. Ulcerative.
   4. Atrophic.
   5. Mixed.
4. By severity:
   1. Light form.
   2. Of moderate severity.
   3. Heavy form.
5. In the course of the disease:
   1. Recurrent.
   2. Monotonous, continuous.
   3. Intermittent, intermittent.
6. For the phases of the disease:
   1. Exacerbation.
   2. Remission:
      1. Partial.
      2. Complete.
7. By the nature of functional disorders:
   1. Motor function:
      1. Disorders of the hypomotor type.
      2. Violations of the hypermotor type.
      3. Without disturbance of motor function.
   2. By type of intestinal dyspepsia:
      1. With the phenomena of fermentation dyspepsia.
      2. With the phenomena of mixed dyspepsia.
      3. With the phenomena of putrefactive dyspepsia.
      4. Without the phenomena of intestinal dyspepsia
8. With the presence or absence of an allergic syndrome

[1], [2], [3], [4]