I was recently informed that I have contracted shigella. I just had an attack that was extremely painful. How can I avoid the cramping, and what pain relievers or medication can I take to combat it? Also, how long will the bacteria remain in my system?

F.T.

Shigella is a bacterium that can infect the intestinal tract, mainly the colon, leading to painful abdominal cramps, fever and bloody diarrhea. Outbreaks of shigella can occur in areas of poor sanitation or in situations where people do not practice good personal hygiene.

Shigella infection, called shigellosis, is generally well-controlled with the appropriate antibiotics -- usually ampicillin, ciprofloxacin (Cipro) or Bactrim. If a doctor even suspects someone has shigellosis, he will often put the patient on antibiotics immediately because it can take several days to get confirmatory test results. It is also important that patients with shigella drink plenty of fluids because they run a risk of becoming dehydrated due to severe diarrhea.

As you mentioned, patients with shigella often suffer from severe abdominal cramps. This occurs because the bacterium causes severe damage to the inner lining of the colon, often resulting in ulcerations. It is these ulcers that produce the bleeding seen in the stool. Unfortunately, there is no specific therapy available to treat the cramping. Most doctors do not recommend taking anti-spasmodic drugs (such as Bentyl) because it slows down the colon's contractions, which theoretically could prolong the infection. In any case, cramping may linger for several weeks after all the shigella have been eradicated by the antibiotics. This may occur because the ulcers and other damage to the colon are often slow to heal.

In general, if you are being treated for shigellosis, it is a good idea to keep in close contact with your doctor to allow him to assess how you are doing.