what would you do?

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auburtica
Regular Member


Date Joined Jul 2010
Total Posts : 92
   Posted 4/6/2012 1:16 PM (GMT -7)   
Hi everybody,

I have not been posting in a while, but have been reading the topics every day.
I am writing to ask for your advice. After a nice 1year and 8 months remission, I started to see symptoms around mid-March. Just some mucous and bloating, but I immediately went on nightly mesalamine enemas. I was hoping it would solve the issues, but they progressed. During the last three days, I started to have more episodes (4-5 a day) where I would only pass bloody mucous and little bits of stool. It is not dripping blood, but it is there and I don't want the inflammation to progress. In my experience, it looks like a proctitis flare right now.

I called the doctor today and he prescribed me some hydrocortison enemas, though he said that studies show the Rowasa to be better. What do you suggest? In your experience, would the steroid enemas help me stop this bleeding faster or should I continue with the ASA ones for more days? When is it time to start the hydrocortison?

Thank you for your opinions on this. Best of health to you all,
RT
female, 36yrs old, pan-colitis dx-ed 06/2010
med: Apriso 6/day
multivitamin, fish oil, curcumin, probiotics

pb4
Elite Member


Date Joined Feb 2004
Total Posts : 18188
   Posted 4/6/2012 1:21 PM (GMT -7)   
Cortifoam is the only enemas that work for me so my answer is obvious, but it's different for everyone of course. Obviously though, if the melsamine enemas are not helping any so far then the hydrocortisone is the next step (that is if anything is "obvious" with having this horrid disease lol). I find the tougher the flare with proctitis, the longer it can take for meds to kick in even with steroid rectal meds...but again it's individual.

Best of luck to you and I hope you can get this under control quickly!
bee propolis caps 500mg one cap twice/day
omegas 369 caps one cap twice/day
probiotics 10 billion cfu once/day
vitamins C-calcium ascorbate (easy on the gut) and vitamin A each once/day
Prodiem fibre supplement one cap before bed
I've also altered my diet (no junky stuff at all, processed, fast-foods, refined sugars, ect) and exercise regularly.
I went from 30+ bloody BM's/day with lots of lower back pain to an average of 5/day no bleeding no back pain and completely formed stools, still have severe urgency issues.
~~~~~~~~My bum is broken....there's a big crack down the middle of it! LOL :)~~~~~~~~

quincy
Elite Member


Date Joined May 2003
Total Posts : 25884
   Posted 4/6/2012 1:48 PM (GMT -7)   
ARe you still on the Apriso? And have you missed any dosages?

WEre you still on the probiotics before this happened..are you still on them?

Mid march...so you were on the enemas nightly for about 2 weeks...it's not unusual for a flare to somewhat progress before it recedes.

Are the hydrocort enemas liquid?

You have some options.... Use them in the morning and the 5ASA at night.

....Alternate the steroid enemas and 5ASA.

....Use the steroid enemas nightly for a week or so and when you improve, alternate with the 5ASA then get back on the 5ASA nightly.

5ASA can be better...but you might need the steroid kick. I wouldn't say totally eliminate them.

Hope you feel better soon. Keep us posted for sure.
q
*Heather* I give suggestions, do with them what you will.
Status: ...Asacol 3 @ 2x daily; Salofalk enema @ 3rd night (nightly/ flares, tapered/maintenance)
~diagnosed January 1989 UC (proctosigmoiditis)
~Bentylol 20mg as needed; Zantac 150mg; Pulmicort/Airomir (asthma);Effexor XR 37.5 (depression)
~vitamins/minerals/supplements; Probiotics....(RenewLife Ultimate Flora Critical Care+Primadophilus Reuteri capsules @ bedtime)
~Metamucil capsules 6 twice daily with meals; Vitamin D 4500 IU
~URSO for PBC(or PSC?) 500mg X 2 daily (LFTs back to NORMAL!!)
My doc's logic.. "TREAT (FROM)BOTH ENDS" worth it !!!

Old Hat
Veteran Member


Date Joined Feb 2007
Total Posts : 4612
   Posted 4/6/2012 3:36 PM (GMT -7)   
Hydrocortisone retention enemas are quicker-acting, in general, to reduce bleeding/mucus than the mesalamine enemas. You can safely use them nightly for 3 weeks; then, if your flare symptoms subside, you can taper off & return to 5-ASA meds. It's very good that you're alert to changes in colon function and consulted the doctor right away to get back under control ASAP. As pb4 wrote above, you could also ask your doctor to Rx Cortifoam-- especially if your inflammation is situated in the rectum. (Cortifoam is easy to retain during daytime when you're up & about.) Best wishes & let us know how you're doing. / Old Hat (31 yrs with left-sided UC; presently in remission taking brandname Colazal)

pmedic
Veteran Member


Date Joined Nov 2009
Total Posts : 1478
   Posted 4/6/2012 3:43 PM (GMT -7)   
I would try Rowasa first and if you are not noticing a significant change in 2 weeks them I would add the other. WHy take a steroid if you do not have to? Steroids can have serious and permanant side effects. Take a look at me, steroids have given me avascular necrosis in both knee joints and I am now disabled. It is always safer to try the the drug with the least side effects first!
Dx:Ulcerative Colitis March 2008
Dx: Crohns May 2008
Avascular necrosis bilateral knees from Prednisone. Surgery on left knee was Oct 2011,
No colon surgeries yet but I am desperately trying to keep my colon.
8 blood transfusions, SVT due to low H&H, Anxiety during new medication injections due to past reactions.
Currently on Lialda, Ambien, xanax(prn) D3, probiotic, Rowasa, B12, fish oi

Old Hat
Veteran Member


Date Joined Feb 2007
Total Posts : 4612
   Posted 4/6/2012 3:55 PM (GMT -7)   
The hydrocortisone retention enemas are about 50% lower in steroid content per dose than Prednisone. Cortifoam is 10% steroid. I agree that we should avoid steroids whenever possible, but sometimes during our UC struggles the 5-ASA meds are not enough to stop blood & mucus. / Old Hat (31 yrs with left-sided UC; presently in remission taking brandname Colazal)

auburtica
Regular Member


Date Joined Jul 2010
Total Posts : 92
   Posted 4/6/2012 3:59 PM (GMT -7)   
Thank you all for your great advice!

pmedic, I have been on generic mesalamine enemas for maintenance (1-2/week) since 2010, then I upped them to 1 nightly for the past two weeks. I also love them and am reluctant to use steroids, but if the bleeding continues, maybe I will start the hydrocort enemas to get things under control faster. Today has been better, only 2 BMs, no urgency, some bloody mucous.

Old Hat: the doctor said that the Cortifoam would not reach too far, so if I try rectal steroids, I should use the enemas...

quincy: I have been on 4 Aprisos daily, never skipped a dose. I stopped taking probiotics about 8 months ago, but I will restart them. My signature is from when I was diagnosed, so a few things changed. I am not taking any fish oil either, just eating as healthy as possible. The thing is, this time around I cannot say what could have triggered this flare: I am staying home right now, no stress, no antibiotics, the kids are great, no viruses etc. Isn't this disease "amazing"?

pb4: thanks for the input, I will take everything into consideration. I think I will wait a couple more days before starting the hydrocortison, and I will continue with the ASAs.

Thanks again, best of luck to all of you too,
RT
female, 36yrs old, pan-colitis dx-ed 06/2010
med: Apriso 6/day
multivitamin, fish oil, curcumin, probiotics

PamSmith
Regular Member


Date Joined May 2010
Total Posts : 115
   Posted 11/8/2012 9:51 AM (GMT -7)   
I need some help too. I have crohn's colitis in sigmoid colon and just finished tapering from 40 mg of prednisone. My BM are formed 1 or 2/day and no pain but still blood/mucus is there. I took advice from here and asked doctor to prescribe cortifoam while tapering after 10mg. It's been 1 week and I don't see improvement. Does cortifoam work in sigmoid colon? Or I should use liquid enema?
 
I also take 12 acasol/day. My GI wants to start immuran or remicade but I see people on those drugs also bleed often, then what's the use of going there? I am wondering if I go from asacol to asacod HD or Lialda, will it help?Thanks.

Post Edited (PamSmith) : 11/8/2012 8:56:36 AM (GMT-7)


kazbern
Veteran Member


Date Joined May 2010
Total Posts : 7793
   Posted 11/8/2012 10:23 AM (GMT -7)   
PamSmith, I think you should be using a mesalamine enema, not a cortisone one.  The cortifoam will not give you a lot of coverage in the sigmoid colon; I think it is a pretty small dose of medication, effective primarily in the rectum.  I may be wrong, though - it's been a long time since I used it.
 
I don't think the different brands of oral mesalamine offer anything new in terms of efficacy - some of them might be better for you if you have trouble remembering a midday dose (I think the Lialda, and the Asacol HD, are only twice per day).

Your dose of oral mesalamine is pretty high for someone with disease only in the sigmoid colon. The rectal mesalamines will treat that very effectively. Please talk to your DR about prescribing rectal mesalamine retention enemas.
*******************
50 yrs old, IBD diagnosis in spring '01. Proctitis, gastritis, ileitis.
Currently taking Pentasa (3g/day)Colazal (96 pills/day), Sulfazine (1.5 g/day), Prevacid, folic acid, vit. D (2K iu), flax seed oil (2 tsp/day), mesalamine enema as needed. Gluten free as of 5/30/11. Colonoscopy found no evidence of inflammation on 8/16/12.
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