Microscopic Colitis: Symptoms, Treatment


Microscopic colitis is an inflammation of the large intestine (colon) that leads to persistent watery diarrhea. As its name shows, a doctor must examine colon tissue under a microscope to identify it. If a doctor uses a colonoscopy or flexible sigmoidoscopy, the tissue may appear normal.

Microscopic colitis has several different subtypes, including:

  • Collagenous colitis: a thicker layer of protein develops in colon tissue.
  • Lymphocytic colitis: white blood cells increase in colon tissue.
  • Incomplete microscopic colitis: there are mixed features of collagenous colitis and lymphocytic colitis.

Collagenous colitis and lymphocytic colitis are believed to be different phases of the same condition. And all subtypes have the same symptoms, testing and treatment.


People with microscopic colitis may have symptoms such as:

  • Chronic watery diarrhea
  • Abdominal pain, cramps or bloating
  • Weight loss
  • Nausea
  • Fecal incontinence
  • Dehydration

These symptoms may come and go frequently. Moreover, they may sometimes resolve on their own.


The exact cause of this disease is still unknown. But the following causes are considered to play a role in the development of microscopic colitis:

  • Medications
  • Bacteria
  • Viruses
  • Autoimmune disease
  • Bile acid

Risk factors

The following risk factors can increase your risk of having microscopic colitis:

  • Age. People aging 50 to 70 are most likely to develop microscopic colitis.
  • Sex. Microscopic colitis is more common in women than in men.
  • Genetic link. According to some researches, microscopic colitis is associated with a family history of irritable bowel syndrome.
  • Smoking. Studies have shown that microscopic colitis has relation to tobacco smoking, especially in people aging 16 to 44.

Besides, there are links between certain medications and microscopic colitis though whether medications cause this disease has not been confirmed. These medications include:

  • Pain reliever, such as aspirin, ibuprofen
  • Proton pump inhibitors, such as lansoprazole, esomeprazole, pantoprazole
  • Selective serotonin reuptake inhibitors (SSRIs) such as sertraline (Zoloft)
  • Acarbose (Precose)
  • Flutamide
  • Ranitidine (Zantac)
  • Carbamazepine (Carbatrol, Tegretol)
  • Clozapine (Clozaril, Fazaclo)
  • Entacapone (Comtan)
  • Paroxetine (Paxil, Pexeva)
  • Simvastatin (Zocor)
  • Topiramate


Your doctor will determine whether your diarrhea is caused by other conditions with a complete medical history and physical examination. Since taking certain medications will increase your risk, the doctor will also ask about the medications you are using. In order to make a diagnosis, one or more of the following tests may be ordered:

  • Colonoscopy
  • Flexible sigmoidoscopy

Considering that intestinal tissues may appear normal, your doctor need to obtain a colon tissue sample during a colonoscopy or flexible sigmoidoscopy and examine cells in it under the microscope. Its distinct appearance under the microscope can help confirm the diagnosis.

Other tests that can help rule out other causes include:

  • Stool sample analysis
  • Blood test
  • Upper endoscopy with biopsy


Diet and discontinuation of medication

Treatment for microscopic colitis often starts with changes in diet and medications. You may be recommended to:

  • Eat a low-fat, low-fiber diet
  • Discontinue dairy products, gluten or both
  • Avoid caffeine and sugar
  • Discontinue any medication that might be a cause of your symptoms


If changes in diet and medications cannot improve your condition, the following medications should be considered:


Surgery is rarely necessary for microscopic colitis. But if medications cannot treat the condition, you may need a surgery to remove all or part of your colon.

Keyword: microscopic colitis.

* The Content is not intended to be a substitute for professional medical advice, diagnosis, or treatment. Always seek the advice of your physician or other qualified health provider with any questions you may have regarding a medical condition.