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6 Silent Symptoms of Ischemic Colitis

This common cause of stomach distress can hit with no warning. Here's what the experts want you to know about ischemic colitis.

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What is ischemic colitis?

Ischemic colitis is kind of like a stroke or heart attack that affects your gut instead of the brain or heart, explains Arun Swaminath, MD, director of the Inflammatory Bowel Disease Program at Lenox Hill Hospital in New York City. Simply, there’s a drop in the blood supply that feeds the gut, causing symptoms such as pain and bloody diarrhea. This condition tends to affect older adults with underlying cardiovascular issues, but the disease also can occur in younger patients due to risk factors like constipation and illicit and prescription drug use.

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Low blood pressure

Unlike high blood pressure—known as the silent killer due to the lack of symptoms—low blood pressure has some clear signs, such as dizziness and lightheadedness. This can be an early sign of impending ischemic colitis, says Will Bulsiewicz, MD, a gastroenterologist in Mount Pleasant, South Carolina. When your blood pressure dips, your body kicks into safe mode, he says. “It wants to make sure that it supports the heart and brain so it clamps down on the blood vessels that supply blood to the colon,” he says. In other words, “we sacrifice the colon in favor of heart and brain.”

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Ischemic colitis attacks come on quickly. “Warning signs of ischemic colitis include cramping and abdominal pain or tenderness in the abdomen, which usually occurs suddenly and most commonly is on the left side of the abdomen,” says David Greenwald, MD, director of clinical gastroenterology and endoscopy at Mount Sinai Hospital in New York City.

Businessman rubbing his temples suffering from headache while sitting at counter in coffee shop, shot behind glass windowPressmaster/Shutterstock


Another silent symptom of ischemic colitis is nausea, Dr. Greenwald says. Nausea also may be a symptom of a heart attack. “Some people also have a feeling of an urgent need for a bowel movement,” he adds.

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Bloody diarrhea commonly occurs along with cramping during an ischemic colitis attack. “People are feeling fine and then all of a sudden there’s pain, and after the pain comes diarrhea that’s often bloody,” adds Dr. Bulsiewicz. (Learn what else your bowel movements can reveal about your health.)

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Many people don’t pay close enough attention to their fluid intake, and dehydration can contribute to ischemic colitis. “The vast majority of cases are due to dehydration and low blood pressure,” says Dr. Bulsiewicz. “A dry, rubbery tongue and chapped lips are signs of dehydration.”

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A change in vital signs

With ischemic colitis, your heart rate goes up and your blood pressure goes down, says Dr. Bulsiewicz, and there may be evidence of urine in your blood. When your kidneys are working hard but they’re not getting enough blood, uremia can occur, he says. That’s when waste products back up into the blood. “These are little clues we see in the lab, and in some cases, they may help us make the diagnosis of ischemic colitis.”

Doctor pressing his patient's stomach, checking the area of painTeodorLazarev/Shutterstock

Are you at risk?

People older than 60 are most likely to battle ischemic colitis, although it can occur at any age, says Dr. Greenwald. Other risk factors include inflammation of blood vessels (vasculitis), blood clotting abnormalities, and prior abdominal surgery. “Certain medications have been implicated in causing ischemic colitis (oral contraceptive medications, for example), and it has occurred in long-distance runners.” The good news? Unlike ulcerative colitis, which is chronic, ischemic colitis usually occurs just once. “Most people recover nicely with supportive care including rehydration,” says Dr. Swaminath.

Next up, don’t miss these 12 things your stomach wants you to know.


Denise Mann, MS
Denise Mann is a freelance health writer whose articles regularly appear in WebMD, HealthDay, and other consumer health portals. She has received numerous awards, including the Arthritis Foundation's Northeast Region Prize for Online Journalism; the Excellence in Women's Health Research Journalism Award; the Journalistic Achievement Award from the American Society for Aesthetic Plastic Surgery; National Newsmaker of the Year by the Community Anti-Drug Coalitions of America; the Gold Award for Best Service Journalism from the Magazine Association of the Southeast; a Bronze Award from The American Society of Healthcare Publication Editors (for a cover story she wrote in Plastic Surgery Practice magazine); and an honorable mention in the International Osteoporosis Foundation Journalism Awards. She was part of the writing team awarded a 2008 Sigma Delta Chi award for her part in a WebMD series on autism. Her first foray into health reporting was with the Medical Tribune News Service, where her articles appeared regularly in such newspapers as the Detroit Free Press, Chicago Sun-Times, Dallas Morning News, and Los Angeles Daily News. Mann received a graduate degree from the Medill School of Journalism at Northwestern University in Evanston, Ill., and her undergraduate degree from Lehigh University in Bethlehem, Pa. She lives in New York with her husband David; sons Teddy and Evan; and their miniature schnauzer, Perri Winkle Blu.