Microscopic Colitis (Collagenous and Lymphocytic Colitis) Clinical Presentation

Updated: Mar 25, 2021
  • Author: Harika Balagoni, MD; Chief Editor: BS Anand, MD  more...
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History & Physical Examination


The presenting complaint of microscopic colitis (MC) is usually chronic watery, nonbloody diarrhea, [10] usually between 4-6 loose stools per day, [29] and frequently associated with other symptoms (eg, fecal urgency/incontinence, nocturnal stools). [10] Less frequent complaints include abdominal cramping, fecal incontinence, fatigue, nocturnal diarrhea, and weight loss, although weight loss may be seen in 40% or more of patients with collagenous colitis (CC). [29, 30]

Symptoms may have been present from several months to 2-3 years before medical attention is sought and a diagnosis is made. In fact, perhaps half of the patients proven to have microscopic colitis meet the Rome II and Manning symptom-based criteria for diarrhea-predominant irritable bowel syndrome (IBS) and, thus, they may be misdiagnosed until endoscopic biopsies of the colon are taken.

Incontinence is probably more a reflection of the advanced age of affected individuals; patients with this problem may do well if treated with antidiarrheal agents.

Physical examination

Physical examination usually does not reveal any specific abnormalities. Severely affected individuals may show signs of dehydration, malnutrition, and weight loss.