What is microscopic colitis and could you have it?

Microscopic colitis is an inflammatory bowel disease (IBD). However, unlike the two main types of IBD, Crohn’s disease and ulcerative colitis, which can cause serious medical complications if not managed appropriately, microscopic colitis is benign. This means it’s not directly associated with serious and potentially life-threatening complications – but this does not diminish the severity of symptoms and the impact they can have.

Unfortunately, microscopic colitis has a high rate of misdiagnosis due to the complex way the condition is detected.

Unlike other inflammatory bowel diseases, microscopic colitis cannot be seen on a camera and requires a tissue sample to be taken from the bowel and examined under a microscope. This step is not always completed, so many cases go undiagnosed.

Most people with the condition can be easily treated with a course of gut-specific steroids or with symptom-relieving medicines but getting a diagnosis is the first, essential step.

Julie Harrington, Guts UK

Experts have also suggested that people aren’t seeking help for symptoms because they are embarrassed or, if they do, they’re often misdiagnosed with irritable bowel syndrome (IBS).

What are the symptoms of microscopic colitis?

Symptoms can be similar to other gut conditions, such as IBS (which is not a form of IBD but can also cause wide-ranging and sometimes severe digestive issues). However, microscopic colitis does have some telltale characteristics that set it apart.

“One of the key things is the watery severity of diarrhoea,” said Dr Sunny Raju, Academic Clinical Fellow in Gastroenterology and clinical researcher at the Sheffield Teaching Hospitals NHS Foundation Trust. “People could sometimes be going up to 20 or 30 times a day [although for some it might be more like four to 10 times a day]. Also, people will have nocturnal symptoms, so they’ll wake up in the night needing to open their bowels.”

Another key thing, said Dr Raju, is that flare-ups can be unpredictable, with no clear patterns of any triggers. Anxiety around incontinence or not reaching a toilet in time is a big thing too, and some people may experience being caught short. Fatigue, nausea, stomach cramps and weight loss can also occur, and people tend to experience ‘flare-ups’ alongside calmer phases.

What impact can microscopic colitis have on people?

Whether your diarrhoea is five times a day or 25, the impact can be hugely debilitating. “People won’t have much notice that they need to open their bowels, so they might say, ‘When I have a flare, I don’t leave the house, I can’t take public transport’,” said Dr Raju. This can impact greatly on people’s work, social lives and relationships, as well as their general emotional wellbeing and self-esteem, and their enjoyment of life and getting out and about.

What causes microscopic colitis and who gets it?

It occurs in males and females of all ages, but women are more likely to be affected and it mostly presents later in adulthood. People with coeliac disease and other autoimmune diseases are also more likely to develop microscopic colitis.

As Dr Raju pointed out, it’s not fully understood what causes it: “We suspect it might be an interplay between the microbiome – the bugs/bacteria in the bowel – and maybe genetic factors and immunological factors.”

There are also associations with certain medications, which doesn’t mean these medications necessarily cause microscopic colitis, but may trigger flare-ups in some people. This includes “medications such as PPIs (proton pump inhibitors), SSRIs (selective serotonin reuptake inhibitors), NSAIDS such as ibuprofen and some statins. In some patients, when they stop these medications, the diarrhoea stops too,” said Dr Raju. “Having said that, obviously you can’t just stop those medications without speaking to your doctor first. It’s also seen a bit sooner in smokers.”

How is microscopic colitis diagnosed?

It can only be diagnosed with biopsies, taken during a colonoscopy. Dr Raju said there are no ‘markers’ that will show up in stool samples and blood tests, plus a colonoscopy alone is not sufficient because “the bowel looks normal to the naked eye”.

How do you treat microscopic colitis?

A previous study has shown that one-in-three patients with the condition were initially diagnosed with irritable bowel syndrome.

“It’s terribly sad that thousands of people are suffering with the debilitating symptoms of microscopic colitis,” said Julie Harrington, chief executive of Guts UK.

“Most people with the condition can be easily treated with a course of gut-specific steroids or with symptom-relieving medicines, but getting a diagnosis is the first, essential step.

“People living with the condition – but without the benefit of a correct diagnosis and effective treatments – can often feel very isolated due to the urgent nature of their symptoms and their need to be near to toilet facilities at all times.

“We know this can also have a detrimental effect on their mental wellbeing.

“The rates of microscopic colitis are increasing and are likely to grow further as the population ages, so it’s crucial that we identify risk factors, provide specific training for healthcare providers, continue to raise awareness and invest in research to improve diagnosis and treatments.”

It’s not clear why cases of the condition are on the increase but it is likely to be due to a mixture of increased awareness of symptoms leading to more diagnoses and environmental factors such as a potential side-effect of common prescription drugs

Chris Probert, University of Liverpool

Chris Probert, professor of gastroenterology at the University of Liverpool, added: “Undiagnosed microscopic colitis can cause years of unnecessary suffering.

“The diarrhoea symptoms tend to be very severe and house limiting, leading to considerable distress for patients.

“It’s not clear why cases of the condition are on the increase, but it is likely to be due to a mixture of increased awareness of symptoms leading to more diagnoses and environmental factors, such as a potential side-effect of common prescription drugs, such as some antidepressants.

“The good news is that effective treatments are available, so people experiencing symptoms could benefit enormously by talking with their GP.”

Have you heard of microscopic colitis? Do you experience any similar symptoms? Let us know in the comments section below.

Also read: Seven common IBS triggers that aren’t food

– With PA