Diversion colitis is a potential side effect from having a small or large bowel enterostomy or high output enteroatmospheric fistula. This blog discusses what diversion colitis is, its prevalence, why it happens, and treatment options.

Diversion colitis, first described in the late 1970’s, is an inflammatory process in the defunctioned segments of bowel. Diversion colitis can occur when a person has an ileostomy, colostomy or high output enterocutaneous fistula, and is not related to an inflammatory bowel condition^1,2. The inflammation is due to lack of faecal stream passing through the out-of-circuit distal bowel. When this occurs the mucosa and luminal cells change shape and become “stickier” with severely reduced gut microbiome activity, inducing an inflammatory response¹. This inflammatory response affects people differently, with varying severity. The symptoms of diversion colitis can involve tenesmus (the feeling of wanting to pass a bowel movement), abdominal pain, and bloody or mucus-like rectal discharge. Almost all patients have a microscopic level of diversion colitis (seen on endoscopic assessment) upon the creation of a diverting stoma (irrespective of location in the intestine) however, most people remain asymptomatic².

The prevalence of symptomatic diversion colitis is around 30% however, there is a spectrum of severity among patients². The prevalence of symptomatic diversion colitis is much higher with the inflammatory bowel disease patients (IBD), at 88%¹. With the symptoms described above, there is a wide range of treatment options depending on how the symptoms present. Ultimately though, the only conclusive treatment for diversion colitis is reversing the stoma or fistula, placing the patient back in continuum and restoring the flow of faecal stream. This allows the gut microbiome to rehabilitate and restore the segment^1,2. To read further on the gut microbiome, please refer to this blog.

The inflammatory response and associated symptoms of diversion colitis may cause one to suspect an infective cause however, inflammation and diversion colitis do not require antibiotics to treat. There are a range of treatments that involve different medicated enemas and rectal washouts with varying efficacy that are completed daily to control symptoms until continuity is restored². The goal of treatment is to reduce the symptoms by simulating restoration of bowel continuity and rehabilitating the out-of-circuit segment of bowel. Two treatments that have high success rates are irrigation with solutions containing dietary fibre, and autologous faecal transplantation².

• Irrigation with dietary fibre is a therapy where the rectal cavity is washed out with warm saline that has been mixed with fibre particles. The fibre is a source of energy for the remaining gut microbiome to ferment and form short chain fatty acids, in particular, Butyrate. Butyrate maintains the health of the intestinal mucosa luminal cells².
• Autologous faecal transplantation is the process where fluid is collected from the patient’s own ostomy appliance and installed in the out of circuit segment of the intestine².

Chyme reinfusion therapy is a form of autologous faecal transplantation and when performed with The Insides System, there is a high level of satisfaction from the user because the patient can perform the therapy at home and make it fit in with their lifestyle rather than being in hospital. Performing chyme reinfusion daily until the enterostomy or fistula is reversed may reduce the symptoms of diversion colitis and provide many other benefits for the patient. For further information on The Insides System and the benefits of chyme reinfusion therapy please read other short blogs here.

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Written by

Emma Ludlow

CNS Stomal Therapist

PG Dip. Stomal Therapy, MNurs (Hons)