Pseudomembranous Colitis

Overview

Pseudomembranous colitis is inflammation of the colon (large intestine) in which patches of raised, yellowish tissue called pseudomembranes form on the inflamed lining. It is most often caused by an overgrowth of bacteria called Clostridioides difficile (often shortened to C. difficile or C. diff). This usually happens after a course of antibiotics has disturbed the normal balance of bacteria in the gut.

The condition causes watery diarrhea, abdominal cramps, and sometimes fever. While many cases respond well to treatment, severe cases can become serious, so it is important to recognize the symptoms, especially after recent antibiotic use, and to seek care when needed. C. difficile spreads through hardy spores that can survive on surfaces and hands, which is why the infection is common in hospitals and care facilities and why careful hand washing and cleaning are so important. The infection can also come back after treatment in some people, so completing the full course of treatment and watching for returning symptoms are both important parts of recovery.

Symptoms

Symptoms can begin during or up to several weeks after a course of antibiotics.

• Frequent, watery diarrhea
• Abdominal cramps, pain, or tenderness
• Fever
• Nausea and loss of appetite
• Dehydration, with signs such as thirst, reduced urination, and weakness
• In severe cases, very frequent diarrhea and a swollen, painful abdomen

Seek urgent care for severe or bloody diarrhea, high fever, severe abdominal pain or a swollen belly, signs of dehydration, or feeling very unwell. Severe colitis can become a medical emergency.

Causes

The main cause is overgrowth of C. difficile bacteria, which produce toxins that damage and inflame the colon lining.

• Antibiotic use: Antibiotics can wipe out the normal protective gut bacteria, allowing C. difficile to multiply. This is the most common trigger.
• Exposure to the bacteria: C. difficile spreads through spores, often in healthcare settings, and can be picked up from surfaces or hands.
• Other factors: Hospital or nursing-home stays, recent gut surgery, and conditions that weaken the body increase the risk.

This condition is closely related to antibiotic-associated diarrhea and to Clostridium difficile colitis.

Risk Factors

• Recent or current antibiotic use, especially broad-spectrum antibiotics
• A hospital or long-term care facility stay
• Older age
• A weakened immune system or serious underlying illness
• Recent gastrointestinal surgery
• Use of acid-reducing medicines in some cases

Diagnosis

Diagnosis is based on symptoms, recent antibiotic use, and tests for C. difficile.

• Stool tests: Testing the stool for C. difficile or its toxins is the main way to confirm the diagnosis.
• Blood tests: To check for signs of infection, inflammation, and dehydration.
• Colonoscopy or sigmoidoscopy: Occasionally used to view the colon directly and see the characteristic pseudomembranes.
• Imaging: A CT scan may be done in severe cases to assess the colon and look for complications.

Treatment

Treatment targets the infection while supporting the body and protecting the gut.

• Stopping the triggering antibiotic: Where possible, the antibiotic that set off the problem is stopped or changed.
• Specific antibiotics for C. difficile: Particular antibiotics are used to treat the C. difficile infection itself.
• Fluids and supportive care: Rehydration and rest, with attention to nutrition.
• Treating recurrences: Infections that come back may need a longer or different course; a fecal microbiota transplant is an option in some recurrent cases.
• Surgery: Rarely, severe or life-threatening colitis may require an operation.

Avoiding anti-diarrheal medicines unless a doctor advises them is important, as they can sometimes worsen the condition.

Prevention

• Use antibiotics only when truly needed and exactly as prescribed
• Practice careful hand washing with soap and water, which helps remove C. difficile spores
• Follow infection-control measures in hospitals and care facilities
• Tell your provider if you have had C. difficile before, as it can recur
• Clean surfaces thoroughly when caring for someone with the infection

When to See a Doctor

See a doctor if you have watery diarrhea several times a day, especially during or after a course of antibiotics. Seek urgent care if you have:

• Severe or bloody diarrhea
• High fever
• Severe abdominal pain or a swollen, tender belly
• Signs of dehydration, such as dizziness, very little urine, or extreme weakness
• Feeling very unwell or rapidly worsening

Severe pseudomembranous colitis can become an emergency, so prompt evaluation is important.

Related Topics

Frequently Asked Questions

References

1. Centers for Disease Control and Prevention (CDC). C. diff (Clostridioides difficile).
2. Mayo Clinic. Pseudomembranous colitis.
3. MedlinePlus, U.S. National Library of Medicine. Pseudomembranous colitis.
4. National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK). C. difficile infection.