Microscopic Colitis: Causes, Triggers, and Medications That Help

When your gut feels like it’s in constant revolt—diarrhea that won’t quit, cramps that come out of nowhere, and no clear reason why—it might not be IBS. It could be microscopic colitis, a type of inflammatory bowel condition that only shows up under a microscope, not during a colonoscopy. Also known as collagenous colitis or lymphocytic colitis, it’s a quiet but persistent problem that affects more people than you think, especially women over 50. Unlike Crohn’s or ulcerative colitis, microscopic colitis doesn’t cause bleeding or weight loss, but it can wreck your daily life. The lining of your colon looks normal during a scope, but when a doctor takes a biopsy and looks closely, they see tiny changes: thickened collagen bands or an overload of white blood cells. That’s why it’s called microscopic.

This condition doesn’t just appear out of nowhere. It’s often linked to certain medications, especially NSAIDs like ibuprofen, proton pump inhibitors like omeprazole, and antidepressants like sertraline. These drugs don’t cause it in everyone, but they can trigger inflammation in people who are already sensitive. You might also see it alongside thyroid disease, celiac disease, or autoimmune disorders. And yes, smoking and age play a role too. The good news? It’s manageable. Most people find relief by switching medications, adjusting their diet, or using simple anti-diarrheal treatments like bismuth subsalicylate (Pepto-Bismol) or loperamide. Some even need short-term steroids like budesonide, which targets the colon without flooding the whole body with hormones.

What you’ll find below are real stories and practical advice from people who’ve lived with this. You’ll see how sertraline, a common antidepressant can trigger diarrhea—and what to do about it. You’ll learn how annual medication reviews, a simple check-up with your pharmacist can uncover hidden triggers you didn’t know were causing problems. There’s advice on how to pack meds for travel, how to avoid drug interactions with supplements like milk thistle, and how to build a routine so you never miss a dose. This isn’t theory. It’s what works for people who wake up every morning wondering if today will be the day they can finally leave the house without panic.