Do you also have frequent bowel movements? Let's learn about this microscopic colitis!

Do you sometimes have a watery bowel movement that lasts for days? Along with that, you feel a lot of discomfort and pain in your stomach, don't you? This is a condition that we don't talk about much, but it can affect many people. That's what microscopic colitis is. Today, we will talk about this in detail and very simply.

What is Microscopic Colitis?

Simply put, microscopic colitis is a chronic (long-term) inflammation of the lining of your large intestine (also known as your colon). The word "colitis" means inflammation of the large intestine. It's called "microscopic" because the inflammation is not visible to the naked eye. It can only be seen clearly with a microscope.

This is also a type of inflammatory bowel disease (IBD). But it's a little different from other types of IBD. The cells in your intestines are constantly irritated . The main symptom is frequent, watery diarrhea. Like other chronic diseases, it can come and go, then go away, and then come back. That is, certain things (we call them ``triggers'') can make the disease worse, sometimes it goes away on its own, and then it comes back after a while. Although it can be a lifelong condition, it can often be well controlled with medical treatment .

Who is most likely to get this?

This condition can actually develop in anyone, but some people are more likely to develop it.

• This is commonly seen in older people .
• It has also been found that women develop it slightly more than men.
• This risk is also higher for smokers .
• It can also occur in people with certain autoimmune diseases, especially celiac disease (gluten allergy).

Microscopic colitis was generally thought to be less common than other inflammatory bowel diseases. However, since a biopsy of the colon is required to accurately diagnose it, it is now believed that more people may have the condition than we thought .

Is this a dangerous disease?

No, compared to other severe forms of IBD, microscopic colitis is not considered a serious, life-threatening disease. However, the constant, severe diarrhea can lead to dehydration, weight loss, and possibly malnutrition. However, it is not usually that severe.

This is a condition that comes and goes and can be controlled with medication, so there is no need to panic. However, living with stomach discomfort after every meal can have an impact on your quality of life . Therefore, it is important to be aware of this.

What are the main types of microscopic colitis?

Doctors can only confirm this disease by looking at a tissue sample from the lining of your intestines (intestinal mucosa) under a microscope. They can then identify the specific characteristics of those cells. These characteristics are used to determine the subtypes of the disease. There are currently two main subtypes that have been identified. Several others are also being discussed.

• Collagenous colitis: The connective tissue lining your colon is made up of collagen and elastin. In this type, the collagen bands in the lining of your colon become abnormally thick. This is similar to the way collagen and elastin swell in other connective tissue diseases, such as rheumatoid arthritis. These autoimmune conditions are also seen in people with microscopic colitis.

• Lymphocytic colitis: In this type, there is an abnormal increase in the number of lymphocytes, a type of cell in the lining of the colon (epithelium). Lymphocytes are a type of white blood cell. They are part of our immune system and protect us from infections. It is normal for the number of white blood cells to increase when there is inflammation related to the immune system.

The best part is that the symptoms of both types are similar. And the treatment is the same. The only difference is when you look at them under a microscope. Some scientists think that these are actually two cases of the same condition. Sometimes, you can even see symptoms of both types in the same person. This is called "incomplete microscopic colitis."

Additionally, some people think that a condition called mastocytic enterocolitis should also be considered a type of microscopic colitis. It has many of the same symptoms. However, "enterocolitis" means that it affects not only the large intestine, but also the small intestine. "Mastocytic" means that there is an abnormal increase in another type of immune cell called mast cells in the lining of the intestine.

What are the symptoms of this?

The main and most prominent symptom of microscopic colitis is chronic, watery bowel movements . Typically, people have five to ten bowel movements a day. Some people may have more or fewer. Very rarely, microscopic colitis has been reported to occur without bowel movements or with constipation. In such cases, it is often discovered incidentally while looking for something else.

In addition to the main symptoms, there are several common side effects that can be seen:

• Abdominal pain and cramping.
• Abdominal distension and bloating.
• Urgent need to go to the bathroom and difficulty holding back stool.
• Hearing bowel sounds (like the stomach gurgling).
• Some people have difficulty eating foods containing gluten (like bread and noodles).
• Feeling tired all the time (Fatigue).

If the condition is more severe, symptoms such as:

• Dehydration.
• Nausea and vomiting.
• Weight loss.

In addition to this, some people mention other features:

• Muscle cramps or muscle pain.
• Joint pain and stiffness.
• Headaches or migraines.
• Mouth sores.
• Skin rashes.
• Heartburn, acid reflux.
• Swollen lymph nodes.
• Thyroid problems.
• Nervous system problems (e.g., difficulty walking - `(ataxia)`).

Important: If you have one or more of these symptoms, it doesn't necessarily mean you have microscopic colitis. However, it's best to seek medical advice, especially if you have persistent diarrhea.

What are the reasons for this?

Scientists still have n't found a definitive cause for this, but they believe several factors may contribute:

• Exposure to certain bacteria, bacterial toxins, and viruses.
• An autoimmune response is a response that occurs due to a mistake in our body's own immune system. That is, the immune system acts against our own cells.
• Genetics. That means it can be something that comes from generations.

Some research suggests that some of the medications we use may also contribute to this problem. For example:

• Nonsteroidal anti-inflammatory drugs (NSAIDs) - for example, painkillers such as ibuprofen and diclofenac.
• Proton pump inhibitors (PPIs) - medications such as Omeprazole, which are used to treat gastritis.
• Selective serotonin reuptake inhibitors (SSRIs) - medications used to treat mental illnesses such as depression.
• Hormone replacement therapy (HRT).
• Beta blockers - some medications used to treat high blood pressure.
• Statins - Medications to lower cholesterol.

Not everyone who takes these medications will develop this condition. However, it is thought that these may be one of the causes. If you are taking these medications, do not stop taking them without talking to your doctor.

How to accurately diagnose this disease? (Diagnosis)

Microscopic colitis is usually diagnosed by a gastroenterologist. He or she will first ask you about your medical history and any medications you are currently taking. Then, they may do various tests to see if there are other things that could be causing your condition.

• Blood tests
• Stool tests
• Maybe imaging tests

If these tests do not find a clear cause, the doctor will then recommend a colonoscopy and biopsy . This is the main way to confirm microscopic colitis.

During a colonoscopy, your doctor will insert a long, flexible instrument (called a colonoscope) through your rectum and into your large intestine. You will be put to sleep during this procedure, so you will not feel any pain. A small instrument will be inserted through the instrument and a small piece of tissue (biopsy) will be taken from the lining of your colon and examined under a microscope. This is the only way to tell if you have microscopic colitis.

How is it treated?

Treatment may vary depending on your symptoms and their severity. Some people may need to make small changes to their diet and lifestyle. Others may need over-the-counter (OTC) or prescription medications.

Imagine, for some people, symptoms come on suddenly and then disappear on their own. For some, controlling their diet can provide significant relief. For others, they may only need to take medication during flare-ups, or they may need to take medication continuously.

Some commonly used medications:

• Medicines that thicken stools and reduce the frequency of bowel movements (`Bulking agents`): For example, things like Isabgol `(psyllium).`
• Anti-diarrheals: Medicines that slow down the rate of intestinal contractions and control diarrhea : For example, loperamide or diphenoxylate.
• Bismuth subsalicylate (like Pepto Bismol®): For diarrhea, heartburn, nausea, and indigestion.
• Budesonide: This is a type of corticosteroid. It is absorbed into the body in the large intestine, where it reduces swelling.
• Mesalamine: This is actually a medication for ulcerative colitis, another inflammatory bowel disease. But it is also used to reduce swelling and pain.
• Bile acid sequestrants (e.g., colesevelam, colestipol): These are given if you have a problem where your body doesn't absorb bile properly (bile acid malabsorption).

If the above medications don't help much, and your doctor thinks it may be due to an autoimmune cause, then other medications that target the immune system may be suggested:

• Immunosuppressants.
• TNF inhibitors (e.g. adalimumab, infliximab).
• Cromolyn sodium (targets mast cells, especially in mastocytic enterocolitis).
• Low dose naltrexone.

Additional advice you can get from your doctor:

• If you are currently taking other medications, consider changing their dosages or switching medications.
• Quitting smoking completely.
• Trying to identify which foods you are allergic to and which aggravate your symptoms.

Will this disease be completely cured?

Not forever. But, you can be symptom-free for a long time . We call this a ``remission`` of the disease. This remission can last for months, even years. But, like any chronic disease, it can come back due to ``triggers``. If you identify your triggers, you can minimize flare-ups.

How long does a flare-up last?

This varies from person to person. However, the typical flare-up period can last from a few days to a few weeks. Many people have been able to reduce the duration and severity of these flare-ups by avoiding foods and chemicals that irritate them, and by taking medication when needed. Be sure to talk to your doctor if your symptoms worsen.

What are the best foods and drinks for someone with microscopic colitis?

There is no specific "microscopic colitis diet" for microscopic colitis. However, it can be helpful to manage your symptoms by reducing foods that make them worse and adding more foods that reduce inflammation. Your specific foods will be different for you. It may take some practice to figure out what foods are good for you. Your doctor may suggest things like:

Eliminating commonly allergenic foods

Here are some foods that have been identified as being able to increase the symptoms of microscopic colitis:

• Alcohol.
• Caffeine (found in coffee, tea, and some soft drinks).
• Gluten (a protein found in grains like wheat, barley, and rye - in things like bread, pasta, and cakes).
• Milk and dairy products.
• Sugar.
• Artificial sweeteners.

Low fat and low fiber foods

During flare-ups, some doctors recommend a "gastrointestinal soft diet." This involves eating foods that are low in fat and low in fiber. This reduces the workload on your digestive system. However, some foods on this diet may be uncomfortable for you.

Elimination diet

One way to find out exactly what foods you are allergic to is to try an elimination diet. For example, a low-FODMAP diet. This is a short-term diet. In this, you completely eliminate certain food groups and then gradually reintroduce them one by one to see which ones you are sensitive to. It is very important to seek the guidance of a registered dietitian when doing something like this.

Anti-inflammatory diet

Certain foods, such as foods high in polyunsaturated fats, have been found to reduce inflammation in the body. The Mediterranean diet is a good example of such an anti-inflammatory diet. Turmeric is also a good addition to your diet, as it has anti-inflammatory properties.

Are probiotics good for this?

Probiotics were previously recommended as a treatment for microscopic colitis. However, current guidelines do not recommend them because more research is needed. Therefore, do not take probiotics without your doctor's advice.

Microscopic colitis is a condition that is still poorly understood. Of the other inflammatory bowel diseases, it is the least recognized. However, scientists now suspect that it may be as common as the others. There is little specific research on it, and there is currently no targeted medication for it. Fortunately, it can often be controlled with current treatments. With a little effort, finding the right medication and diet, you can manage your symptoms well when they arise.

Finally, a few things to remember

• Microscopic Colitis is a manageable condition, so don't panic.
• To accurately diagnose this, a colonoscopy and biopsy are required.
• Work with your doctor to find the treatment that works best for you.
• It is very important to identify the foods, drinks, and other things that make you sick (triggers).
• If you have symptoms, don't hide them and suffer, but seek medical advice. You are not alone!

Microscopic Colitis, Diarrhea, Stomach ache, Intestinal inflammation, Colitis, Food allergies, Gastroenterology