What Is Diversion Colitis?

Learn Symptoms and Treatment Options After Ostomy Surgery

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Diversion colitis is a condition that sometimes occurs after colostomy or ileostomy surgery. Colitis is the medical term that’s used to refer to inflammation in the large intestine (colon). It can occur in anyone who has ostomy surgery that spares a section of the large intestine, but it happens more frequently in people who also have inflammatory bowel disease (IBD). This condition may also be called diversion proctitis if the rectum is affected.

Diversion colitis is common but in many cases, there aren’t any symptoms.

Types of Ostomy Surgery

Ostomy surgery may be performed to treat ulcerative colitis, Crohn’s disease, cancer or a variety of other conditions. Part or all of the large intestine may be removed and an ostomy is placed. The type of ostomy used could be a loop or end ileostomy or a colostomy, although diversion colitis is more often associated with a colostomy.

Ostomy surgery also might be referred to as a “diversion” because the procedure is used to divert stool away from a section of the digestive tract such as the large intestine or rectum. In some cases where all or part of the large intestine is removed, a part of the small intestine is brought through to the outside of the abdomen to create a stoma.

A stoma may be created from the end of the small intestine, in which case it’s called an end ileostomy. In the case of a loop ileostomy, a stoma is created that resembles a cut hose where only part of the hose is cut and folded in half. Stool leaves the body through the stoma, and the waste is collected into an ostomy appliance worn on the abdomen over the stoma.

A colostomy is similar to an ileostomy, but in a colostomy a piece of the large intestine is brought through the abdomen to create a stoma. The type of ostomy created could be an end colostomy or a loop colostomy.

A colostomy isn’t used to treat ulcerative colitis because the ulcerative colitis will come back in the part of the large intestine that is left. But it might be used in certain select cases of Crohn’s disease, or, more 

Causes

In the case of an ostomy where part of the large intestine is left in place, diversion colitis is a possibility. It’s not known exactly why this happens but it’s thought to be because part of the colon is no longer being used to process stool, yet that colon section is still in the body.

There are compounds that are created by the body that are no longer going through the part of the bowel that’s not currently in use to digest food because of the diversion. The lack of these substances traveling through the diverted section of colon could be part of the reason why colitis develops there.

Risk Factors

It’s unclear as to how many people with diversion surgeries develop diversion colitis. Some studies show that the condition may occur in between 70 and 100 percent of patients, based on the changes found in the colon. It’s also more common in patients who have a form of IBD than it is in those who have colorectal cancer or diverticular disease.

Symptoms

In some cases, diversion colitis is asymptomatic, meaning that there are no signs or symptoms. But in other cases symptoms appear.

Colitis (inflammation) can be measured through a white blood cell count test or detected through an endoscopy procedure. But inflammation is not necessarily something that can be felt by a patient. Colitis can cause symptoms including:

  • Abdominal pain
  • Rectal discharge
  • Rectal bleeding 
  • Tenesmus (an urgent need to empty the bowels)

Treatment

Diversion colitis typically gets better when the diversion is reversed. This is sometimes also called a take down. When and how the reversal takes place is individualized for every patient.

When the underlying reason for the diversion has been treated effectively, generally, the stoma is removed and the intestine connected again (anastamosis). This could mean that the Crohn’s disease, ulcerative colitis, cancer, or other digestive disease or condition for which the diversion was created has been treated effectively. Reconnection could also take place when the part of the colon which was bypassed through the diversion has fully healed from surgery.

One method of treatment that has been studied for diversion colitis is using twice-daily enemas containing short-chain-fatty acids. Some studies found that this treatment was effective and others found that it was only effective in certain situations or not effective at all.

When the enema treatment was found to be effective, improvement took place over a period of four to six weeks. In some cases when symptoms resolved after using the enemas, patients could take a break from the routine for a week or two without symptoms coming back.

Another type of treatment that has been studied (largely only in rats so far) is using butyrate or glutamine enemas. Similar to the short-chain-fatty acids, the enemas are given twice a day and the rats studied showed improvement in their signs and symptoms of diversion colitis.

Long-Term Prognosis

At least one study found that while symptoms and inflammation resolved for patients with diversion colitis after reconnection, there were changes in the bowel that did not always resolve. Patients in this study were followed for up to six years, showing that these changes may be long-term. It’s unclear what this might mean for the future of patients who have these differences in their colon and it’s an area of ongoing research.

For patients who have a diversion because of rectal cancer there are studies that show that diarrhea is common after a reversal. People with this condition report that it does lower quality of life and researchers recommend that ongoing nursing care and support is provided to help patients cope, especially in the first several months after reconnection.

A Word From Verywell

Diversion colitis is common but it doesn’t usually cause any symptoms and it usually reverses after the intestine is reconnected. In many cases, however, treatment might not be needed because there’s no change in quality of life for the patient.

Diversion colitis is not the same as ulcerative colitis, because it is not an immune-mediated condition and is not a progressive disease. Most people will find that this condition resolves and there’s no long-term issues that affect quality of life afterward.

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