Ulcerative Colitis and C. Diff: What You Need to Know

Fever, nausea, cramping, and diarrhea — if you have ulcerative colitis, you probably know that those symptoms signal a flare. But sometimes, there’s another culprit at work that can trigger those same symptoms: a Clostridioides difficile (aka C. diff) infection.

C. diff is a highly contagious bacterium that infects the large intestine and causes inflammation in the colon. People with inflammatory bowel disease (IBD) are particularly susceptible to the infection. Research published in the journal Gastroenterology found that people with IBD are nearly five times as likely as people without IBD to develop C. diff.

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“The relationship between C. diff and IBD isn’t well understood, but what some research is starting to uncover is that inflammation present in the gut can possibly … create a more supportive environment for C. diff to thrive,” says Megan Hilbert, a registered dietitian with Top Nutrition Coaching in Madison, Wisconsin.

Unlike other bacterial infections that affect the large intestine, C. diff can cause serious complications, especially for people with ulcerative colitis.

Understanding Your Risk of C. diff

C. diff (formerly known as Clostridium difficile) is a bacterium that’s present in people’s intestines and can spread through the stool, such as when someone doesn’t wash their hands after using the bathroom. If you ingest this bacterium by mouth, the spores are released into your body, causing inflammation in the cells lining the large intestine.

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Not everyone is aware that they’re carrying C. diff, which causes them to unknowingly spread the bacterium to others. In fact, for many people, the good bacteria normally present in the gut can help keep C. diff from spreading unchecked, according to Cleveland Clinic.

The problem usually comes after people take a course of antibiotics, which kills off good bacteria and causes C. diff to spread quickly, causing inflammation and other symptoms, explains Kelley Shackelford, MD, an internal medicine specialist at Orlando Health Physician Associates in Florida.

An estimated half million infections occur in the United States every year, according to the Centers for Disease Control and Prevention (CDC). Having IBD is one risk factor. Others include being 65 or older, having a weakened immune system (which can occur in people who are taking immunosuppressive drugs), and having previously had a C. diff infection.

One in 6 people who’ve had C. diff will get it again in the following two to eight weeks, says the CDC.

What are the symptoms of C. diff?

The symptoms of a C. diff infection can mimic those of a flare. According to the CDC, they can include:

• Watery diarrhea
• Blood in the stool
• Abdominal pain and swelling
• Fever
• Nausea
• Loss of appetite

What to do if you think you have a C. diff infection

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Anytime you’re experiencing “symptoms of watery diarrhea, abdominal pain, or nausea, consult your doctor immediately,” says Dr. Shackelford. Often, doctors will want to take a stool sample to make sure you have C. diff rather than a flare.

If you test positive for C diff., your treatment will depend on the severity of the infection. Your doctor will most likely prescribe you an antibiotic to take at home that can kill C. diff bacteria specifically.

Other cases of C. diff require more serious treatment. “If you have severe symptoms, such as signs of dehydration or fever, I recommend going to the hospital to be monitored closely with antibiotics and IV fluids,” says Shackelford.

If you require hospitalization, your doctors will use procedures that can help limit the spread of the bacteria (such as wearing gloves or giving you a single room), as well as give you IV hydration and electrolyte replacement. Severe cases may require surgery, which involves removing a large part of the colon and performing an ileostomy, says Shackelford.

People who have recurring C. diff may be candidates for fecal transplantation, in which stool from a healthy donor is introduced into the GI tract (usually via a colonoscopy), where it will help restore healthy bacteria to the gut, according to Johns Hopkins Medicine.

If you think you may have a C. diff infection, don’t hesitate to contact your doctor, even if you’re unsure what’s causing your symptoms. A simple stool test can clear up the confusion and point you toward the right treatment.

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