Microscopic Colitis – Causes, Symptoms And Treatment

What is Microscopic Colitis?

This condition is caused by severe inflammation of the bowel tissue and causes chronic diarrhea. It gets its name from how it is diagnosed, under a microscope. There currently is no standard blood test and most people see the doctor to check for this condition when diarrhea persists for a long period of time. It is most commonly seen in those who are middle-aged in both men and women equally.

Collagenous colitis is one of the types and shows increased collagen cells in the bowel tissue. Another type is Lymphocytic colitis and shows a large amount of WBC’s (White Blood Cells) in the bowel tissue. (See figure 1 below)Commonly, people who have microscopic colitis will think that they have Crohn’s Disease. This is untrue, so a visit to the physician can help to diagnose the proper form of colitis and ensure proper treatment.

Microscopic colitis is thought to be caused by auto-immune disorders, viruses, bacterial infections and various toxins. Steroid treatment and dietary changes can help calm the inflammation in the bowels. The good news this disease is treatable and manageable with proper medication and diet.

Microscopic Colitis pictures

Figure 1: Picture of Microscopic Colitis

Courtesy of Hopkins Gastroenterology

Causes of Microscopic Colitis

There are a number of theories behind the cause of microscopic colitis. Some researchers believe that certain bacteria or viruses irritate the lining of the colon and cause the inflammation. When viruses and bacteria are the cause, the condition is usually self-limiting and often temporary. Others believe that the immune system itself attacks the lining of the colon for no reason at all, otherwise known as “auto-immunity.” Lastly, this disease may be related to certain medications that are being taken including; non-steroidal anti-inflammatory medications, certain medications taken for stomach issues and cholesterol medications. When the cause is medication related, stopping the offending medication can usually resolve the condition. Still, the exact cause is unclear and prompt medical diagnosis and treatment can help to improve this condition regardless of the cause.

Microscopic Colitis Symptoms

The main symptom of microscopic colitis is watery diarrhea on a chronic and daily basis. It lasts longer than a normal case of bacterial or viral diarrhea, sometimes for decades of time. Some of the actual symptoms are outlined below:

  • Up to 10 watery stools daily
  • Abdominal Pain and Cramping
  • Joint Pain (Collagenous Colitis)
  • Weight Loss
  • Fatigue
  • Nausea
  • Incontinence of stools

Some sufferers claim they cannot even leave the house in the morning due to recurrent episodes of diarrhea. If necessary, some people have to return home to change clothes after leaving for work in the morning due to incontinence. Symptoms and severity differ from person to person, especially those with other underlying auto-immune diseases.

Treatment for Microscopic Colitis

It is highly recommended that patient’s with microscopic colitis first try modifying their diet before trying medications. Microscopic colitis may resolve with bowel rest, bland low-fat diet and avoidance of medications that irritate the bowels. Some patients may never experience colitis again, but some may experience some episodes in the future.

People who are unable to completely control their condition with diet and lifestyle changes may need supportive medications. These are usually the patients that have underlying auto-immune disorders such as; rheumatoid arthritis, Sjogren’s syndrome and Lupus. Medications given are aimed at suppressing the immune system response and include;

  • Corticosteroids (Prednisone, Budesonide)
  • Anti-Diarrheal medications (Immodium, Donnatal, Bismuth)
  • Colectomy (Removal of part of the colon) *Very Rarely done*

Bismuth has been found to be one of the most successful treatments for microscopic colitis. Patients need to stay on the treatment regimen for up to eight weeks, but the results were the most positive out of all the treatments for this disorder. Second, the steroid treatment has also been found very effective. Steroids do come with side-effects and most doctors are reluctant to use this as a first-line treatment. As with any condition, it is important to see your physician for proper diagnosis and treatment plan first.

Complications of Microscopic Colitis

The main complication of microscopic colitis is dehydration. Watery bowel movements deplete the body of needed fluids and electrolytes. People with this condition need to replenish fluids often, especially fluids that contain electrolytes. A Good high-quality sport drink containing sodium and potassium is usually efficient in replacing lost minerals.

The next complication is weight-loss. With several episodes of diarrhea daily, it is hard for the body to absorb the nutrition from foods eaten. People with microscopic colitis can lose anywhere from 5 to 35 pounds due to the condition. Adding in easily digestible high-calorie and nutrient dense foods can help maintain healthy weights. People with colitis can also add a nutritional shake a few times daily to supplement the diet.

This disease is usually pretty benign in most people and does not cause major complications. Very rarely, ulceration of the bowel can occur and even more rare, perforation of the bowel. With proper treatment and diet, this disease is usually very self-limiting and only a nuisance to the sufferer.


Microscopic colitis can be a very disruptive disease and require some lifestyle changes to assist in coping with chronic diarrhea. The good news is serious complications are rare and medications are only necessary in certain instances, such as auto-immune disease.

People who develop complications are usually those with other underlying health problems that worsen the effects of the colitis. It could also be a medication that is causing the colitis as a side-effect. For the most part, the complications are mild and can be avoided mainly through proper dietary modifications such as; increased fluids and low-fat non-spicy foods.

It is very important to see a physician as soon as possible if diarrhea persists. Proper diagnosis and management can help to relieve the annoying symptoms of this condition and prevent dehydration and weight loss. With the right care, people with colitis of any type can live normal and healthy lives.

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