C. Diff: Signs and Symptoms

Clostridiodes difficile or C. diff is a bacteria that can cause diarrhea and colon inflammation (colitis). Because watery diarrhea is the primary symptom, C. diff can closely resemble other viral diarrhea causes, which may make the condition hard to diagnose. Half a million people in the United States experience C. diff infections each year with those ages 65 and older experiencing the most severe and potentially deadly complications from the infection.

Most of the time, C. diff occurs when you are taking (or recently finished taking) antibiotic medications, such as penicillins, cephalosporins, or clindamycin. These medicines may destroy healthy bacteria in your intestines that keep C. diff bacteria from multiplying.

Common Symptoms

Some people may have C. diff bacteria present in their intestines and have no symptoms. For example, an estimated 20% of hospitalized people have asymptomatic C. diff infections.

Those who do have symptoms may find they closely resemble those of a stomach virus. The most common C. diff infection symptom is watery diarrhea with more than three bowel movements in a 24-hour period. Other common C. diff infection symptoms include:

• Abdominal tenderness
• Lower abdominal pain
• Appetite loss
• Low-grade fever
• Nausea
• Stomach cramping

Typically, you will have these symptoms about two weeks after stopping antibiotic medications. Important to note is C. diff infections do not usually cause significant intestinal bleeding. If you see blood in your stool, the blood may be related to another condition.

Less Common Symptoms

Some people may experience C. diff infections that progress to severe and complicated symptoms. These symptoms are the results of severe loss of fluid, progressive infection, and abnormal muscle contractions in the intestines.

Examples of less common but severe symptoms include:

• Dehydration
• Dizziness
• Electrolyte imbalances which can affect your heart rate
• Extreme fatigue
• Fever
• Severe abdominal pain, usually in the lower right or lower left parts of the stomach
• Stomach that feels hard and painful to the touch

These symptoms can indicate emergency medical events, such as an ileus, which is when your intestines aren't moving so stool cannot pass. You are at risk for bowel perforation (tearing of your intestinal lining) if this occurs.

Rare Symptoms

Sometimes C. diff infections cause unusual symptoms outside stomach-related complaints that a healthcare provider may not initially recognize as being related to C. diff bacteria. Examples of these symptoms include:

• Appendicitis
• Cellulitis, a serious and painful skin infection
• Joint pain and swelling
• Swelling of the hands and feet

Again, these symptoms rarely occur in relation to C. diff infections.

Symptoms in Children

Infections with C. diff occur less frequently in children than they do in adults. Children also tend to have fewer severe complications compared to adults.

Newborns and children younger than age 2 may have C. diff bacteria present in their digestive tract, but they don't seem to experience the same severe side effects or symptoms as adults can. An estimated 12 to 30% of children with C. diff will experience recurrent C. diff infections.

When children do experience C. diff symptoms, their most common symptom is mild to moderate diarrhea that is frequent and watery. Other C. diff symptoms in children include:

• Fever
• Lower abdominal cramping
• Vomiting
• Blood visible in the diarrhea

In very rare instances, children with C. diff can experience pseudomembranous colitis, a condition characterized by severe inflammation of the inner lining of the large intestine, and other severe symptoms associated with C. diff infections.

When to See a Healthcare Provider

Seek emergency medical attention if you have a fever greater than 103 degrees, severe abdominal pain, or if your abdomen feels hard to the touch. These could indicate a severe infection and possibly bowel perforation.

A case of C. diff can be most serious for older adults and shouldn't be ignored. If you've been taking antibiotics recently and experience diarrhea that does not go away or get better after two to three days, you should see a healthcare provider.

If you have recently had a C. diff infection and experience similar symptoms again, see your healthcare provider. C. diff infections recur in about one in six people, usually within 2-8 weeks after first having the condition. Your healthcare provider may recommend alternate treatments if you have recurring C. diff infections.

A Quick Review

C. diff infections can cause symptoms that range from mild diarrhea to severe and life-threatening bowel perforation. If you have recently taken antibiotics, you may be at an increased risk for C. diff. Fortunately, C. diff is treatable. Treatments include antibiotics that specifically target the C. diff bacteria and fecal transplant for infections that keep coming back.