Microscopic colitis: diagnosis, treatment and follow-up
Short patient information to print or keep.
Understand the diagnosis
Microscopic colitis usually causes watery diarrhoea without visible blood. Urgency, night-time stools and accidents can occur. The colon often looks normal. Biopsies from the right and left colon reveal the changes. Collagenous and lymphocytic colitis are related tissue patterns, not cancer stages.
Interpret tests carefully
Normal calprotectin or low FIT cannot reliably exclude microscopic colitis. I check for infection, coeliac disease and other causes as appropriate. Keep eating gluten until coeliac assessment is complete unless advised otherwise.
Review medicines safely
Some medicines are associated with microscopic colitis, but this does not prove causation. Bring an updated medicine list and recent changes. Do not stop prescribed medicines yourself.
Follow the treatment plan
Budesonide commonly settles symptoms. Recurrence may need another course or individual maintenance treatment. Follow the prescribed dose and any reduction instructions. Longer use needs review of safety, interactions and bone health.
Support recovery
Drink regularly and ask a pharmacist about rehydration solution, particularly with kidney or heart disease. Avoid unnecessary food restrictions. Agree any anti-diarrhoeal medicine with your clinician. Keep a short symptom and weight record. A dietitian can help if eating is difficult or you are losing weight.
Keep appropriate follow-up
Repeat biopsies are not routinely needed to assess response. Microscopic colitis alone does not require cancer surveillance, but routine screening and other indications still apply. Seek urgent help for bleeding, severe pain, fever with marked illness or dehydration. Call 111 for collapse or unsafe travel.
When to get help
Contact our team or your GP if diarrhoea returns, treatment is not helping, or you are losing weight. Seek urgent assessment for blood or black tarry poo, severe or worsening pain, fever with marked illness, repeated vomiting, or dehydration such as very little urine, dizziness or difficulty keeping fluids down. Do not assume these are simply microscopic colitis.
Call 111 if you collapse, are confused or too unwell to travel safely, or have heavy bleeding with faintness.
General information. Follow your own care instructions.