Microscopic Colitis

Microscopic colitis is an inflammatory bowel condition that causes chronic, watery diarrhoea. The bowel often looks normal during colonoscopy, so the diagnosis relies on biopsies examined under a microscope. There are two main types: lymphocytic colitis and collagenous colitis.

At The New Foscote Hospital, we offer consultant assessment and onsite colonoscopy with targeted and random biopsies, followed by a personalised treatment plan and clear follow-up.

Endoscopy – Colonoscopy
Meet Our Consultants

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Symptoms

• Watery diarrhoea, often several times a day
• Urgency and sometimes nocturnal bowel motions
• Abdominal cramps, bloating and wind
• Fatigue; occasional weight loss
• Symptoms may wax and wane over weeks to months

Seek urgent medical help if you develop severe dehydration, blood in stool, fever, or marked abdominal pain.

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Causes And Risk Factors

Microscopic colitis is likely immune-mediated and can be linked with:

• Certain medications (e.g., NSAIDs, PPIs, SSRIs/SNRIs; discuss changes only with your prescriber)
• Smoking
• Associated autoimmune conditions (e.g., coeliac disease, thyroid disease)
• Female sex and age over 50, though it can occur earlier

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Diagnosis At New Foscote Hospital

Your consultant will take a focused history and may recommend:

• Onsite colonoscopy with multiple biopsies throughout the colon (appearance may be normal)
• Blood tests (inflammation, thyroid, coeliac screen)
• Stool tests (exclude infection; faecal calprotectin as indicated)

Biopsy results distinguish lymphocytic from collagenous colitis and guide treatment.

Imaging & Diagnostics
Endoscopy – Colonoscopy

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Treatment

Your plan is tailored to symptom severity, biopsy type and any triggers:

• Medication review: consider alternatives if a likely drug trigger is identified (with the prescribing clinician)
• Budesonide (topical steroid acting in the bowel) is often first-line for inducing remission
• Anti-diarrhoeals (e.g., loperamide) for symptom control when appropriate
• Bile-acid binders if bile-acid malabsorption is suspected
• Bismuth (selected cases) or immunomodulators for refractory disease (specialist-led)
• Dietary advice: hydration, limit caffeine/alcohol for flares; consider coeliac testing and gluten-free diet only if coeliac disease is confirmed

Most people respond well; relapses can occur but usually respond to another short course of budesonide or maintenance plans set by your specialist.

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Recovery And Follow-Up

• Symptom improvement often occurs within days to weeks of starting treatment
• Ongoing review to titrate medication and address triggers
• Routine cancer surveillance is not usually required solely for microscopic colitis; your consultant will advise if follow-up colonoscopy is needed for other reasons

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When To Seek Specialist Help

Book an assessment if you have:

• Watery diarrhoea for more than 3–4 weeks
• Nocturnal diarrhoea, urgency or accidents
• Symptoms that do not improve with initial measures
• Unexplained weight loss or iron-deficiency anaemia

Early diagnosis brings faster relief and reduces the impact on work and daily life.