Microscopic Colitis is one of the lesser known inflammatory bowel diseases. It affects the large bowel which is the last part of the bowel made up of the colon and the rectum. It is called microscopic because changes to the bowel cannot be seen with the naked eye but only when a sample of tissue is looked at under a microscope.
There are two different types:
Some doctors and scientists believe that these different types could just be different stages of the disease, although they are often found in the same person at the same time.
As these two different types have the same symptoms and treatment they are usually lumped together under the same name of microscopic colitis.
You may be reading this page because you have been given a diagnosis and want more information or because you have chronic diarrhea and are looking for answers.
DiarrheaNurse.com is always looking to provide answers for people who are suffering with this horrible symptom. Please read on to find out the answer to the question ' what is microscopic colitis ?' and find out more about this not very well known disorder.
Unfortunately at present the cause of microscopic colitis is unknown but there are several theories. Some of these ideas are listed below and one of them may be correct or there could be a combination of reasons.
It is estimated that about 2 per 10,000 people in the US have microscopic colitis but the exact number is not known. It it also thought that 20-30% of cases of chronic diarrhea have this cause. These factors will make you more at risk:
The main symptom is chronic diarrhea which is watery, usually comes on suddenly and can be explosive. You will not see any blood which is common in other inflammatory bowel diseases.
One of the characteristics of this disorder is that you can be diarrhea free for a period of time and then you will have what is termed a 'flare up'. This could last for days, weeks or even months. It is possible to have as many as 20 episodes of diarrhea a day during a flare up. This will mean that you are at great risk of dehydration and in severe cases may need fluid replacement therapy in a hospital. Other symptoms you may have are:
It is quite common for this condition to be misdiagnosed as irritable bowel syndrome but one of the main differences is that with this disorder diarrhea and fecal incontinence often happens at night which is never the case with IBS.
The only way to diagnose this form of colitis is to take a biopsy of the intestinal tissue and look at it under a microscope. If your symptoms are suggestive of microscopic colitis then you should be referred to a gastroenterologist who will have a look inside your colon with a colonoscopy which is a flexible tube with a light and a camera on the end.
If the lining of the bowel looks normal then this would rule out other inflammatory bowel diseases and the gastroenterologist may suspect microscopic colitis and should take several biopsies. More than one biopsy is needed as the disease is patchy.
The good news is that some people recover spontaneously and no microscopic colitis treatment is required. Many people also find that their symptoms lessen over time and they can cope well by using anti-diarrheal medications such as loperamide hydrochloride (Imodium) occasionally.
If you are taking one or more of the implicated medications mentioned above then in consultation with your doctor these should be changed or the dosage reduced. Giving up smoking may also help.
There is no definite cure but if the symptoms do not become manageable or clear up completely with time as they do for many people then there are other microscopic colitis treatment options.
The steroid budesonide (Entocort) has been found to be effective and it has fewer side effects than other steroids.
Other medications which may help are antibiotics, anti-inflammatories and bile acid blockers.
For difficult cases that are not responding to treatment newer drugs can be tried such as:
These drugs are only used in difficult cases as they carry risks with their side effects.
In very rare cases surgery is needed and a part of the colon may be removed but this is extremely unlikely.
There is no specific recommended microscopic colitis diet but some people find that their diarrhea is worse if they eat certain foods. Some people react to caffeine and artificial sweeteners, others to spicy or fatty foods and others to dairy products.
You should keep a food diary and see if your diarrhea is worse when you eat or drink certain things. Do not cut out whole food groups however as this could be dangerous and always see a doctor or dietitian before making radical changes to your diet.
It is very important to drink plenty of fluids to prevent dehydration when you have a flare up.
There is no evidence that people with this disorder are more at risk of colon cancer.
In most cases the outlook is very good. Most people go on to make a full recovery or to have mild symptoms which are managed with medication.
Chronic diarrhea is a very difficult and life disrupting thing to live with. DiarrheaNurse.com hopes that you find some answers to your problem. It is important to see a doctor and have some tests done to discover exactly what is going on, as there are many different things that can cause this distressing symptom not just microscopic colitis.
For more information about other inflammatory bowel diseases please see the information below.
You are plagued with gut symptoms; is it ulcerative colitis?
Are you exhausted in pain and have to keep running to the bathroom? It could be Crohn's.
Get an overview here of the different diseases that cause inflammation of the bowel and other symptoms.