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Blood in stool
Bleeding from anus
Stomachache
Diarrhea
Stomach pain with diarrhea
Abdominal discomfort
Frequent bowel movements with stomach ache
Not seeing your symptoms? No worries!
An inflammatory condition of the large intestine that damages the gut wall. The exact cause is not well known.
Your doctor may ask these questions to check for this disease:
Treatment includes medications to reduce inflammation and suppress the immune system. Lifestyle changes like a modified diet and stress reduction may be helpful. In severe cases, hospitalization for intravenous hydration, and surgery to remove part of the large intestine may be needed.
Reviewed By:
Samantha Nazareth, MD (Gastroenterology)
Board-certified gastroenterologist. Experience managing gastrointestinal conditions (GERD, IBS, ulcerative colitis, Crohn’s, celiac disease, NASH) within healthcare organizations (three ambulatory surgical centers, single-specialty practice, multi-specialty practice and solo practice).
Aiko Yoshioka, MD (Gastroenterology)
Dr. Yoshioka graduated from the Niigata University School of Medicine. He worked as a gastroenterologist at Saiseikai Niigata Hospital and Niigata University Medical & Dental Hospital before serving as the Deputy Chief of Gastroenterology at Tsubame Rosai Hospital and Nagaoka Red Cross Hospital. Dr. Yoshioka joined Saitama Saiseikai Kawaguchi General Hospital as Chief of Gastroenterology in April 2018.
Content updated on Mar 31, 2024
Following the Medical Content Editorial Policy
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Q.
Body Not Healing? Why Your Cells Need Apoptosis + Medically Approved Next Steps
A.
Apoptosis is your body's essential cell clean-up system; when it falters, damaged cells persist, driving chronic inflammation, slow wound healing, digestive flares like ulcerative colitis, and increased cancer risk. Medically approved next steps include calming inflammation with a Mediterranean-style diet and regular exercise, prioritizing 7 to 9 hours of sleep, checking vitamin D with your clinician, avoiding smoking, managing stress, and seeking prompt care for red flags such as blood in stool or non-healing wounds. There are several factors to consider; see the complete guidance and symptom-check resources below.
References:
* Fan S, et al. Apoptosis in wound healing. Adv Wound Care (New Rochelle). 2014 Mar 1;3(3):209-222. doi: 10.1089/wound.2013.0483. PMID: 24761400.
* Liu X, et al. Dysregulation of Apoptosis and Necroptosis in Disease: From Molecular Mechanisms to Therapeutic Targets. Front Cell Dev Biol. 2021 Jul 26;9:718712. doi: 10.3389/fcell.2021.718712. PMID: 34386407.
* Sreedhar A, et al. Apoptosis and its modulation: an update. Biomed Pharmacother. 2022 May;149:112879. doi: 10.1016/j.biopha.2022.112879. PMID: 35345759.
* Singh N, et al. Apoptosis: An Update on Basic Mechanisms and Therapeutic Strategies. Cells. 2023 Jul 21;12(14):1949. doi: 10.3390/cells12141949. PMID: 37508492.
* Li X, et al. Apoptosis, Necroptosis, and Pyroptosis in Aging and Age-Related Diseases. Oxid Med Cell Longev. 2020 Jul 15;2020:6463931. doi: 10.1155/2020/6463931. PMID: 32733479.
Q.
Chronic GI Pain? Why Your Gut Is Inflamed + Medically Approved IBD Next Steps
A.
Chronic GI pain with diarrhea, bloating, blood in your stool, or fatigue often points to gut inflammation from inflammatory bowel disease like Crohn's or ulcerative colitis. There are several factors to consider. See below for the urgent warning signs, how doctors confirm IBD with blood and stool tests plus colonoscopy and imaging, which treatments from anti-inflammatory medicines, immunomodulators, and biologics to small molecules, nutrition guidance, and surgery may apply, and how testing distinguishes IBD from IBS. Early diagnosis improves outcomes.
References:
* Balint A, Galimberti R, Pálvölgyi L. Inflammatory Bowel Disease: Pathogenesis, Diagnosis, and Treatment. Int J Mol Sci. 2022 Jan 19;23(3):1040. doi: 10.3390/ijms23031040. PMID: 35087309; PMCID: PMC8835269.
* Painsi C, Storr M, Schicho R. The role of inflammation in chronic abdominal pain and its management. Expert Rev Gastroenterol Hepatol. 2021 May;15(5):561-572. doi: 10.1080/17476321.2021.1895687. Epub 2021 Mar 30. PMID: 33810237.
* Al-Khafaji AM, Al-Muzaini MF, Hashlamoun RA, Almubarak Z, Arafat M. Current and Emerging Pharmacological Therapies for Inflammatory Bowel Disease. Pharmaceutics. 2023 Jan 30;15(2):438. doi: 10.3390/pharmaceutics15020438. PMID: 36767733; PMCID: PMC9961637.
* Lichtenstein GR, Loftus EV Jr, Isaacs KL, Regueiro MA, Gerson LB, Sands BE. ACG Clinical Guidelines: Management of Crohn's Disease in Adults. Am J Gastroenterol. 2021 Apr 1;116(4):657-682. doi: 10.14309/ajg.0000000000001063. PMID: 33810287.
* Rubin DT, Ananthakrishnan AN, Siegel CA, Sauer BG, Long MD. ACG Clinical Guidelines: Ulcerative Colitis in Adults. Am J Gastroenterol. 2021 Apr 1;116(4):683-714. doi: 10.14309/ajg.0000000000001062. PMID: 33810288.
Q.
Damaged Epithelial Tissue? Why Your Lining Is Failing & Medically Approved Next Steps
A.
Damaged epithelial tissue means your protective lining in the gut, skin, lungs, bladder, and more is failing, most often from chronic inflammation, infections, autoimmune disease, medication or chemical injury, poor blood flow, or nutrient deficits. Medically approved next steps focus on identifying the cause, controlling inflammation, treating confirmed infections, removing triggers like NSAIDs, supporting nutrition, and managing underlying conditions, with urgent care for red flags. There are several factors to consider that could change your plan; see below for the specific symptoms, tests, and step by step actions to discuss with your doctor.
References:
* Vliagoftis, G. V., & Nwaro, N. (2020). Epithelial Barrier Dysfunction: Causes, Consequences, and Therapeutic Approaches. *Journal of Clinical Medicine*, *9*(6), 1937.
* Luppino, V., D'Alessio, S., & Vetrano, S. (2022). Intestinal epithelial barrier dysfunction: A route to progression of inflammatory bowel disease. *World Journal of Gastroenterology*, *28*(5), 589–599.
* Proksch, E., Brandner, J. M., & Jensen, J. M. (2018). The skin: an indispensable barrier. *Drugs in Dermatology*, *17*(6), 682–684.
* Kim, D. L., Ko, J. H., Kim, K. J., Jang, A. S., & Kim, M. A. (2021). Airway epithelial barrier dysfunction in respiratory diseases: from mechanisms to therapeutic strategies. *Allergy, Asthma & Immunology Research*, *13*(2), 209–221.
* Nguyen, T. T., Chen, E. B., & Stappenbeck, T. S. (2020). Epithelial Repair and Regeneration in the Gastrointestinal Tract. *Cells*, *9*(7), 1729.
Q.
Sick of Inflammation? Black Seed Oil Benefits & Medical Next Steps
A.
Black seed oil may modestly reduce inflammation and support digestion, mild asthma and allergies, metabolic markers, joint discomfort, and certain skin issues, but evidence is limited and it should complement, not replace, medical care. There are several factors to consider. See below to understand side effects and drug interactions, who should avoid it, red flag symptoms that need prompt evaluation, and step by step guidance on testing, dosing, and partnering with your clinician, including a link to a free ulcerative colitis symptom check if gut symptoms persist.
References:
* Hasini A, et al. Nigella sativa (black seed) is a promising natural remedy for the treatment of inflammatory and oxidative stress-related diseases. Phytomedicine Plus. 2022 Mar 23;2(2):100234. doi: 10.1016/j.phyplu.2022.100234. PMID: 35509923; PMCID: PMC9028456.
* Mohammadi S, et al. Effect of Nigella sativa (black seed) on inflammatory biomarkers in patients with metabolic syndrome: a systematic review and meta-analysis of clinical trials. Inflammopharmacology. 2023 Feb;31(1):127-140. doi: 10.1007/s10787-022-01116-7. Epub 2023 Jan 9. PMID: 36625807.
* Talebi M, et al. Thymoquinone: an integrative natural compound in inflammatory-related diseases. Inflammopharmacology. 2022 Dec;30(6):2181-2200. doi: 10.1007/s10787-022-01053-y. Epub 2022 Aug 4. PMID: 35919379.
* Ahmad A, et al. A review of clinical trials of Nigella sativa (black seed) in inflammatory diseases. Saudi J Biol Sci. 2021 Jan;28(1):112-121. doi: 10.1016/j.sjbs.2020.09.006. Epub 2020 Sep 11. PMID: 33496338; PMCID: PMC7800742.
* Majdalawieh AF, Fayyad MW. Anti-inflammatory and antioxidant activities of Nigella sativa and its main component, thymoquinone: A review. J Complement Integr Med. 2016 Mar;13(1):15-24. doi: 10.1515/jcim-2015-0015. PMID: 26085189.
Q.
Is It Listeria? Why Your Body Is Reacting & Medically Approved Next Steps
A.
Listeria from certain ready-to-eat or refrigerated foods can cause fever, muscle aches, nausea, or diarrhea, and in high-risk people such as those who are pregnant, over 65, or immunocompromised it can progress to severe infection with stiff neck, confusion, or seizures; symptoms may start within hours or take up to 30 days after exposure. There are several factors to consider, so see below for the medically approved next steps, including when to seek urgent care, how it is diagnosed, what home care is appropriate for mild illness, and key prevention tips that could change what you should do right now.
References:
* Goulet V, et al. Listeriosis: A global public health challenge. Lancet Infect Dis. 2024 Feb;24(2):e75-e87. doi: 10.1016/S1473-3099(23)00414-7. Epub 2023 Aug 24. PMID: 37626359.
* Slutsky AM, et al. Clinical manifestations, diagnosis, and treatment of listeriosis: a narrative review. Int J Infect Dis. 2023 Dec;137:111-120. doi: 10.1016/j.ijid.2023.09.022. Epub 2023 Sep 26. PMID: 37757912.
* Maertens H, et al. Listeriosis: Current Insights and Future Challenges. Microbiol Spectr. 2022 Dec 21;10(6):e0202122. doi: 10.1128/spectrum.02021-22. Epub 2022 Dec 21. PMID: 36542157; PMCID: PMC9768603.
* Aghasi Z, et al. Current strategies for the diagnosis and treatment of listeriosis. Microb Pathog. 2021 Apr;153:104780. doi: 10.1016/j.micpath.2021.104780. Epub 2021 Feb 20. PMID: 33621644.
* Doggett SL, et al. Treatment of Listeriosis: A Review. Curr Infect Dis Rep. 2020 Jan 27;22(2):5. doi: 10.1007/s11908-020-0708-2. PMID: 31989397.
Q.
Struggling with your colostomy bag? Why your stoma is reacting and medically approved next steps.
A.
There are several factors to consider. Most stoma reactions are due to skin irritation or leakage from a poor-fitting appliance or stoma size changes, with other causes including temporary swelling, parastomal hernia, infection, and diet or medication effects. Medically approved next steps include remeasuring the stoma, improving fit with barrier rings or a convex system, keeping skin clean and dry, emptying the bag when one third full, consulting a WOC nurse, and seeking urgent care for color changes, no output with pain or vomiting, heavy bleeding, high fever, or severe dehydration; see the complete, step by step guidance below, as important details there can affect which actions you take.
References:
* Persson N, Belcher E, Benbow M. Management of common stoma complications. J Wound Ostomy Continence Nurs. 2017 May/Jun;44(3):263-268. doi: 10.1097/WON.0000000000000320. PMID: 28414902.
* Rolstad BS, Erwin-Toth P, Spencer C, et al. Evidence-based management of parastomal skin complications. J Wound Ostomy Continence Nurs. 2020 May/Jun;47(3):218-223. doi: 10.1097/WON.0000000000000645. PMID: 32321948.
* Tilley D, Wilson V. Stoma care: a review of current practices and future directions. J Wound Care. 2021 Jun 2;30(6):411-417. doi: 10.12968/jowc.2021.30.6.411. PMID: 34164627.
* Blackley G, Corcoran T, Lobb L, et al. Self-care education and support for patients with a stoma: A narrative review. J Wound Ostomy Continence Nurs. 2023 May-Jun 01;50(3):241-248. doi: 10.1097/WON.0000000000000966. PMID: 37175218.
* Kim J, Kang H, Kim D. Interventions to prevent and treat stoma complications: a systematic review. Int J Surg. 2018 Aug;56:225-231. doi: 10.1016/j.ijsu.2018.06.012. Epub 2018 Jun 28. PMID: 30125866.
Q.
Worried About Zetia? Why Your Gut Absorbs Fat & Medically Approved Next Steps
A.
There are several factors to consider. Zetia (ezetimibe) lowers LDL by blocking NPC1L1 in the small intestine, reducing cholesterol absorption while your gut still normally absorbs the fats and cholesterol your body needs, and it can be used alone or with statins. Medically approved next steps include pairing medication with heart-healthy lifestyle changes, confirming your LDL target and monitoring plan with your clinician, and watching for rare problems like liver enzyme elevation or severe muscle pain without stopping therapy on your own. Key nuances, who benefits most, safety data, and urgent warning signs are explained below.
References:
* van de Steeg E, van Gageldonk PG, de Groot E, et al. Ezetimibe: a specific inhibitor of Niemann-Pick C1-like 1. Curr Opin Lipidol. 2020 Jun;31(3):180-186. doi: 10.1097/MOL.0000000000000676. PMID: 32371720.
* Cannon CP, Blazing RP, Giugliano RP, et al. Ezetimibe Added to Statin Therapy after Acute Coronary Syndromes. N Engl J Med. 2015 Jun 18;372(25):2387-97. doi: 10.1056/NEJMoa1410489. Epub 2015 Jun 3. PMID: 26039521.
* Pan X, Husain I, Hu Z, Hu M. Intestinal lipid metabolism in health and disease. J Pharm Sci. 2021 Jul;110(7):2606-2615. doi: 10.1016/j.xphs.2021.03.016. Epub 2021 Mar 22. PMID: 33766579.
* Grundy SM, Stone NJ, Bailey AL, et al. 2018 AHA/ACC/AACVPR/AAPA/ABC/ACPM/ADA/AGS/APhA/ASH/ASPC/NLA/PCNA Guideline on the Management of Blood Cholesterol: A Report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines. Circulation. 2019 Jun 18;139(25):e1082-e1143. doi: 10.1161/CIR.0000000000000625. Epub 2018 Nov 10. PMID: 30586774.
* Wang X, Li J, Liu X, et al. Dietary lipids as modifiers of cholesterol metabolism. Prog Lipid Res. 2022 Sep;87:101183. doi: 10.1016/j.plipres.2022.101183. Epub 2022 Jul 14. PMID: 35843469.
Q.
Gut on Fire? Why Your Colon is Inflamed and Your Medical Path to Relief
A.
Colon inflammation, or colitis, can stem from ulcerative colitis, infections, reduced blood flow, or microscopic colitis; symptoms like persistent diarrhea, abdominal pain or cramps, urgency, blood in stool, fever, or weight loss need timely medical evaluation with stool tests, blood work, colonoscopy, and sometimes imaging to identify the cause. There are several factors to consider. See below for critical details on which tests you may need, the full range of treatments from hydration and targeted antibiotics to anti inflammatory, immune, or biologic therapies and, when necessary, surgery, plus diet and stress strategies and the red flags that mean you should seek urgent care.
References:
* Ananthakrishnan AN, et al. Inflammatory Bowel Disease: A Clinical Review. JAMA. 2022 Jul 26;328(4):372-383. PMID: 35881005.
* Ungaro RC, et al. Advances in the Medical Treatment of Inflammatory Bowel Disease. Clin Transl Gastroenterol. 2021 Nov 16;12(11):e00424. PMID: 34789512.
* Franzosa EA, et al. The gut microbiome and inflammatory bowel disease: from association to therapeutics. J Clin Invest. 2021 May 17;131(10):e148814. PMID: 33998967.
* Chandragholam MM, et al. Common and Uncommon Causes of Colitis: A Review of Radiologic and Pathologic Features. Clin Gastroenterol Hepatol. 2023 Sep;21(10):2524-2538. PMID: 37172778.
* Gecse KB, et al. Emerging Therapies in Inflammatory Bowel Disease. Curr Gastroenterol Rep. 2023 Jun;25(6):137-147. PMID: 37043003.
Q.
Internal Firestorm? Why Your Body Attacks Your Colon + Medically Approved Next Steps
A.
Ulcerative colitis is an autoimmune condition where a misfiring immune system attacks the colon, influenced by genetics, microbiome shifts, and environmental triggers, leading to cycles of diarrhea, blood in the stool, cramping, fatigue, and weight loss. There are several factors to consider; medically approved next steps cover how it is diagnosed (blood and stool tests plus colonoscopy), first line and advanced treatments (5-ASA, short-term steroids, immune suppressors and biologics, surgery when needed), lifestyle support, cancer screening timelines, and when to seek urgent care for severe symptoms, all detailed below.
References:
* Kelsen JR, Kostic AD. The complex interplay of genetics, environment, and the microbiome in inflammatory bowel disease pathogenesis. *Nat Rev Gastroenterol Hepatol*. 2019 Dec;16(12):737-750. doi: 10.1038/s41575-019-0231-1. Epub 2019 Nov 11. PMID: 31712613.
* Neurath MF. Pathogenesis of Inflammatory Bowel Disease. *Dig Dis*. 2022;40(2):166-172. doi: 10.1159/000520633. Epub 2021 Dec 2. PMID: 34856614.
* Singh S, Feuerstein JD, Binion DG, Cheifetz AS, Feagan BG, Kaplan GG, Melmed GY, Nowak J, Sandborn WJ, Sultan S, Terdiman JP, Ullman TA, Wald A. AGA Clinical Practice Guideline on the Management of Crohn's Disease. *Gastroenterology*. 2021 Jan;160(1):49-74. doi: 10.1053/j.gastro.2020.09.006. Epub 2020 Sep 17. PMID: 32949788.
* Ko CW, Singh S, Feuerstein JD, Feagan BG, Kaplan GG, Melmed GY, Nowak J, Sandborn WJ, Sultan S, Terdiman JP, Ullman TA, Wald A. AGA Clinical Practice Guideline on the Management of Ulcerative Colitis. *Gastroenterology*. 2021 Sep;161(3):1021-1044. doi: 10.1053/j.gastro.2021.06.059. Epub 2021 Jul 10. PMID: 34256037.
* Man SM, Kim JJ, Ko Y, Kim SM. The Role of the Gut Microbiome in the Pathogenesis of Inflammatory Bowel Disease. *Cells*. 2021 Aug 30;10(9):2263. doi: 10.3390/cells10092263. PMID: 34571932.
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https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(12)60150-0/fulltextDu L, Ha C. Epidemiology and Pathogenesis of Ulcerative Colitis. Gastroenterol Clin North Am. 2020 Dec;49(4):643-654. doi: 10.1016/j.gtc.2020.07.005. Epub 2020 Sep 25. PMID: 33121686.
https://www.sciencedirect.com/science/article/abs/pii/S088985532030073X?via%3DihubKeshteli AH, Madsen KL, Dieleman LA. Diet in the Pathogenesis and Management of Ulcerative Colitis; A Review of Randomized Controlled Dietary Interventions. Nutrients. 2019 Jun 30;11(7):1498. doi: 10.3390/nu11071498. PMID: 31262022; PMCID: PMC6683258.
https://www.mdpi.com/2072-6643/11/7/1498Kaenkumchorn T, Wahbeh G. Ulcerative Colitis: Making the Diagnosis. Gastroenterol Clin North Am. 2020 Dec;49(4):655-669. doi: 10.1016/j.gtc.2020.07.001. Epub 2020 Sep 23. PMID: 33121687.
https://www.sciencedirect.com/science/article/abs/pii/S0889855320300698?via%3Dihub