Everything You Should Know About Collagenous Colitis

Medically reviewed by Judith Marcin, MD on July 5, 2017Written by Lana Bandoim

What is collagenous colitis?

Collagenous colitis is one of the two main types of microscopic colitis. Microscopic colitis is inflammation in the colon that is best identified by looking at colon cells under the microscope. The other type of microscopic colitis is lymphocytic colitis.

In collagenous colitis, a thick layer of collagen, which is a type of connective protein, forms within the colon tissue. The symptoms can disappear and reappear.

Learn more about the different types of colitis »

Symptoms

The symptoms of collagenous colitis can come and go, and vary in severity.

The most common symptoms include:

  • chronic watery diarrhea
  • abdominal pain
  • abdominal cramps

Other symptoms that can be less common include:

  • dehydration
  • weight loss
  • bloating
  • gas or flatulence
  • nausea
  • vomiting
  • fatigue
  • urgency to go to the bathroom
  • incontinence, which is the loss of bladder control

Collagenous colitis doesn’t cause blood in your stool or increase your risk for colon cancer. The diarrhea can appear and disappear over a period of weeks, months, or years. Up to one third of people may be misdiagnosed with irritable bowel syndrome (IBS) because many of the symptoms of the two conditions overlap.

Causes

The exact cause of collagenous colitis is unknown. A virus or bacteria may cause it. It may also be an autoimmune response or genetically inherited.

Collagenous colitis isn’t contagious. It can’t spread to other people.

Incidence

Collagenous colitis is more common among women than men. It’s also more common among people who are in their 50s. In addition, women who have celiac disease are more likely to have collagenous colitis. Collagenous colitis may also be more common among current smokers.

An estimated 4 to 13 percent of all chronic diarrhea cases are collagenous colitis. Researchers have noticed that the number of collagenous colitis cases is increasing. This may be because better detection is available.

Diagnosis

This condition can only be diagnosed with a biopsy of the colon. You’ll likely also have a colonoscopy or sigmoidoscopy so that your doctor can better evaluate the health of your colon.

During a biopsy, a doctor removes several small pieces of tissue from your colon. Then the tissues are examined under a microscope.

The common diagnosis process includes:

  • physical exam and medical history
  • colonoscopy with a biopsy
  • lab tests, such as blood and stool tests
  • imaging tests, such as CT scans, MRI scans, or X-rays
  • endoscopy

Some of the tests and procedures are used to rule out other medical conditions that may cause similar symptoms.

Treatment

In some cases, collagenous colitis disappears on its own without treatment. However, some people need treatment. Your treatment plan will depend on the severity of your symptoms.

Diet

Your doctor may recommend diet changes to help treat this condition. These changes are usually the first part of any treatment plan.

Common diet changes include:

  • switching to a reduced-fat diet
  • eliminating caffeine and lactose
  • avoiding food with artificial sweeteners
  • eating a gluten-free diet
  • drinking more fluids to prevent dehydration from diarrhea
  • switching to a milk-free diet

Medication

Your doctor will review the medications you currently take and make suggestions about either continuing or stopping them. In addition, your doctor may recommend new medications to help treat this condition.

Your doctor may also recommend that you take:

  • anti-diarrheal medications
  • intestinal anti-inflammatory medications, like mesalamine (Pentasa) or sulfasalazine (Azulfidine)
  • psyllium
  • corticosteroids
  • antibiotics
  • immunomodulators
  • anti-TNF therapies
  • medications that block bile acids

Surgery

Your doctor may recommend surgery if diet and medication changes don’t help. Surgery is usually only used in extreme cases. It’s not a typical treatment for collagenous colitis.

The most common types of surgery for collagenous colitis include:

  • colectomy, which means removing all or part of the colon
  • ileostomy, which means creating an opening in the abdomen after a colectomy

Recovery

Collagenous colitis can come and go, and relapses are common. You may need to try several treatments to find relief from the symptoms. The time it takes to recover can vary. Some people may have symptoms for weeks, months, or years.

There are no current recommendations for preventing collagenous colitis. However, following diet and medication changes recommended by your doctor may reduce the likelihood of having a relapse.

Outlook

Collagenous colitis is a type of inflammatory bowel disease. It’s not contagious and can’t spread to other people. The only way to diagnose this inflammation is by examining colon tissue from a biopsy under a microscope.

The symptoms of this condition can come and go. The most common symptoms are watery diarrhea, abdominal pain, and cramps. You may have relapses of collagenous colitis. Seek your doctor’s help on a treatment plan to avoid the chance of this happening.

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