Microscopic Colitis – Diagnosis and Treatment
Diagnosis
Laboratory and Visual Checks
Doctors use clinical exams and laboratory tests to check for microscopic colitis. Chronic watery diarrhea and abdominal pain often prompt further tests.
Doctors often perform a colonoscopy to see the inside of the large intestine with a flexible tube and camera. This tool helps them look for signs of inflammation, though the colon may look normal.
During the colonoscopy, doctors collect small tissue samples called biopsies from different areas of the colon. Examining these samples under a microscope helps identify types of microscopic colitis, such as lymphocytic colitis and collagenous colitis.
| Test | Purpose |
|---|---|
| Colonoscopy + Biopsy | To visualize the colon and collect samples for microscopic study |
| Flexible Sigmoidoscopy | A similar test, but looks at the last part of the large intestine |
Sometimes, doctors use a flexible sigmoidoscopy instead of a full colonoscopy. This test examines only the lower part of the colon but still allows for tissue sampling.
Doctors check the structure and number of certain cells, like lymphocytes or a thickened collagen band, to tell the difference between lymphocytic colitis (LC) and collagenous colitis (CC).
Additional Testing Options
Doctors use other tests to rule out different causes of chronic diarrhea. They may perform a stool analysis to look for infections that cause watery stools.
If infection is not the cause, doctors focus again on microscopic colitis. Blood tests can reveal problems like anemia or signs of celiac disease.
These blood tests help doctors see if symptoms are linked to other gut or immune issues. If celiac disease seems likely, doctors may do an upper endoscopy with a biopsy of the small intestine.
During this test, a camera examines the upper digestive system, and tissue samples are checked for inflammation. These steps help confirm microscopic colitis or find other reasons for symptoms like dehydration and fatigue.
Treatment
Adjusting Diet and Reviewing Medications
Doctors usually suggest simple lifestyle changes first. People are often told to eat low-fat, low-fiber foods for a short time to ease diarrhea.
Avoiding dairy, gluten, caffeine, and sugar can help, since these may trigger symptoms. Doctors also review medications that might cause problems.
They may ask patients to stop or switch drugs like proton pump inhibitors, NSAIDs such as ibuprofen, or SSRIs.
Quick tips:
- Choose simple, bland foods.
- Limit milk and cheese.
- Skip caffeinated drinks.
- Review all medicines with a healthcare provider.
Medicines to Help Symptoms
If diet changes are not enough, doctors prescribe medications. Common options include:
| Medicine Type | Purpose |
|---|---|
| Anti-diarrheal | Slow bowel movements |
| Steroid | Reduce inflammation |
| Bile acid binder | Bind bile acids, help diarrhea |
| Immune suppressor | Lower immune response |
| Biologic | Treat severe, long-lasting symptoms |
Surgery Options
Doctors rarely recommend surgery for microscopic colitis. They consider it only when symptoms are very severe and medications have failed.
In these cases, surgeons may remove part or all of the colon.
Everyday Tips for Managing at Home
Making small changes at home can help with microscopic colitis symptoms. People should drink more fluids, such as water or broths.
Drinks with added electrolytes, like watered-down fruit juice or special electrolyte products, are also helpful. Avoid drinks high in sugar, alcohol, caffeine, or sugar substitutes like sorbitol, as these may worsen diarrhea.
A list of gentle foods for the stomach includes:
- Applesauce
- Bananas
- Melons
- Rice
Limit high-fiber foods like beans, nuts, and raw or tough vegetables until symptoms improve. Eat only well-cooked vegetables.
When symptoms get better, slowly add fiber back under a doctor’s advice. Eating smaller meals more often can also help.
Avoid fried, fatty, spicy foods, or anything that has caused issues before. Sometimes, a gluten-free diet is tried, but this should be discussed with a doctor.
Getting Ready for Your Visit
Steps You Can Take Beforehand
Prepare for your appointment with a few steps:
Check for any restrictions. Some visits might require fasting or drinking only clear liquids.
Keep a symptom record. Write down when symptoms started, how often they happen, and what makes them better or worse.
List all medications and supplements. Include doses and how long you have used them. Remember to add vitamins and herbal products.
Gather your medical history. Note other health problems and any recent hospital stays.
Include lifestyle and diet details. Record any big changes, stressful events, and a summary of your daily diet, caffeine use, and alcohol intake.
Write down questions. Make a list of topics to discuss with your doctor.
A simple table can help you get organized:
| What to Prepare | Example |
|---|---|
| Symptoms | “Watery diarrhea, since Feb 10” |
| Medicines & Supplements | “Loperamide 2mg, daily” |
| Medical History | “Diabetes, admitted Dec 2024” |
| Diet & Lifestyle | “Coffee daily, no alcohol” |
| Recent Stress/Changes | “Moved homes last month” |
| Questions for Doctor | “Will this go away?” |
Good Topics to Discuss
Prepare a clear set of questions to make your visit more useful. Consider these topics:
- What could be causing my symptoms?
- Is this a short-term or long-term problem?
- Will I need certain tests, and what are they?
- What treatment options do you recommend?
- Could this relate to other health problems I have?
- Is surgery ever needed, and what does it involve?
- Are there foods or drinks I should avoid?
Ask for more details if something is unclear.
Information Your Health Provider May Request
Your doctor will ask for detailed information. Be ready to answer questions like:
When did the symptoms start?
Are symptoms constant or do they come and go?
How many times a day do you have loose stools?
Do you have other symptoms like stomach pain or nausea?
Have you noticed blood in your stool?
Have you lost weight?
Have you traveled recently, or has anyone at home been sick?
Have you had a hospital stay or taken antibiotics lately?
Do certain foods make symptoms worse?
What do you usually eat and drink, including caffeine and alcohol?
Do you have other health problems, such as celiac disease, diabetes, or thyroid issues?
Does anything make your symptoms better or worse?
Things You Can Try While Waiting for Your Visit
You can take steps to manage your symptoms until you see your healthcare provider. Choose bland and lower-fat foods to help reduce an upset stomach.
Avoid dairy, spicy foods, caffeine, and alcohol because these can make symptoms worse. Drink water and broth to stay hydrated.
