Do you also have frequent watery diarrhea? It could be Microscopic Colitis!

Do you have frequent bowel movements? Do you have to go to the bathroom five or six times a day, sometimes even more? This condition, which comes with stomach pain and discomfort, may have made it difficult for you to do your daily activities properly. You may have seen a doctor for this, and you may have had scans and tests. But all of them came back as "normal." So you may be thinking, "So what's wrong with me?" If you have had a similar experience, it will be very important for you to know about the disease we are talking about today, namely Microscopic Colitis (MC) .

Simply put, what is Microscopic Colitis?

This name may sound a bit complicated, but let's break it down and understand it simply.

• Colitis: This means inflammation or swelling of the lining of your large intestine (colon). Just like when our skin gets red and swollen when we have a wound, we call it 'colitis' because something similar happens inside the intestine.
• Microscopic: This word means 'microscopic'. This means that the inflammation is so small that it cannot be seen by the naked eye, the camera used during an endoscopy, or a scan. It can only be seen clearly if a very small piece of tissue is taken from your large intestine and looked at under a microscope.

Simply put, Microscopic Colitis is an inflammatory condition of the large intestine that is not detected by routine tests and can only be detected through a microscope. This is because the cells in your colon are constantly "angry." As a result, you often have watery bowel movements.

This condition can be a bit of a nuisance. It can come on suddenly, go away on its own after a while, and then come back again. But the good news is that although it is a lifelong condition, it can often be managed well . It just requires the right medication and some dietary changes.

There are two main types of Microscopic Colitis:

When a doctor looks at a tissue sample from your colon under a microscope, they divide the disease into two main types based on the changes they see. But you don't need to worry too much about this, because the symptoms and treatments for both types are very similar. The difference is only at the microscopic level.

What are the most common symptoms of this disease?

The main and most annoying symptom of Microscopic Colitis is frequent watery bowel movements (diarrhea) . This can occur five to ten times a day, sometimes even more. Imagine how much you dread leaving the house, going to work, or traveling.

In addition, several other features can be seen:

• Abdominal pain and limping: You may feel a squeezing pain in your abdomen.
• Bloating and flatulence: A feeling as if the stomach is full of gas.
• Feeling an urgent need to go to the bathroom and having difficulty controlling it: Running as soon as you feel the need to go to the bathroom.
• Rumbling sounds from inside the stomach: Abnormal sounds heard during digestion.

Why does this happen? What are the reasons?

Scientists have yet to find a single definitive cause for this, but there are several suspected factors that could be contributing to it.

• Germs, viruses, or bacteria: This condition may occur because you may have had a gut infection in the past, which has altered the functioning of your immune system.
• Autoimmune disease: This is when our body's immune system misbehaves and attacks our own healthy cells. Some people with microscopic colitis may also have other autoimmune diseases (e.g., rheumatoid arthritis, thyroid disease).
• Genetics: If someone in your family has this disease or other intestinal diseases, you may be at risk of developing it too.
• Certain medications: Some research has found that certain medications we take long-term can cause or worsen this condition.

Medications that require special attention

If you are taking any of the following medications long-term, it is important to talk to your doctor about it. Never stop taking these medications without consulting your doctor.

Does stress affect this?

Yes, absolutely. There is a bigger connection between our brain and our gut than you might think. Sometimes we say, "The gut is the second brain." It's true. When we are under a lot of stress and anxiety, our body's hormone levels change. This can directly affect our digestive system. So, it's worth taking a moment to think about how your mental state was on days when you have these symptoms.

Who is at higher risk of developing this disease?

Although this condition can develop in anyone, some people are at higher risk.

• Women over 60 years of age: Although the exact cause is unknown, this disease is most common among women in this age group.
• People with other (autoimmune) diseases: This risk is especially high for people with Celiac disease (an allergy to the protein gluten found in wheat flour).
• Smokers: Smoking is a cause of this disease and can worsen symptoms.

How to correctly diagnose the disease?

As I mentioned earlier, this is difficult to detect with routine tests, so if you have these symptoms, you will likely be referred to a gastroenterologist .

The main tests to confirm the diagnosis are colonoscopy and biopsy .

• Colonoscopy: This involves inserting a flexible tube with a small camera through your rectum to examine your entire large intestine. You will be given a general anesthetic before the procedure, so you will not usually feel any pain.
• Biopsy: During the colonoscopy, your doctor will take a small sample of tissue from the lining of your large intestine. This is called a biopsy. The tissue is then examined under a microscope to determine if you have microscopic colitis and, if so, what type.

In addition, blood and stool tests may be performed to rule out other medical conditions.

How to treat and manage?

Treatment options vary depending on the nature and severity of your symptoms. Sometimes, small changes in diet can make a big difference. Some people may also need medication.

1. Dietary and lifestyle changes

This is the first and most important step. What you need to do here is to find out what foods "trigger" your symptoms. This is different for each person.

• Avoiding common allergens: There are several foods that can aggravate symptoms for many people. The most common are alcohol, caffeine (coffee, tea), milk and dairy products, gluten (wheat, barley), and foods high in sugar.
• A diet low in fat and fiber: When symptoms are severe, eating easily digestible foods low in fat and fiber can reduce the burden on the intestines. (e.g. white rice, boiled potatoes, soups, bananas).
• Elimination Diet: This involves completely eliminating foods that you suspect are causing you discomfort for a period of time, then re-introducing them one by one to see which foods trigger your symptoms. This is best done under the guidance of a doctor or nutritionist.
• Anti-inflammatory diet: Some foods have the ability to reduce inflammation in the body. Foods like fresh vegetables, fruits, fish (especially oily fish like salmon and mackerel), and olive oil help with this.

2. Drug treatment

If it's difficult to control through diet alone, your doctor will prescribe medication for you.

• Diarrhea control medications: Medications like Loperamide can reduce the frequency of bowel movements.
• Bismuth subsalicylate: This is also a common medication for diarrhea.
• Budesonide: This is a special type of corticosteroid . It works directly in the intestines to reduce inflammation, so it has fewer side effects than other steroids. This is a very effective treatment for Microscopic Colitis.

In addition to all of this, it is very important to talk to your doctor about other medications you are taking (e.g. painkillers) and take steps to change them if necessary, and to quit smoking if you smoke.

Will this disease be completely cured?

It will not go away completely. However, it can be controlled well and you can live a normal life without symptoms. This period of time without symptoms is called remission . This period can last for months, even years. However, if you eat a bad diet, are under a lot of stress, or for other reasons, your symptoms may flare up again (flare-up).

The most important thing when living with this disease is to listen to your body. The best treatment is to identify what triggers your symptoms.

Although Microscopic Colitis is not as well-known as other intestinal diseases, that doesn't mean it's unmanageable. When a doctor tells you that you have this disease, on one hand you may feel sad, "Oh, what happened to me?" But on the other hand, you may also feel relieved, "I finally know the cause of the problem that I've had for years."

With a little effort, a healthy diet, and possibly medication, you can manage this condition and stay healthy. Be open and honest with your doctor about your symptoms and how they are affecting your life. He or she will be able to help you find the best solution for you.