Microscopic Colitis

Microscopic colitis (MC) is an inflammatory disease that causes frequent, watery diarrhea. It can be hard to diagnose because imaging tests often look normal unless your provider analyzes tissue samples from your colon.

“Colitis” refers to inflammation of the inner lining of your colon (large intestine). It’s called “microscopic” because it can only be seen under a microscope.

If you have microscopic colitis, the cells in your intestinal lining are irritated. Microscopic colitis may come and go. It may flare up in reaction to certain triggers, then subside on its own, and then return. While it’s a lifelong condition, it’s usually manageable with medication and by avoiding certain foods.

Types of microscopic colitis

Healthcare providers diagnose microscopic colitis by looking at a sample of your colon tissue under a microscope. When they do, they’ll recognize certain features in the cells. Different features suggest different types of the disease. There are two main types:

1. Collagenous colitis: Collagen and elastin make up the connective tissue of your colon lining. With this type of MC, collagen bands under the surface lining of your colon are thicker than usual.
2. Lymphocytic colitis: The surface layer of your colon lining has a high level of white blood cells. The layer of collagen under the surface is normal or only slightly thicker than usual.

These two variations of microscopic colitis have the same symptoms and treatment. Their differences only appear under the microscope.

Symptoms of microscopic colitis

The main symptom of microscopic colitis is having watery diarrhea around five to 10 times per day.

Other common symptoms include:

• Abdominal pain and cramping
• Abdominal distension and bloating
• Urgency to poop and trouble holding poop in
• Noisy digestive system

Microscopic colitis causes

Scientists aren’t exactly sure what causes microscopic colitis. But they suspect it may involve the following factors:

• Exposure to certain bacteria, toxins or viruses
• Immune system dysfunction (autoimmune disease)
• Genetics

Some research suggests that certain medications may contribute to the problem, including:

• Nonsteroidal anti-inflammatory drugs (NSAIDs)
• Proton pump inhibitors (PPIs)
• Selective serotonin reuptake inhibitors (SSRIs)
• Hormone replacement therapy (HRT)
• Beta-blockers
• Statins

Can stress trigger microscopic colitis?

There’s some evidence that anxiety and depression can trigger colitis symptoms. Stress can impact your hormone levels and activate your fight-or-flight response, which can affect your digestive system. Your brain and your gut use many of the same neurotransmitters.

Risk factors for microscopic colitis

Anyone can get it, but it’s more common in people who:

• Are females over 60
• Have autoimmune diseases(especially celiac disease)
• Smoke

Complications of microscopic colitis

MC doesn’t usually cause serious complications. But persistent diarrhea could lead to dehydration, weight loss or malnutrition.

How doctors diagnose microscopic colitis

A gastroenterologist diagnoses the condition. They can only diagnose microscopic colitis after they take and analyze a tissue sample from your colon. This usually comes during a colonoscopy and biopsy.

They may also order blood tests, stool tests or imaging tests, depending on your symptoms.

What is the treatment for microscopic colitis?

Treatment can vary depending on your symptoms and how severe they are. They range from food and lifestyle changes to over-the-counter and prescription medications. Symptoms may flare up and then go away on their own. You may be able to manage your symptoms with food changes alone, or you may need to use medication at times.

Common medications include:

• Bulking agents, such as psyllium, to make your poop more solid
• Anti-diarrheals like loperamide or diphenoxylate to slow down your poop
• Bismuth subsalicylate (Pepto Bismol^®) for diarrhea
• Budesonide, a corticosteroid that reduces inflammation

Other recommendations for treatment could involve:

• Adjusting your usual medications
• Quitting smoking
• Identifying any food intolerances

What kind of diet is helpful for microscopic colitis?

What you eat can play a role in managing your symptoms. Reducing foods that trigger your symptoms is usually one of the first recommendations your provider will give you. Your trigger foods will be specific to you, and identifying them can take some trial and error.

Some common food-related suggestions are:

• Eliminating triggers: Some of the most common trigger foods include alcohol, caffeine, gluten, dairy and sugar.
• Low fat and low fiber: To manage flare-ups, some healthcare providers recommend a gastrointestinal soft diet, which is made up of low-fat and low-fiber foods. Reducing fat and fiber in your diet gives your digestive system less work to do.
• Elimination diet: One way to isolate trigger foods is to try an elimination diet, such as the low-FODMAP diet. This short-term diet eliminates certain foods and then reintroduces them in a systematic way.
• Anti-inflammatory diet: Certain foods may reduce inflammation. The Mediterranean diet is a good example of a diet that promotes anti-inflammatory foods.

When should I see my healthcare provider?

Contact your provider if you have symptoms of microscopic colitis — frequent diarrhea and abdominal pain. They can examine you and determine if microscopic colitis is causing your symptoms.

Does microscopic colitis ever go away?

Not forever, but it may go away for a while. When it does, it’s called being in remission. Remission might last for months or years. But certain triggers can cause it to return. You can minimize these flare-ups by learning to recognize your triggers.

How long will my microscopic colitis flare-up last?

It’s different for everyone, but flare-ups typically last for days to weeks. Many people find that they can reduce their flare-ups by avoiding triggers or taking medication.