If you’re dealing with persistent, watery diarrhea, you might be wondering what causes microscopic colitis. This common condition is a major reason for chronic diarrhea, especially in older adults, and understanding its triggers is the first step to managing it.
Microscopic colitis is an inflammatory bowel disease that causes colon inflammation. Unlike other types, this inflammation is only visible under a microscope, which is how it gets its name. The symptoms can be disruptive, but getting a clear picture of the causes can help you and your doctor find the right path forward.
What Causes Microscopic Colitis
Doctors don’t know the single exact cause of microscopic colitis. Instead, they believe it’s likely due to a combination of factors. These factors trigger an abnormal immune response in the colon lining, leading to inflammation and the classic symptom of watery diarrhea.
Here are the primary factors thought to play a role:
1. Autoimmune Activity
Many experts classify microscopic colitis as an autoimmune condition. This means the body’s immune system mistakenly attacks healthy cells in the colon lining. This attack causes inflammation and prevents the colon from properly absorbing water, leading to diarrhea. It’s often seen alongside other autoimmune disorders.
2. Medications
Certain medications are strongly linked to the development of microscopic colitis. The connection is so strong that if you’re diagnosed, your doctor will likely review all your medicines. The most common culprits include:
- NSAIDs: Nonsteroidal anti-inflammatory drugs like ibuprofen, aspirin, and naproxen.
- Proton Pump Inhibitors (PPIs): Drugs used for acid reflux, such as omeprazole or lansoprazole.
- Selective Serotonin Reuptake Inhibitors (SSRIs): A common class of antidepressants.
- Statins: Medications used to lower cholesterol.
- Certain diabetes medications: Like acarbose or metformin.
It’s important to never stop a prescribed medication without talking to your doctor first.
3. Bacterial or Viral Infections
Some cases of microscopic colitis begin after an infection that causes gastroenteritis (a “stomach bug”). The theory is that bacteria or their toxins irritate the colon or trigger that ongoing immune system response. The infection clears, but the inflammation in the colon persists.
4. Bile Acid Malabsorption
Bile acids, which help digest fats, can sometimes irritate the colon lining if they aren’t absorbed properly in the small intestine. This irritation can contribute to the inflammation seen in microscopic colitis. This is why bile acid binders are sometimes used as a treatment.
5. Genetic Factors
Having a family member with microscopic colitis or another inflammatory bowel disease (like Crohn’s) slightly increases your risk. This suggests genetics may make some people more susceptible to developing the condition when exposed to other triggers.
6. Smoking
Smoking is a significant risk factor, particular for the collagenous subtype of microscopic colitis. Smokers are more likely to develop the condition, and they may have symptoms that are harder to treat. Quitting smoking is a crucial part of management.
7. Hormonal Factors
The condition is more common in women, especially after menopause. This points to a potential hormonal link. Fluctuations or declines in estrogen might influence how the immune system functions in the gut.
Common Risk Factors to Consider
While the causes aren’t fully understood, we know who is most at risk. Knowing these can help with diagnosis:
- Age: Most common in people between 50 and 70 years old.
- Sex: Women are diagnosed up to 10 times more often then men.
- Autoimmune History: Having another autoimmune disease (like celiac disease, thyroid disorders, or rheumatoid arthritis) increases risk.
- Smoking Status: Current or former smokers have a higher risk.
How is it Diagnosed?
Since the colon looks normal during a colonoscopy, diagnosis requires a biopsy. Here’s the typical process:
- You report ongoing watery diarrhea to your doctor.
- They will likely order a colonoscopy or sigmoidoscopy.
- During the procedure, the doctor takes multiple small tissue samples (biopsies) from your colon.
- A pathologist examines these samples under a microscope to look for signs of inflammation or thickened collagen bands.
Management and Treatment Approaches
Treatment focuses on reducing inflammation and managing diarrhea. The first step is often reviewing and potentially stopping any triggering medications (under medical supervision). Other common strategies include:
- Anti-diarrheal medications: Like loperamide, for immediate symptom control.
- Budesonide: This is a corticosteroid that acts mainly in the gut and is the first-line drug therapy. It’s very effective at inducing remission.
- Other medications: If budesonide doesn’t work, options include bile acid binders (cholestyramine), immunosuppressants, or biologics.
- Dietary adjustments: While no specific diet cures it, some find relief by avoiding caffeine, lactose, artificial sweeteners, and high-fat foods. A low-FODMAP diet, tried with a dietitian, can sometimes help.
- Stress management: Stress can exacerbate symptoms, so techniques like mindfulness may be beneficial.
Living with Microscopic Colitis
This condition often follows a pattern of flare-ups and remission. With the right treatment plan, most people achieve excellent control of their symptoms and maintain a good quality of life. Regular follow-up with a gastroenterologist is key to managing it long-term.
FAQ Section
What is the main cause of microscopic colitis?
There isn’t one main cause. It’s believed to be caused by an abnormal immune reaction in the colon, triggered by factors like certain medications, autoimmune activity, smoking, or genetics.
What triggers microscopic colitis flare ups?
Flare-ups can be triggered by use of NSAID painkillers, infections like a stomach bug, periods of high stress, or sometimes without an obvious trigger. Identifying and avoiding your personal triggers is an important part of management.
What is the root cause of microscopic colitis?
The root cause is an dysregulated immune response in the colon lining. Why this happens in certain individuals is likely due to a combination of genetic predisposition and environmental triggers, such as medications or infections.
How do you get rid of microscopic colitis?
While there’s no permanent cure, it can be effectively managed into long-term remission. Treatment usually involves medications like budesonide to calm inflammation, stopping any triggering drugs, and lifestyle changes like quitting smoking. Symptoms often resolve completely with proper treatment.