Toxic Megacolon
Toxic megacolon is a rare and serious health complication that can result from a condition causing serious inflammation or infection in your colon or large intestine, such as inflammatory bowel disease (IBD) or salmonella infection.
If you have toxic megacolon, your colon swells, weakens, stops working properly, and becomes filled with food and gas. Potentially, toxins from the food and gas buildup could leak into the blood and cause infection that affects the whole body. It can also cause shock and dehydration.
You might have symptoms such as diarrhea, belly swelling and pain, and fever, and you’ll need to get immediate medical help.
Toxic Megacolon Causes
Toxic megacolon is a complication resulting from an inflammation in your colon that happens over time, especially if it's left untreated. Health conditions that cause inflammation or infection in your colon that could cause toxic megacolon include:
Ulcerative colitis
Ulcerative colitis (UC) is a type of inflammatory bowel disease, and it's the most common initial cause of toxic megacolon. Ulcerative colitis happens when your immune system overreacts, causing inflammation and ulcers in the inner lining of your large intestine. It causes symptoms such as diarrhea, blood in your poop, belly pain, fever, tiredness, nausea, and vomiting.
Ulcerative colitis may lead to toxic megacolon when inflammation in the colon’s inner lining reaches the inner areas of the large intestine. This causes your large intestine to stop working and swell. Most cases of death from ulcerative colitis happen because of toxic megacolon.
Crohn’s disease
Crohn’s disease is another form of inflammatory bowel disease. It involves an overreaction by your immune system that causes inflammation anywhere in your digestive tract, from your mouth to your anus. But most of the time, it affects your small intestine and the start of your large intestine. It can cause belly pain, weight loss, diarrhea, bloody poop, nausea, joint pain, fever, and skin rashes.
Crohn’s disease may also cause toxic megacolon, but it happens less often in ulcerative colitis. You’re also more likely to have it in the early stages of Crohn’s disease.
Clostridioides difficile infection
It’s less common, but infection from Clostridioides difficile (C. diff) bacteria can inflame your bowel and cause diarrhea. You might have other symptoms such as fever, belly pain, vomiting, and nausea.
You’re 7 to 10 times more likely to have a C. diff infection when taking antibiotics or the month after. These antibiotics can harm the good bacteria in your gut, which usually ensures that harmful bacteria such as the C. diff bacteria don’t cause any serious problems.
Without the good bacteria working as they should, a C. diff infection can cause serious health problems, such as toxic megacolon.
Parasitic infections
Your colon can get inflamed from a parasitic infection such as those cause by some types of worms. Most of the time, these infections are mild and don’t cause any symptoms. But you might also have symptoms such as diarrhea, stomach pain, and fever. In serious cases, especially when you don’t get treated for the infection, or if you have a weakened immune system, it can lead to toxic megacolon or other serious health problems.
Bacterial infections
Intestinal infections caused by bacteria such as salmonella, shigella, and campylobacteria can inflame your intestines. These infections cause diarrhea, belly pain, and stomach pain. In severe but rare cases, you’re likely to have toxic megacolon from them.
Drugs that cause toxic megacolon
Some medications such as opioids, antidiarrheals, nonsteroidal anti-inflammatory medicines (NSAIDs), and antidepressants can trigger or worsen toxic megacolon. These medications affect the bowel by reducing blood flow or changing how it contracts, putting you at risk of having toxic megacolon or even worse symptoms.
Who Gets Toxic Megacolon?
Anyone can get it. But certain conditions, especially IBD, put you at a higher risk. In addition, it’s more likely if you have:
- Diabetes
- Kidney problems
- A transplanted organ
- Problems with your immune system
- HIV/AIDS
- Heart failure
- Lung disease
Toxic Megacolon Symptoms
Toxic megacolon causes symptoms such as:
- Belly pain, swelling, and tenderness
- Nausea
- Diarrhea which may or may not have bloody poop
- Fever
- Low blood pressure
- Racing heart
- Mental confusion
- Feeling sick
Early symptoms of toxic megacolon
Diarrhea, often quite serious and bloody, is common at first. You also might have a fever, dizziness, a swollen belly, and a racing heart. When your colon swells, which is a classic sign of toxic megacolon, it can’t move gas through your gut. As a result, your lower belly could bloat quite a bit and may become painful and tender to the touch.
Get to a doctor ASAP if you notice these symptoms. Toxic megacolon can get serious very quickly.
When to seek medical attention
Get emergency medical help or see a doctor immediately if you have any of these symptoms:
- Serious belly pain and tenderness
- Swollen belly
- Frequent and bloody diarrhea
- Fever
- Racing heart
- Shock symptoms such as weak or rapid pulse, dilated eyes (when your pupils look bigger), fast or shallow breathing, and mental confusion
Diagnosis of Toxic Megacolon
If you have symptoms of toxic megacolon, your doctor and health care team will examine you. They will ask about your symptoms, your health history, and any other conditions, such as IBD, that tend to inflame the colon.
They may take pictures of the inside of your gut with X-rays or a CT scan to see if your colon has dilated, and do blood tests to check for infection and other possible problems.
A swollen belly, along with other symptoms such as a fever over 100 F, a heart rate over 120, a low red blood cell count, low blood pressure, and dehydration , might point to a toxic megacolon diagnosis.
Toxic Megacolon Treatment
Treatment depends on how serious it is, as well as your symptoms, age, general health, and the cause of the condition.
Medication to treat the underlying condition that led to toxic megacolon can help. If the cause is IBD, treatment often includes steroids and an immune system drug such as infliximab or cyclosporine. If it resulted from an infection, you’ll probably need antibiotics. For ulcerative colitis, your doctor might prescribe antibiotics to stop or prevent bacterial infection, and anti-inflammatories to help ease swelling in your colon.
You also might go on bowel rest, which means you may get your nutrition through a needle or a tube instead of eating food. Your health care team might try to remove air from your colon with a suction tube. This is all to lessen pressure on your inflamed, swollen colon and prevent it from tearing, which is serious.
You may get fluids through a needle to prevent dehydration and low blood pressure.
Some people need surgery. The decision on when and if to have it is complex. There may be several things for you and your medical team to consider. If nonsurgical treatments don’t ease the condition in 2 or 3 days, you’ll likely need surgery to remove all or part of your colon. You’ll also typically go straight to surgery if it’s clear that your bowel is torn or dead, you’re bleeding internally, your colon is getting wider, or your blood is getting more toxic.
Your doctor might ask you to stop certain medications that could worsen toxic megacolon, such as opioids, anticholinergics, antidepressants, and antidiarrheals.
Toxic Megacolon Prognosis
As long as your colon doesn’t perforate or tear, the survival rate for well-treated toxic megacolon is above 95%. Even if it does tear, the survival rate is around 80%. But some studies show that if you get toxic megacolon once and your doctor treats it without surgery, you’re more likely than others to get it again.
Takeaways
Toxic megacolon is a serious and life-threatening health complication that could, in rare cases, happen when you have a disease or infection that causes your colon to be inflamed. See a doctor immediately if you have toxic megacolon symptoms such as severe and bloody diarrhea, belly pain, swelling, and tenderness, rapid heart and breathing rate, nausea, and vomiting. Your doctor will recommend treatment to reduce your symptoms, manage the condition causing the toxic megacolon, and help your colon heal.
Toxic Megacolon FAQs
What are toxic megacolon symptoms?
Belly pain, swelling, tenderness, diarrhea (which may be bloody), nausea, vomiting, and fever are toxic megacolon symptoms.
What triggers toxic megacolon?
Toxic megacolon happens when you have a condition that causes your colon to be inflamed. It can be triggered by a weakened immune system, any untreated condition causing inflammation, or the use of medicines such as antidiarrheals, opioids, anticholinergics, and antidepressants.
What is the definition of a megacolon?
Megacolon is defined as a serious enlargement of the colon, typically more than 6 centimeters.
Can you survive toxic megacolon?
Yes, you can survive toxic megacolon, even if your colon tears. Get medical help as soon as you notice any disturbing symptoms.
