Colitis refers to inflammation of the inner lining of the colon (large intestine). There are several types of colitis, with the most common being ulcerative colitis and Crohn’s colitis, which is a form of Crohn’s disease affecting the colon. Symptoms of colitis often include diarrhea, abdominal pain and cramping, blood or pus in the stool, fatigue, reduced appetite and weight loss. Colitis can range in severity from mild to severe. Mild cases may be managed with medication at home, while severe flares may require hospitalization for more intensive treatment.
When hospitalization may be necessary
Many people with colitis can manage their condition at home during mild or moderate flares. However, hospitalization may be necessary in some cases, including:
- Severe flares – Severe flares involve 6 or more bloody stools per day plus signs of systemic illness such as fever, rapid heart rate, and anemia. Hospitalization allows for intravenous corticosteroid treatment, hydration, and close monitoring.
- Intractable symptoms – If symptoms are not improving with oral medications and outpatient treatment, hospitalization may be needed for intravenous medications or nutrition.
- Bowel perforation – This serious complication requires emergency surgery to repair the hole in the colon.
- Toxic megacolon – Rare complication involving extreme colon dilation that requires close monitoring and possibly surgery.
- Dehydration – If oral rehydration solutions are not sufficient to correct fluid and electrolyte imbalances.
- Severe pain – Hospitalization may provide better pain control.
- Malnutrition – If the person is unable to maintain their weight and nutritional requirements at home.
- Growth failure in children – To enable improved nutrition through feeding tubes or intravenous nutrition.
Factors determining the need for hospitalization
The decision about hospitalization is made on a case-by-case basis. Factors physicians consider include:
- Severity of symptoms
- How well symptoms respond to outpatient treatment
- Signs of dehydration or malnutrition
- Presence of concerning complications like perforation
- A flare while on immunosuppressant medications
- Primary sclerosing cholangitis, a bile duct disease more common with colitis
- The extent of inflammation and prior damage seen on colonoscopy
- How much the disease is impairing quality of life
- Ability to eat and drink enough at home
- Support systems at home
- Distance to the hospital
Younger patients under 18 are more likely to require hospitalization since their nutrition and growth needs to be monitored closely.
What to expect during a hospitalization
If you require hospitalization for colitis, you can expect:
- Medications – Corticosteroids like intravenous hydrocortisone or methylprednisolone are commonly used. Other medications may include antibiotics, immunomodulators, biologics, anti-diarrheal, pain medications, iron supplements, vitamin B12 shots, and others based on your symptoms.
- Rehydration – Fluids and electrolytes are replenished through an IV.
- Nutrition – If eating makes symptoms worse, nutrition may be provided through an NG tube, IV, or for prolonged hospitalization, a PICC line or central venous catheter. Total parenteral nutrition provides nutrition intravenously.
- Surgery – Emergency surgery may be necessary, such as for bowel perforation or toxic megacolon. This may involve removal of part of the colon.
- Monitoring – Doctors monitor your vital signs, labs, bowel movements, and response to treatment.
- Rest – Hospitalization allows your body to rest and heal properly.
You can discuss pain management options, dietary needs, having a private or shared room, and other accommodations with your care team.
How long is the hospital stay?
The length of hospitalization for colitis varies depending on the severity of the flare and how quickly you respond to treatment. Somehospital stays may last only 3-5 days. More severe cases often require 7-10 days on average. Stays over 2 weeks are possible depending on complications like infections, slow response to medications, or surgery.
Children and teenagers with colitis tend to have longer hospital stays than adults, as their condition is monitored closely. Individual factors also play a role, so it’s not possible to predict an exact hospital stay length. Staying until symptoms have resolved sufficiently is preferable to avoid readmission.
Can hospitalization be avoided?
Sometimes hospitalization can be avoided by:
- Working closely with your gastroenterologist to manage symptoms
- Having regular checkups even when feeling well to monitor disease activity
- Taking medications as prescribed
- Getting prompt treatment for flares before they become severe
- Having an action plan listing when to see the doctor or go to the ER
- Avoiding trigger foods like dairy, fatty foods, alcohol, caffeine, raw vegetables or nuts
- Staying hydrated and nourished
- Learning coping techniques to manage stress, which can trigger flares
- Getting enough rest and sleep
- Following up promptly after a flare to prevent recurrence
- Getting recommended screening tests like colonoscopies
Having an extensive support network and resources can also help avoid hospitalization when possible. However, severe flares generally do require hospital-level care. Call your doctor right away if your symptoms become concerning to help prevent an emergency.
Risks and complications of hospitalization
While hospitalization has clear benefits for severe colitis flares, potential risks include:
- Infections – Like C. difficile, sepsis, pneumonia, and urinary tract infections.
- Blood clots – From reduced mobility and intravenous lines.
- Punctured lung – Rare complication from central IV lines.
- Bleeding – Related to medications or procedures.
- Allergic reactions – To new medications or blood products.
- Worsening anxiety or depression – Exacerbated by the hospital environment and illness.
Your medical team takes precautions to avoid complications. Alert staff to any new or concerning symptoms that arise during your stay. Having advocates visit frequently also helps minimize risks.
Coping with a hospitalization
Being hospitalized can be stressful. Coping strategies include:
- Communicating any needs clearly to your care team.
- Bringing comforting items from home.
- Having friends or family visit or stay with you.
- Requesting mental health or social work consults if you feel overwhelmed.
- Talking to a therapist or counselor.
- Joining a hospital support group temporarily.
- Keeping a journal.
- Practicing relaxation techniques like meditation.
- Listening to music or podcasts.
- Watching videos or reading.
- Taking walks around the floor when able.
Share your worries and emotions with those who care about you. They want to help you through this difficult time.
After hospital discharge
The hospital team will prepare discharge instructions covering:
- Medications and how to take them
- Diet and nutritional guidelines
- Follow-up appointment schedule with all providers
- Symptoms to watch for that should prompt calling the doctor
- Instructions for care of any incisions or intravenous lines
- Home health services if needed, like IV medication administration or wound care
Be sure you understand all instructions before leaving. Have your caregiver or advocate review the plan as well. Follow up promptly with your providers and call with any questions or issues. With careful monitoring and treatment, you can successfully manage colitis at home after hospital discharge.
Conclusion
While people with colitis often manage flares on an outpatient basis, severe symptoms may necessitate hospitalization for more intensive therapy. Indications include intractable symptoms, dehydration, serious complications like perforation or toxic megacolon, and inability to maintain nutrition at home. Typical hospital care involves IV medication, nutrition, close monitoring of disease activity, and possible surgery. Hospital stays average about a week but can vary considerably depending on the severity and other factors. Risks of hospitalization may include infections, blood clots, and psychological issues. However, the benefits generally outweigh the risks for severe colitis. With careful follow-up after discharge, many people with colitis recover well and return to their normal routines. Working closely with your medical team helps determine the best treatment options and avoid emergency situations leading to hospitalization when possible.