17227 Microscopic Colitis

Overview

Microscopic colitis is a type of inflammation in the large bowel (colon) that can only be seen under a microscope. It causes long-lasting watery diarrhea and other tummy symptoms, but it is not the same as inflammatory bowel disease (IBD) like Crohn's disease or ulcerative colitis.

It is not as common as other bowel conditions, but it is diagnosed more often now because doctors are more aware of it. It is still considered a relatively rare condition, though some people may have it without knowing.

It is more common in older adults, especially women over the age of 50. It can affect younger people too, but this is less typical. People with certain autoimmune conditions may also be at higher risk.

Symptoms

Common symptoms

• Chronic, watery diarrhea that can come and go or be constant
• A sudden, strong urge to use the toilet
• Abdominal pain or cramping
• Feeling bloated or gassy
• Weight loss without trying
• Feeling tired or weak, sometimes from losing too much fluid

Symptoms in children

• Microscopic colitis is rare in children, but if it happens, symptoms may include ongoing watery diarrhea, belly pain, and poor weight gain.
• Children may also have trouble controlling their bowel movements, which can be very distressing.

Symptoms in older adults

• Older adults may be more likely to become dehydrated from diarrhea, which can lead to dizziness, confusion, or falls.
• They may also have other health conditions or take medicines that make symptoms worse, so it is especially important to seek medical advice.

Causes

Main causes

• The exact cause is unknown, but it likely involves an abnormal immune reaction in the lining of the colon.
• Some medicines, such as certain pain relievers (NSAIDs), stomach acid reducers, or antidepressants, may trigger the condition in some people.
• It may also be linked to autoimmune conditions, where the body's immune system mistakenly attacks its own tissues.

Risk factors

• Being over 50 years old
• Being female
• Having an autoimmune disease, such as celiac disease, rheumatoid arthritis, or thyroid problems
• Taking medicines like NSAIDs, proton pump inhibitors, or selective serotonin reuptake inhibitors (SSRIs)
• Smoking

When to see a doctor

See a doctor urgently if:

• If you have diarrhea that lasts more than a week, especially with abdominal pain or weight loss
• If you see blood in your stool or black, tarry stools
• If you feel very lightheaded, confused, or have fainted — these can be signs of dehydration

Book a routine appointment if:

• If you have ongoing watery diarrhea that comes and goes, even if it is not severe
• If you have been taking a medicine that might be causing your symptoms and you are not sure what to do

Diagnosis

To diagnose microscopic colitis, a doctor will review your symptoms, do a physical exam, and usually arrange tests. The most reliable way to diagnose it is with a colonoscopy, which lets the doctor see the inside of your bowel and take small tissue samples (biopsies) to examine under a microscope.

Tests that may be done

• Stool tests to rule out infections or other causes of diarrhea
• Blood tests to check for inflammation or signs of other conditions
• A colonoscopy with biopsy, where a thin, flexible tube with a tiny camera is passed into your bowel to collect tissue samples

What to expect at your appointment

A colonoscopy can sound uncomfortable, but you will be given medicine to help you relax or sleep, so you should not feel pain. It usually takes about 30 minutes, and you can go home the same day. The biopsy results take a few days, and your doctor will explain what they mean and discuss next steps.

Treatment

Treatment for microscopic colitis focuses on reducing inflammation in the colon and managing symptoms. The approach depends on how severe your symptoms are and what may be triggering them. Your doctor will work with you to find the safest and most effective plan.

Self-care at home

• Stay well-hydrated by sipping water throughout the day, and consider oral rehydration solutions if you have had a lot of diarrhea
• Keep a food diary to identify foods that seem to make your symptoms worse
• Eat smaller, more frequent meals instead of large ones
• Avoid caffeine, alcohol, and very spicy or fatty foods if they seem to trigger your symptoms
• Manage stress with relaxation techniques, gentle exercise, or talking to someone you trust

Medical treatments

Your doctor may suggest stopping any medicine that could be contributing, but only if it is safe to do so. They may also prescribe a type of steroid that acts mainly in the bowel to reduce inflammation. In some cases, other medicines that calm the immune system or treat diarrhea may be used. You should always take prescribed medicines exactly as directed, and never change or stop a medicine without talking to your doctor.

When is surgery considered?

Surgery is very rarely needed for microscopic colitis. It is only considered if symptoms are extremely severe and do not respond to any other treatment. Your doctor would discuss all options and refer you to a specialist if needed.

Living with this condition

Living with microscopic colitis can be challenging, especially when diarrhea comes suddenly. Knowing where toilets are when you go out, carrying a small supplies kit, and planning your day around your symptoms can help you feel more in control.

Lifestyle tips

• Drink plenty of fluids to avoid dehydration
• Build a simple, consistent routine for meals and medication
• Stay active, but choose low-impact activities that you enjoy, like walking or swimming
• Avoid smoking, as it may worsen symptoms
• Talk to your employer or school about needing flexible access to a toilet if symptoms affect your daily activities

Diet and exercise

There is no one-size-fits-all diet for microscopic colitis, but many people find that a low-fat, low-fiber diet during flare-ups helps. Cooked fruits and vegetables may be easier to digest than raw ones. Regular exercise, like walking, can improve your mood and support digestion, but listen to your body and rest when you need to.

Mental health and emotional wellbeing

Living with constant diarrhea can be embarrassing and stressful. It is normal to feel anxious, frustrated, or down. Remember that your condition is not your fault, and it is okay to ask for help. Speaking to a counselor or joining a support group can make a real difference.

Prevention

There is no known way to prevent microscopic colitis, because the exact cause is not fully understood. However, you may be able to reduce flare-ups by avoiding known triggers, such as certain medicines (only under your doctor's guidance) or cigarettes. If a medicine is causing your symptoms, your doctor can help you find a safer alternative.

Complications

If left untreated

• Chronic diarrhea can lead to dehydration and electrolyte imbalances, which can make you feel weak, dizzy, or confused
• Ongoing inflammation may cause difficulty absorbing nutrients, leading to weight loss or vitamin deficiencies
• Although rare, severe diarrhea can affect kidney function if it is not managed

Long-term outlook

With the right treatment and support, most people with microscopic colitis see significant improvement or even complete resolution of symptoms. It is not a cancer-causing condition, and it does not usually lead to serious long-term damage. Many people learn to manage their condition well and live full, active lives.

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