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What is microscopic colitis and could you have it?

By Abi Jackson
Are bouts of diarrhoea making your life difficult? While lots of things can cause digestive issues, thousands of people could be living with microscopic colitis – which is actually very treatable.

This Microscopic Colitis Awareness Week (April 12-17), the charity Guts UK is highlighting the lack of awareness around the condition – which is typically associated with severe watery diarrhoea, and mostly affects women in their 40-70s.

We might not talk about microscopic colitis much, but around 17,000 new cases are diagnosed each year in the UK, and many more could have the condition and not know it. It’s often diagnosed late, and one-in-three people diagnosed with microscopic colitis have previously been told they have IBS.

What is microscopic colitis?
Microscopic colitis is an inflammatory bowel disease (IBD). However, unlike other IBDs Crohn’s 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.

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

“One of the key things is the watery severity of diarrhoea,” says Dr Sunny Raju, Academic Clinical Fellow in Gastroenterology with a special interest in microscopic colitis MC at the Academic Unit of Gastroenterology, Sheffield University. “People could sometimes be going up to 20 or 30 times a day [although for some it might be more like 4-10 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, says 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’,” says Dr Raju. This can impact greatly on people’s work and 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. Just 25% of cases occur in under-45s, and most are diagnosed between ages 50-70. People with coeliac disease and other autoimmune diseases are also more likely to develop microscopic colitis.

As Dr Raju points 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 like PPIs (Proton pump inhibitors), SSRIs (Selective Serotonin Reuptake Inhibitors), NSAIDS like Ibuprofen and some statins. In some patients, when they stop these medications, the diarrhoea stops too,” says 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 says 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”.

I’ve been told I have IBS – should I have biopsies?
IBS is very common, and while some people may end up later finding out they have microscopic colitis, not everyone with digestive symptoms needs biopsies. If you are worried though, or your symptoms sound like they could be microscopic colitis, go back and have a good chat with your doctor. “If people are having horrible symptoms that are impacting their day-to-day living, then that’s a reason to go to their GP,” says Dr Raju. “Especially when, if it is microscopic colitis, there is treatment available that can resolve these symptoms.”

Another important thing? Whether or not you have a history of digestive problems, everyone should tell their doctor about any ongoing, new or unusual changes in their bowel habits – especially if there any additional ‘red flags’, such as blood when you go to the loo or unexplained weight loss. Your doctor may need to rule out the possibility of bowel cancer.

How do you treat microscopic colitis?
“There are very effective treatments,” says Dr Raju. “Steroid treatments do have a very good effect and the majority of patients will find remission from their symptoms. And, most won’t have to be on these treatments long term, it might just be that when they have a flare, they take the steroids.”

Quitting smoking is also advisable. And if you are taking other medications possibly associated with symptoms, your doctor will be able to help with looking at alternative options – but make sure you do this with their guidance, as stopping other meds abruptly could be risky.

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