A holiday mishap prompted a woman to confront months of unexplained watery diarrhoea. After multiple GP visits and normal initial tests, a colonoscopy and biopsy in January 2026 confirmed microscopic colitis. This article explains symptoms, diagnostic pitfalls, common triggers and the steroid treatment budesonide that often restores quality of life.
The story begins with a distressing and private moment during a holiday that highlighted a much longer problem. A woman in her early 60s experienced an urgent episode of incontinence while staying abroad, which forced her to confront months of unexplained, very watery diarrhoea.
Initially treated as an infection, her symptoms persisted, affecting sleep, weight and daily routines until a hospital investigation provided clarity.
This article outlines the clinical journey from symptom onset to diagnosis and treatment, explains why microscopic colitis is frequently missed, and describes the medicines and research options now available.
Throughout, key terms such as microscopic colitis, colonoscopy and budesonide are highlighted to help readers recognise the condition and the typical care pathway.
Recognising the symptoms and the personal impact
The initial warning sign was a dramatic change in bowel habits: persistent watery diarrhoea with no blood or mucus.
The condition caused frequent urgent trips to the bathroom — at night sometimes seven or eight times — and daytime episodes that left little time to reach facilities. Alongside the bowel changes came fatigue, occasional dizziness and noticeable weight loss. The woman reduced social outings, avoided long drives and became anxious about leaving home, carrying spare underwear and toilet paper at all times.
Symptoms like these can severely affect relationships, work and mental health. In surveys, many people with this pattern reported major disruptions to daily life and intimacy. The embarrassment of an accident during a holiday with a new partner crystallised how isolating and debilitating ongoing diarrhoea can be.
Why microscopic colitis is often overlooked
Microscopic colitis is an inflammatory condition of the colon lining that typically causes chronic watery diarrhoea. First recognised in 1976, it does not usually produce obvious changes visible during a routine colonoscopy because the bowel often looks normal to the eye. Only biopsies taken from several sites in the colon reveal the inflammation under a microscope.
Because of this invisibility on standard imaging and its tendency to appear in older adults, symptoms are frequently misattributed to irritable bowel syndrome, menopause, stress or ageing. In one patient survey, many people waited through multiple GP visits and long delays before being referred for hospital tests; in some cases, the wait stretched to years. This diagnostic gap means appropriate treatment is delayed and suffering continues unnecessarily.
Common triggers and risk factors
Although the exact cause is unclear, certain medications are associated with triggering microscopic colitis. These include some proton pump inhibitors (PPIs) such as lansoprazole and omeprazole, non-steroidal anti-inflammatory drugs (NSAIDs) like ibuprofen and diclofenac, and some antidepressants. Older adults may be more affected because of longer cumulative exposure to these drugs.
It is important to consider medication history when diarrhoea lasts for six weeks or more. Experts advise against prolonged self-medication with over-the-counter anti-diarrhoeals without medical assessment, because stopping or reviewing a potential culprit drug can be crucial to diagnosis and management.
Diagnosis, treatment and ongoing options
Definitive diagnosis requires a colonoscopy with multiple biopsies from the top, middle and bottom of the colon. When histological evidence of microscopic inflammation is present, the condition is confirmed. Once identified, microscopic colitis is often highly treatable.
The first-line therapy for most patients is budesonide, an oral steroid that acts primarily on the surface tissue of the colon and has limited systemic absorption. Many people respond quickly to a two to three-month course and experience remission of symptoms. Some patients need repeat courses or a low maintenance dose, and a minority who do not respond may be considered for immunosuppressants or biologic therapies that target inflammatory pathways.
Research and clinical trials
Ongoing studies are exploring new approaches. One example is a clinical trial that investigates immune-modulating therapies designed to stimulate beneficial white blood cells, potentially offering longer-term protection against flares. Participation in trials can help individuals access new treatments and contribute to understanding of the disease.
For the woman whose experience began with a distressing incident on holiday, the path to diagnosis culminated after multiple GP visits and a colonoscopy and biopsy in January 2026. She received a three-month course of budesonide, which relieved symptoms quickly. Subsequent flares were treated successfully with further steroid courses, and she later joined a trial to help others while reclaiming activities like mountain biking with her partner.
Anyone experiencing persistent watery diarrhoea lasting six weeks or more should consult a GP and discuss the possibility of microscopic colitis as part of the assessment. Early recognition, appropriate testing and timely treatment can restore quality of life and reduce prolonged distress.
