Symptoms of Collagenous Colitis
Collagenous colitis primarily presents with chronic, watery, non-bloody diarrhea that can significantly impact quality of life, often accompanied by nocturnal diarrhea and fecal incontinence. 1
Primary Clinical Presentation
- Chronic, watery diarrhea (non-bloody)
- Nocturnal diarrhea (frequently present)
- Fecal incontinence (frequently present)
- Abdominal pain and cramping
- Urgency to defecate
- Presence of mucus in stool (but not blood)
- Fever (in some cases)
Disease Characteristics
- Normal endoscopic appearance of the colon despite symptoms 2
- Diagnosis requires histological confirmation showing:
- Thickened subepithelial collagen band
- Increased intraepithelial lymphocytes 2
- Symptoms may be intermittent with symptom-free intervals that can last years 3
- More common in women (77% of cases) 1
- Mean age at presentation is around 60, though 25% of cases occur in patients under 45 1
Associated Symptoms and Conditions
- Mild weight loss (reported in some patients) 3
- Arthralgias (joint pain) that can be incapacitating in some cases 3
- Associated autoimmune diseases:
- Rheumatic disease
- Thyroid disease
- Coeliac disease (in approximately 5-7% of cases) 1
- Bile acid diarrhea is prevalent in 41% (37-45%) of collagenous colitis cases 1
Important Distinctions
- The absence of blood in stool is a key distinguishing feature of collagenous colitis 2
- If bloody diarrhea develops in a patient with collagenous colitis, this should prompt immediate evaluation for:
- Alternative diagnoses
- Disease progression to other forms of inflammatory bowel disease
- Infections or other causes of GI bleeding 2
Severity Assessment
The severity of symptoms can vary:
- Mild cases: Increase of <4 bowel movements per day above baseline 1
- Moderate cases: Increase of 4-6 bowel movements per day above baseline 1
- Severe cases: Increase of >6 bowel movements per day above baseline, potentially with complications like dehydration 1
Warning Signs Requiring Immediate Attention
- Development of bloody stools (not typical of collagenous colitis)
- Severe abdominal pain
- Signs of dehydration
- Significant weight loss
- Fever
Understanding these symptoms is crucial for early diagnosis, as collagenous colitis often goes undiagnosed due to normal endoscopic appearance, requiring specific biopsies for confirmation.