What is Microscopic Colitis and How to Manage It

Relapse is common but can usually be treated with the steroid budesonide.

Jan. 27, 2026 at 9:17am

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Microscopic colitis is a chronic inflammatory condition of the colon that causes persistent diarrhea. It is most common in women around the age of 64. The exact cause is unknown, but certain medications, smoking, and other factors may increase the risk. Diagnosis requires a colonoscopy with biopsy, as the colon lining often appears normal. Treatment with the steroid budesonide is usually effective, but relapses are common and may require ongoing low-dose treatment.

Why it matters

Microscopic colitis can be debilitating due to the severe diarrhea and risk of dehydration. Understanding the condition and how to manage flare-ups is important for those affected, as it can significantly impact quality of life. This article provides helpful information for patients and their doctors.

The details

Microscopic colitis comes in two forms - collagenous colitis and lymphocytic colitis - but both lead to chronic diarrhea as the main symptom. Symptoms can start slowly or suddenly, and may also include abdominal pain. Diagnosis requires a colonoscopy with biopsy, as the colon lining often appears normal to the naked eye. Certain medications like aspirin, ibuprofen, and acid suppressors may increase the risk of microscopic colitis, so patients should review their medications with their gastroenterologist. The steroid budesonide is an effective treatment, with 80-90% of patients responding, but relapse is common and ongoing low-dose treatment may be needed.

  • Symptoms can begin slowly or suddenly.

The players

Dr. Keith Roach

A physician who answered a reader's question about microscopic colitis.

K.G.

A 64-year-old female reader who was diagnosed with microscopic colitis after experiencing a months-long bout of diarrhea.

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What they’re saying

“Relapse, unfortunately, is common but can usually be treated with budesonide again.”

— Dr. Keith Roach, Physician (oregonlive.com)

What’s next

Some experts keep their patients on budesonide at the lowest effective dose, especially if they have relapsed more than once.

The takeaway

Understanding microscopic colitis and how to manage flare-ups through medication like budesonide is crucial for those affected, as the condition can significantly impact quality of life due to the severe diarrhea and risk of dehydration.