Microscopic colitis (MC) in both of its forms, collagenous and lymphocytic colitis, is considered now an important cause of diarrhea in middle aged and elderly patients. In this entity, endoscopic and radiological examinations are normal while specific histological findings are seen on colonic biopsy. Once the diagnosis of MC is confirmed, a stepwise approach with medical therapy is suggested. Ruling out other causes of chronic diarrhea should be the initial step. Once the diagnosis of MC is confirmed, a stepwise treatment algorithm is suggested. In this review, I will introduce the entity of MC and describe the stepwise approach to diagnosis and management by reviewing the available evidence. The literature was reviewed regarding both collagenous colitis and lymphocystic colitits focusing on clinical trails. This was then critically examined and an approach to the diagnosis and management of microscopic colitis was suggested.