As we've all become more open about topics that have traditionally been considered taboo, it's become abundantly clear that tummy problems like ulcerative colitis and irritable bowel syndrome (IBS) are more common than we could have ever imagined with symptoms like bloating, abdominal cramping, diarrhoea and constipation being regularly reported. In fact, a whopping 41% of the UK population has sought professional advice from their doctor about recurring tummy problems.
The issue is, getting a definitive diagnosis is difficult, in part due to the fact that symptoms are vague and can be attributed to a number of underlying causes. Take diarrhoea, for example. Diarrhoea is one of the main symptoms of IBS, ulcerative colitis, Crohn's disease, and coeliac disease – and that's just the conditions that are confined to the gastrointestinal tract.
IBS is by far the most common of all the conditions, and is often a doctor's first port of call for exclusion before testing for other causes. As there is no test for IBS, doctors will often suggest that patients try the Low FODMAP Diet (FODMAP stands for Fermentable Oligossaccharides Disaccharides Monosaccharides And Polyols – the diet basically involves avoiding fructose, lactose, fructans - certain vegetables, galactans - grains and sweeteners) for a few weeks and monitor whether their symptoms improve.
While a low FODMAP diet is very effective at easing IBS symptoms, it's not so great at treating other causes of tummy symptoms. This can mean symptoms are prolonged and a diagnosis is delayed, leading to feelings of despair as well as deteriorating health.
One of the lesser known causes of symptoms like bloating, cramping and diarrhoea that is currently gaining attention on social media for being more common than we may realise is microscopic colitis. Microscopic colitis is a type of inflammatory bowel disease (IBD) that affects the large colon and commonly causes watery diarrhoea and cramping. The term ‘microscopic’ comes from the fact that the inflammation can only be seen under a microscope following a biopsy, making diagnosis even harder and lengthier to achieve.
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Here, two experts discuss everything you need to know about the condition so you can be aware of what to look out for, and the key points to discuss with your doctor if you are worried.
“When we think of IBD, often Crohn’s disease or ulcerative colitis come to mind. But, microscopic colitis is a form of IBD too, but it isn’t as well recognised,” says Dr Sammie Gill, gastroenterology dietitian. “It’s called microscopic colitis because in order to make a diagnosis, a sample taken from the lining of the large intestine (called a biopsy) must be looked at under a microscope.”
“Symptoms largely overlap with IBS and can be hard to distinguish,” notes Dr Chris George, GP. “In fact, one study showed that one third of people with microscopic colitis had symptoms compatible with IBS. The difference between the two can sometimes be established by the clinical history and more precisely following biopsy results where a sample of tissue is looked under a microscope.”
According to Dr George, common symptoms include watery diarrhoea, abdominal pain (cramping or dull), weight loss, fatigue, faecal incontinence, joint or muscle pains, bloating and wind.
“Fatigue, joint pains and weight loss are not typical symptoms of IBS, but may be symptoms of other types of IBD such as Crohn’s disease or ulcerative colitis,” explains Dr Gill. “Other gut disorders such as coeliac disease and bile acid diarrhoea [urgent, watery, pale stools] are more common in those with microscopic colitis.”
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As Dr Gill explained earlier, a diagnosis of microscopic colitis can only be made once a biopsy of the large intestine has been examined under a microscope. In order to perform the biopsy, patients have to have a procedure known as a colonoscopy, which is where a doctor or nurse (an endoscopist) uses a flexible tube with a camera on the end (called a colonoscope) to examine the inside of your large intestine.
The tube is inserted up your bottom, and although it can be uncomfortable, it's not usually painful. Once inserted, the endoscopist can take a sample of the tissue (a biopsy), which is then sent to the lab for examination and diagnosis.
Unfortunately, the causes of microscopic colitis are not properly understood. “The short answer is we don’t really know," says Dr Gill. "It’s thought to be a combination of factors that trigger your immune system to go into overdrive and start attacking the healthy cells that line the large intestine.”
However, there are some risk factors that could increase your chance of having it. “More research is needed but risk factors are thought to be increasing age – most common between the ages of 50-70 years, sex – women are more affected than me and cigarette smoking,” explains Dr George.
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While it may seem that more people are being diagnoses with microscopic colitis, it's more likely that the condition is simply getting more attention on social media, especially TikTok, due to women sharing their experiences and stories of diagnosis in order to help others suffering from similar symptoms.
“Thankfully, in recent years, there has been far more openness and awareness on social media around breaking the poo taboo, stimulating dialogue and breaking the stigma around gut issues," says Dr Gill. "I mean, we all go to the toilet, most of us have experienced a bout of diarrhoea or constipation at some point, and so many people are troubled with gut disorders, so we should be talking about it. People are more conscious of their gut health than ever before, and information about what to do if you are experiencing symptoms is more accessible, so it’s moving in the right direction.”
“Treatment for microscopic colitis should always be done in conjunction with a registered healthcare professional. It is important that all the relevant investigations have been carried out before embarking on treatment," warns Dr George. “Treatment varies depending on the severity of symptoms and ranges from lifestyle changes to prescription medications.”
Once the condition is under control and the patient is in remission, there are a number of lifestyle changes that can prevent a flare up. “If a person does smoke, it would be highly recommended to stop in order to reduce the risk of other gut disorders, as well as preventing worsening of symptoms,” recommends Dr Gill. “Avoiding excessive alcohol consumption is recommended and reducing caffeine may also be helpful.”
Other than that, Dr Gill suggests consuming a diverse plant-based diet containing fruits, vegetables, whole-grains, beans and pulses, nuts, seeds, herbs and spices. These foods contain many different types of fibre, naturally-occurring prebiotics, phytochemicals (plant chemicals such as polyphenols), as well as vitamins and minerals.
You may also want to think about taking a probiotic. “New research shows that there may be a role for food supplements or probiotics such as Symprove in managing symptoms of microscopic colitis,” says Dr George.
