Overview
Microscopic colitis is an inflammation of the large intestine (colon) that causes persistent watery diarrhea. The disorder gets its name from the fact that it's necessary to examine colon tissue under a microscope to identify it, as the tissue may appear normal with a colonoscopy or flexible sigmoidoscopy. There are different subtypes of microscopic colitis, including collagenous colitis, lymphocytic colitis, and incomplete microscopic colitis. Symptoms include chronic watery diarrhea, abdominal pain, cramps, bloating, weight loss, nausea, fecal incontinence, and dehydration. The exact cause of microscopic colitis is not clear, but it may be related to medications, bacteria, viruses, autoimmune diseases, or bile acid malabsorption. Risk factors include age, sex, autoimmune diseases, and a family history of irritable bowel syndrome.
Understanding the disease
Symptoms
The symptoms of microscopic colitis include chronic watery diarrhea, abdominal pain, cramps, or bloating, weight loss, nausea, fecal incontinence, and dehydration. Symptoms can come and go frequently, and sometimes they resolve on their own. It is recommended to contact your doctor if you have watery diarrhea that lasts for more than a few days.
Risk Factors
Risk factors for microscopic colitis include:
- Age: Microscopic colitis is most common in people ages 50 to 70.
- Sex: Women are more likely to have microscopic colitis than men. Some studies suggest an association between post-menopausal hormone therapy and microscopic colitis.
- Autoimmune disease: People with microscopic colitis sometimes also have an autoimmune disorder, such as celiac disease, thyroid disease, rheumatoid arthritis, type 1 diabetes, or psoriasis.
- Genetic link: Research suggests that there may be a connection between microscopic colitis and a family history of irritable bowel syndrome.
- Smoking: Recent research studies have shown an association between tobacco smoking and microscopic colitis, especially in people ages 16 to 44.
- Medications: Certain medications may increase your risk of microscopic colitis. These include pain relievers, proton pump inhibitors, selective serotonin reuptake inhibitors (SSRIs), acarbose, flutamide, ranitidine, carbamazepine, clozapine, and entacapone. However, not all studies agree on this association.
Development
Microscopic colitis is considered an inflammation of the large intestine (colon), causing persistent watery diarrhea. It is identified by examining colon tissue under a microscope, as the tissue may appear normal during colonoscopies or flexible sigmoidoscopies. There are different subtypes of microscopic colitis, including collagenous colitis, lymphocytic colitis, and incomplete microscopic colitis. Researchers believe collagenous colitis and lymphocytic colitis may be different phases of the same condition. The exact cause of microscopic colitis is not clear, but it may be related to medications, bacteria, viruses, and autoimmune diseases. Certain medications, such as pain relievers, proton pump inhibitors, and selective serotonin reuptake inhibitors, have been linked to the development of microscopic colitis. Additionally, smoking has been associated with an increased risk of microscopic colitis, especially in people aged 16 to 44. It is important to note that genetic factors may also play a role in the development of microscopic colitis, as there seems to be a connection between the condition and a family history of irritable bowel syndrome. Overall, the development of microscopic colitis is thought to involve a combination of factors, including genetics, environmental triggers, and autoimmune diseases.
Assessment and Diagnosis
Triage
You should see a doctor if you have persistent watery diarrhea that lasts more than a few days, even if you suspect microscopic colitis. Early diagnosis and proper treatment are important to manage the symptoms and prevent complications such as dehydration.
Diagnosis
To diagnose microscopic colitis, a complete medical history and physical examination are conducted by a doctor. The doctor will ask about any medications the patient is taking, which may contribute to the diarrhea. Tests used to confirm a diagnosis of microscopic colitis include a colonoscopy or flexible sigmoidoscopy, where a tissue sample (biopsy) is taken from the colon to examine the intestinal lining under a microscope. These tests can reveal the distinct appearance of cells in colon tissue for a definite diagnosis. Other tests may be performed to rule out other causes of symptoms.
Management and Treatment
Complications
Dehydration, kidney failure, and complications related to severe diarrhea are potential complications of microscopic colitis. Severe diarrhea can lead to a significant loss of fluids and electrolytes, making it difficult for the body to function and potentially causing blood pressure to drop to dangerously low levels. In some cases, dehydration can occur so quickly that kidney function rapidly deteriorates, causing kidney failure. Prompt diagnosis and treatment are important to prevent these complications.
Treatment
Treatments for microscopic colitis may vary, but typically involve managing symptoms and addressing any underlying causes. The following treatments may be recommended:
- Medications: Your doctor may prescribe medications to reduce inflammation and alleviate symptoms. Some medications that may be used to treat microscopic colitis include corticosteroids, such as prednisone, and aminosalicylates, such as mesalamine or sulfasalazine.
- Lifestyle changes: Making certain lifestyle changes may help alleviate symptoms. These may include avoiding trigger foods, managing stress, and practicing good hygiene to prevent infection.
- Anti-diarrheal medications: Over-the-counter anti-diarrheal medications may be recommended to help manage diarrhea symptoms. However, it's essential to consult with your doctor before using these medications, as they may not be suitable for everyone.
- Dietary modifications: Some individuals may benefit from specific dietary modifications, such as avoiding high-fat foods, raw fruits, and vegetables, which may worsen symptoms in some cases. It's important to note that the treatment for microscopic colitis may differ depending on the subtype of the disorder and the severity of the symptoms. Consult with your healthcare professional for personalized advice and management.
Preparing for medical consultation
To prepare for an appointment for microscopic colitis, follow these steps:
- Make a list of your symptoms, including when they started and how they have changed or worsened over time.
- Gather information about your medications, vitamins, or supplements, and any other medical conditions you have.
- Note down any recent life changes, stressors, or significant events that may be relevant.
- Consider your diet and any foods that may be aggravating your symptoms, and be prepared to discuss them with your doctor.
- Prepare a list of questions to ask your doctor, such as the cause of your condition, potential treatments, dietary restrictions, and any other concerns you may have. Remember to be open and honest with your doctor about your symptoms and medical history, and don't hesitate to ask questions if there's anything you don't understand.