Pseudomembranous colitis

Tests and procedures that may be used to diagnose the cause of diarrhea:

• Stool sample. There are different stool tests used to detect C. diff bacteria or their toxins or other disease-causing germs or parasites that can cause pseudomembranous colitis. This is the primary test for diagnosing a C. diff infection.
• Blood tests. These may reveal an unusually high white blood cell count, called leukocytosis, which may indicate an infection such as C. difficile if you also have diarrhea.
• Colonoscopy or flexible sigmoidoscopy. A tube with a miniature camera at its tip is used to examine the inside of your colon. A tool may be used to remove a tissue sample, called a biopsy. These tissue samples may be tested in a lab to identify causes other than C. diff. A colonoscopy is an exam of the entire colon. A flexible sigmoidoscopy is an exam of a part of the colon.
• Imaging tests. An X-ray or CT scan may be used to look for serious complications of pseudomembranous colitis, such as toxic megacolon or bowel perforation.

Treatments for pseudomembranous colitis usually include:

• Treating dehydration. Treating dehydration. Fluids and essential minerals are delivered through a tube inserted in a vein. This restores typical fluid levels.
• Stopping the use of antibiotics. If pseudomembranous colitis is linked to an antibiotic, use of that medicine is stopped unless it's critical for treating another condition. Other medicines may be stopped if they are likely linked to the condition.
• Taking another antibiotic targeting C. diff. You'll likely take an antibiotic that targets C. diff but not the broad range of bacteria in the colon. This treats the C. diff infection but allows other bacteria to recover. More than one round of treatment may be needed. Commonly used antibiotics include:
  • Vancomycin
  • Fidaxomicin (Dificid)
  • Metronidazole (Flagyl)
• Preventing recurring C. diff infections. Bezlotoxumab is a human monoclonal antibody, a medicine that supports the immune system. When there is a risk of a repeat infection, this may be used with antibiotic treatment to prevent another C. diff infection.

When antibiotic treatments don't work, your healthcare team may look for other possible causes for pseudomembranous colitis or try other treatments.

Restoring healthy bacteria

Sometimes treatments may be used to restore healthy bacteria in the colon. Stool from a healthy donor — often from stool banks — are screened to make sure they don't carry harmful germs. This stool with healthy bacteria is transplanted into the diseased colon to restore typical gut bacteria. This is called fecal microbiota transplantation.

The stool with healthy bacteria is delivered to the colon with a scope that passes through the anus. Or the transplant is delivered through a tube that passes through the nose and down to the stomach.

Two other methods to restore healthy bacteria include:

• An enema that introduces healthy bacteria into the rectum.
• A pill that delivers inactive bacteria that are then activated when they reach the intestines.

Surgery

Serious damage to the colon, rupture or toxic megacolon may require surgery. Procedures may include:

• Removing all of the colon, so that stool is emptied from the small intestine through a hole in the belly wall and into a bag.
• Removing a diseased section of the colon and connecting the remaining healthy portions.
• Redirecting the stool into an opening in the belly wall, cleaning the diseased part of the colon through a second opening, and treating it with antibiotics. If the diseased portion heals, the colon may be restored to its original form.

Pseudomembranous colitis is often diagnosed when you are already under care in a hospital or nursing home. Diagnosis and treatment are then a continuation of current care. You also may see your primary healthcare professional first.

What you can do

If you are seeing your primary healthcare professional for diarrhea, you can write down the following information before your appointment:

• Your symptoms, including any that seem unrelated to the reason for your appointment.
• Key personal information, including major stresses, recent life changes and family medical history.
• All medicines, vitamins or other supplements you take, including the doses.
• Questions to ask your healthcare professional.

Some basic questions you might want to ask include:

• What's the most likely cause of my symptoms?
• What tests do I need?
• Is my condition likely temporary or long lasting?
• What treatments are available and which do you recommend for me?
• I have other health conditions. How can I best manage them together?
• Are there restrictions I need to follow?
• Should I see a specialist?
• Are there brochures or other printed material I can have? What websites do you recommend?

Don't hesitate to ask additional questions. And, if possible, take a family member or friend along to help you remember the information you're given.

What to expect from your doctor

Your healthcare professional is likely to ask you several questions, such as:

• When did you first begin experiencing signs and symptoms?
• Do you have diarrhea?
• Is there blood or pus in your stools?
• Do you have a fever?
• Are you having stomach pain?
• Have your symptoms stayed the same or gotten worse?
• During the last several weeks, have you taken antibiotics, had a surgical procedure or been hospitalized?
• Is anyone at home sick with diarrhea, or has anyone at home been hospitalized in the last several weeks?
• Have you ever been diagnosed with diarrhea related to C. diff or antibiotics?
• Do you have inflammatory bowel disease?
• Are you being treated for any other medical conditions?
• Have you traveled recently to an area with an unsafe water supply?
• Does anything seem to improve your symptoms?
• What, if anything, appears to worsen your symptoms?

What you can do in the meantime

While you're waiting for your appointment, drink plenty of fluids to help prevent dehydration. Sports drinks, oral rehydration solutions (Pedialyte, Ceralyte, others), noncaffeinated soft drinks, broths and fruit juices are good options.