From the Research
Management of right-sided colitis in a young female with constipation requires a comprehensive approach focusing on diagnosis and targeted treatment, with the most recent evidence suggesting a combination of oral mesalamine and osmotic laxatives as the first-line treatment. Initial evaluation should include a colonoscopy with biopsies to confirm the diagnosis and determine the extent and severity of inflammation, as recommended by 1. Laboratory tests including complete blood count, C-reactive protein, fecal calprotectin, and stool studies to rule out infectious causes are essential.
For mild to moderate right-sided colitis, first-line treatment typically includes oral mesalamine at 2.4-4.8g daily, which delivers anti-inflammatory effects directly to the colon. For constipation symptoms, a combination approach is recommended:
- increase dietary fiber (25-30g daily)
- ensure adequate hydration (2-3 liters daily)
- consider osmotic laxatives like polyethylene glycol (17g daily), as constipation has been identified as a risk factor for ischemic colitis in young and middle-aged adults 2. Avoid stimulant laxatives long-term as they may worsen inflammation. If symptoms persist, adding budesonide 9mg daily for 8 weeks can help control inflammation while minimizing systemic steroid effects.
For moderate to severe disease, consultation with gastroenterology for consideration of immunomodulators (azathioprine, 6-mercaptopurine) or biologics may be necessary, as outlined in 3. Regular follow-up every 3-6 months is important to monitor disease activity and treatment response. Patient education about avoiding NSAIDs and recognizing flare symptoms is crucial. This approach addresses both the inflammatory bowel component and constipation symptoms while minimizing medication side effects. It is also important to consider the potential risks of ischemic colitis, particularly in young and middle-aged adults with constipation or taking calcium channel antagonists, as highlighted in 2.