Colitis refers to inflammation of the large intestine (colon). There are several types of colitis, with the most common being ulcerative colitis and Crohn’s colitis. Symptoms of colitis often include abdominal pain, diarrhea, rectal bleeding, and fatigue. Some people with colitis also notice distinct odors from their stool.
What causes the smell with colitis?
There are a few reasons why stool may smell particularly foul or unusual in someone with colitis:
- Malabsorption of nutrients – Due to inflammation and damage to the colon lining, people with colitis often don’t properly absorb nutrients from food. This can lead to steatorrhea, or excess fat in the stool. The extra fat can contribute to particularly foul-smelling stool.
- Changes in gut bacteria – Colitis disrupts the normal balance of bacteria in the colon. Harmful bacteria like C. difficile may overgrow and produce nasty-smelling gas and sulfur compounds.
- Blood and mucus – Rectal bleeding associated with colitis can give stool a metallic odor. Excess mucus secretion can also lead to a particularly offensive sulfur or fishy smell.
- Dietary changes – Some foods may be poorly digested and cause bad-smelling gas and stool. People with colitis often need to avoid problem foods like dairy, cruciferous vegetables, beans, etc.
In addition to odd stool odors, people with severe colitis may have bad-smelling flatulence. This is from fermentation of undigested carbohydrates by gut bacteria, which produces smelly hydrogen and methane gases.
What does colitis stool smell like?
There is no single smell that is universally described with colitis stool. However, some common descriptions include:
- Sulfur or rotten egg smell – Caused by hydrogen sulfide gas produced by bacteria as a byproduct of fermenting undigested protein and amino acids.
- Fishy or ammonia-like odor – Related to increased mucus production and bacterial overgrowth in the colon.
- Foul or rancid smell – Results from steatorrhea and excess fat in the stool.
- Metallic smell – Due to blood from ulceration and inflammation of the colon.
The specific smell likely depends on the severity of inflammation, types of gut bacteria present, and dietary factors unique to each individual.
When is the smell a concern?
Mild to moderate odor changes can be normal with colitis flares. However, if the smell is extremely foul or you notice other concerning symptoms, it may signify:
- A severe flare or infection
- Stricture or blockage developing in the colon
- Overgrowth of harmful bacteria like C. difficile
Some signs that warrant contacting your doctor include:
- Stool smell is very severe or new/unusual for you
- Smell is accompanied by high fever, vomiting, or severe pain
- You pass very narrow, ribbon-like stools
- You have >10 stools per day, especially with visible blood or pus
This may indicate a complication like toxic megacolon, bowel perforation, or sepsis requires prompt medical treatment.
Tips for reducing colitis smell
While some odor is expected with active colitis, you may be able to reduce the smell by:
- Avoiding foods that worsen symptoms – Common culprits are dairy, alcohol, spicy foods, high-fiber grains and vegetables.
- Staying hydrated – Drinking adequate fluids can help dilute stool and prevent very foul-smelling concentrated stool.
- Taking probiotics – Probiotics may curb growth of bad bacteria and reduce odor-causing fermentation.
- Treating flares – Getting active disease under control with corticosteroids or biologics can reduce problematic inflammation and absorption issues.
- Emptying the colon – Using laxatives or enemas as needed to frequently empty the colon may lessen odor.
For significant ongoing odor issues, talk to your doctor about adjusting medications or having your stool tested for causes like infections.
When to see a doctor
Schedule an appointment with your gastroenterologist if you notice:
- New onset of very foul-smelling stool
- Worsening stool odor along with bleeding or increased diarrhea
- Severe or persistent odor accompanied by fever, vomiting, or dehydration
- Symptoms that are impacting your quality of life
Your doctor can evaluate potential causes and recommend targeted treatment options to help reduce troublesome odor symptoms.
Diagnostic tests
To identify factors contributing to foul-smelling stool, your doctor may recommend:
- Stool testing – Checks for blood, excess fat, or infectious organisms like C. difficile.
- Blood tests – Assess for anemia, dehydration, or malnutrition.
- Colonoscopy – Examines the colon lining for inflammation, ulcers, strictures, or cancer.
- CT scan – Provides imaging to check for colitis complications like perforation or toxic megacolon.
Treatment options
Treatments that may help reduce odor symptoms include:
- Diet changes – Avoiding foods that worsen diarrhea or gas production.
- Probiotics – Can improve bacterial balance in the colon.
- Antibiotics – For confirmed C. difficile infection.
- Amino acid supplements – May reduce sulfur-smelling byproducts.
- Anti-diarrheal medication – Slows motility to allow better nutrient absorption.
- Corticosteroids – Powerful anti-inflammatories to treat moderate to severe flares.
- Biologics (Infliximab, Adalimumab, etc.) – Provide targeted immune system suppression to control inflammation in more serious cases.
With the right diagnosis and treatment plan, it is often possible to significantly improve or resolve troublesome odor symptoms.
Coping strategies
In addition to medical therapies, try these tips for managing colitis odor:
- Communicate openly with your care team – don’t let embarrassment prevent you from getting help.
- Carry air fresheners or scented disposal bags when leaving home.
- Limit foods a few hours before going out.
- Shower and change clothes after a foul-smelling bowel movement.
- Avoid holding in gas or stool when possible.
- Wear breathable natural fabrics, cotton underwear.
- Practice stress-reduction and self-care techniques.
With time, you will learn how to best manage symptoms and minimize odor concerns. Don’t hesitate to speak up – you should be able to live life to the fullest.
When will the smell go away?
How long colitis odor persists depends greatly on the underlying cause and response to treatment. Some general timelines include:
- Dietary triggers – Odor may improve within days of avoiding problem foods.
- Mild flares – Odor typically resolves within 1-2 weeks with anti-inflammatory treatment.
- Moderate flares – May take 2-4 weeks to improve smell with steroids or other medications.
- Severe flares – Can sometimes take 4+ weeks to get fully under control even with strong biologics.
- C. difficile infection – Requires at least 10-14 days of vancomycin or fidaxomicin.
- Chronic active colitis – May have persistent mild odor even during periods of remission.
Have patience and keep your doctor informed if odor lingers longer than expected. Further adjustment of medications or testing may be needed to resolve severe or stubborn symptoms.
Can you become nose-blind?
It is possible to become desensitized or “nose-blind” to bad smells that you are exposed to on an ongoing basis. This is thought to occur due to olfactory fatigue – essentially your brain tunes out the smell after prolonged exposure.
People with conditions like colitis, kidney failure, or metabolic disorders affecting odor often report becoming nose-blind to the smell of their own stool over time. However, the odor remains apparent to others around them.
Strategies to combat nose-blindness include:
- Leaving the room or house after passing stool to “reset” your nose.
- Asking a trusted friend or family member if they can detect a significant odor.
- Notice when others react subtly to odor such as turning their head.
Working closely with your doctor to minimize odor can help prevent you from becoming fully desensitized in the long run.
Impact on relationships
It’s understandable to feel self-conscious about odor symptoms when dating or in intimate relationships. However, good partners should react with empathy, not judgment.
Tips for navigating odor concerns include:
- Communicate openly when first discussing your condition.
- Set boundaries and agree on strategies to manage odor proactively.
- Schedule activities around times when odor may be better or worse.
- Work together on problem-solving – diet changes, air fresheners, etc.
- Find non-odor related ways to remain physically intimate if needed.
- Seek counselling support if odor negatively impacts your relationship.
With mutual understanding, patience, and creativity, it is certainly possible to maintain a happy and healthy relationship.
Takeaways
- Colitis odor is often caused by malabsorption of nutrients, altered gut bacteria, blood, and excess mucus.
- Common descriptions include sulfur, fishy, foul, metallic, or rancid smells.
- See a doctor promptly for very severe or worsening odor along with concerning symptoms.
- Treatments aim to reduce inflammation, control diarrhea, and normalize gut bacteria.
- Coping strategies involve open communication, personal hygiene, and thoughtful planning.
- With proper treatment and support, odor symptoms can often be significantly improved.