Hello...I could use some help please...Thanks

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bbc
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Date Joined Mar 2008
Total Posts : 1580
   Posted 3/22/2008 12:44 PM (GMT -6)   
I have moderate UC through out my entire colon (pancolitis) and am on Asacol with Rowasa enemas 2x's per week. The Asacol pills alone don't do the trick but with the Rowasa it helps me greatly. The problem I'm having is if I use the Rowasas after a bowel movement (even waiting an hour or so) sometimes when I go to squeeze the medication in, my rectum rejects it; I know we can have some sphincter muscle issues with UC, but I need to get this medince inside me as it truly helps.  So I have some questions:
 
Has anyone else had this issue when using a rowasa enema and if so what did you do?
 
If you do not have a BM before using the enema does that greatly reduce its effectiveness or is it to help prevent the urge to go or both?
 
When I was using the Rowasa every other day I did not remember having this issue so perhaps there is some additonal inflammation present now that I only use it twice  per week (per the Dr's suggestion as he's trying to tapper me down). I did ask my GI about this problem and he said it could be some dermatitis and to cut down to once per week but as I mentioned, the enema is much more effective than the Asacol pills so I'm not sure he is giving me the best advice for this paticular issue.
 
I would greatly appreciate any thoughts and thanks :-)
 

Post Edited (bbc) : 3/22/2008 12:47:47 PM (GMT-6)


quincy
Elite Member


Date Joined May 2003
Total Posts : 30384
   Posted 3/22/2008 1:05 PM (GMT -6)   
Hi..welcome to the forum!!

Are you using the enemas nightly or during the day?

I don't usually have bms at night, but if I'm feeling the urge, I'll wait.

Where are you having dermatitis??

The 5ASA meds...oral and rectal should be used together to be totally effective.

You're on the right track.

How long were you on the nightly/daily enemas before tapering down?

what other symptoms are you having at this time?

quincy
*Heather*Status: mini flare Dec 28... tapered to every 4th night
~diagnosed January 1989 UC (proctosigmoiditis)
~5ASA: Asacol (6 daily) + Salofalk enemas (increase for flares tapered to maintenance)
~Bentylol (dicyclomine) 20mg as needed
~vitamins/minerals/supplements 
~Probiotic 3(Natural Factors Protec) bedtime + 1 (Primadophilus Reuteri) occasionally
~multi-digestive enzymes as needed ....zymactive 3 - 5x daily
~Ranitidine,Pariet (reflux) Effexor XR 75mg;  Pulmicort/Airomir (asthma)
~URSO for PSC (or PBC) 500mg X 2 daily (LFTs back to NORMAL!!)
My doc's logic.. "TREAT (FROM)BOTH ENDS"  worth it !!!


julee70
Regular Member


Date Joined Oct 2007
Total Posts : 486
   Posted 3/22/2008 1:15 PM (GMT -6)   
I haven't had that exact issue, but I've used Rowasa in the past and I have a couple of thoughts --

Have you tried putting extra vaseline on the tip of the enema? Maybe that would help.
Have you tried using the Rowasa at a different time of the day? You can use it any time, though you probably know that it's most useful if you can lie on your side for a half hour.

Last, there's actually no need to ever taper down on Rowasa, so I wonder why your doctor would want you to do that. There's at least one study that proves that Asacol (or similiar med) in conjunction with Rowasa (or similar) is much more beneficial for UC patients. So if it's working for you, the only issue is finding a good maintenance dose/regimen. Maybe twice a week is that amount. Or every other day. If you can keep yourself in remission that way, I'm not sure it's worth the risk to taper off it completely. It's easier to use Rowasa a couple times a week than to try to get yourself out of a flare. Do you think your doctor thinks you should eventually stop using it? It sounds premature to try that unless you've been in remission for a while.

The dermatitis theory seems plausible. But if you're not itching or sore, then I'd guess it's more likely muscles. I had one doctor prescribe a low-dose tranquilizer that I could take before bed and using Rowasa. It helped me not have to run to the bathroom right after. Just an idea.
-------
UC for the last ten years
Current Meds: 6MP since 2006, Cortifoam
Past Meds: You name it; I've tried it. (Asacol, Colazol, Pentasa, DiPentum, Rowasa, Canasa, Cortenema, sulfasalazine)


bbc
Veteran Member


Date Joined Mar 2008
Total Posts : 1580
   Posted 3/22/2008 1:25 PM (GMT -6)   

Thanks Quincy.

 

I don't have to have a nighttime BM but the directions for Rowasa enemas are clear saying to have a BM before use and I guess it's to help get the meds better distributed and also prevent the urge to go right after using it.

I was up to 12 Asacol per day and still flairing then my GI then put me on Rowasa which stopped the bleeding and D in just one day! (the Rowasa isa blessing for me  :-)  ) I was initially told to use the Rowasa every day for a month then every other day for the next month and now (the 3rd month) twice a week and that's when this problem began. 

I'm thinking as is my Pharmacist, that I need to go back to using the Rowasa every other day, as when I did I did not have this issue and I may be having some additional inflammation since cutting down to twice a week which is allowing my sphincter to remain irratated after a BM and is preventing the liquid from going in and causing a very uncomfortable feeling.

With respect to the dermatitis (around the anus), this was something the GI thought could be causing the problem but it was over the phone so he was just guessing; he also told me to cut the Rowasa down to once a week, but I think the reduction of the Roawas is not good for me; as I mentioned it has been a lifesaver.

I am having no other symptoms except for right after a BM I can feel my sphincter muscle not settling down for 3-4 of hours...nothing to bad at all but if I went to use the enema it would make it very difficult if not impossible. I have very well shaped stool except for may be the very tail end of a BM where they get very soft but still formed, and no blood or very little or no pain.

I also take fish oils, extra calcium, Bowel Soother from RenewLife, eat very low fat w/ no dairy and avoid high fiber. Aside for the UC, I am in good health and keep in shape.

Thanks and I look forward to your thoughts :-)


jujub
Forum Moderator


Date Joined Mar 2003
Total Posts : 10407
   Posted 3/22/2008 1:28 PM (GMT -6)   
Welcome to HealingWell, bbc. My guess is that if you're having trouble putting the fluid in (as opposed to inserting the enema tip,) it may be due to increased inflammation. Some here have found that warming the fluid slightly by putting the container in warm water or under your arm helps. It also may mean you need to use the Rowasa more often rather than less.
Judy
 
Moderate to severe left-sided UC (21 cm) diagnosed 2001.
Asacol, Rowasa, Pentasa, Prednisone, Entocort, Azathioprine
Colazal,  Remicade, Nature's Way Primadophilus Reuteri.
In remission since April, 2006. Remicade has been my wonder drug.
 
Co-Moderator UC Forum


bbc
Veteran Member


Date Joined Mar 2008
Total Posts : 1580
   Posted 3/22/2008 1:32 PM (GMT -6)   

Hi Julie and thanks.

The insertion of the tube hurts a bit here and there but it's when the liquid goes in that my sphincter seems to contract and not let the liquid enter causing a very uncomforatble feeling and I have to remove the tube immdeiately. As I mentioned I don't get this feeling every time but since I cut down on the rowasa to twice a week is when it started. I really belive I have some serious inflammation right around the rectum and that needs to get settled down asap. I am starting to lose a little faith in my GI doc and my go see my proctologist for some gudiance with this specific area.

Looking forward to your thoughts. :-)

Post Edited (bbc) : 3/22/2008 1:39:22 PM (GMT-6)


bbc
Veteran Member


Date Joined Mar 2008
Total Posts : 1580
   Posted 3/22/2008 1:36 PM (GMT -6)   
Judilyn said...
Welcome to HealingWell, bbc. My guess is that if you're having trouble putting the fluid in (as opposed to inserting the enema tip,) it may be due to increased inflammation. Some here have found that warming the fluid slightly by putting the container in warm water or under your arm helps. It also may mean you need to use the Rowasa more often rather than less.

Hi Judilyn and thanks.  I agree with you and think I need to go back to every other day and maybe cut down on the Asacol to 6 per day. BTW, if I don't have a BM before using the Rowasa I don't have any issues using the Rowasa.
 
I do have an old fissure that acts up every once in a while and I can feel some pain from that when inserting the tip but it is not whats causing the problem I've described above.
 
How are the Rowasa suppositories vs. the enemas?
 
THanks and I look foprward to your thoughts :-)

Post Edited (bbc) : 3/22/2008 1:40:56 PM (GMT-6)


BigLucy
Regular Member


Date Joined Mar 2007
Total Posts : 413
   Posted 3/22/2008 3:43 PM (GMT -6)   
I have this exact problem at least for two years now. I can feel now when the Rowasa won't stay in ( I just started to pay attention); with me, it usually means stomach growling, pain, gas--I also have really bad IBS. My GI says it can also happen when there's increased inflamation. Now I use Rowasa on the nights it will stay up there. My rectum is fully infected, lots of inflamation down there so I'm guessing that contributes to it.

bbc
Veteran Member


Date Joined Mar 2008
Total Posts : 1580
   Posted 3/22/2008 4:06 PM (GMT -6)   
Hi BigLucy. Normally it has not been much of an issue but lately I can't even get but one squirt in there without my sphincter going into a spasm. I wonder if rowasa suppositories will be easier to tolerate and better for the rectal inflammation>

julee70
Regular Member


Date Joined Oct 2007
Total Posts : 486
   Posted 3/22/2008 4:16 PM (GMT -6)   
I have doubts about the suppositories being easier to tolerate because you feel the presence of them for longer than you have the enema tip in... if that makes any sense. (You know, something hard there for just a few seconds until you stop feeling it.)

What about some kind of numbing thing first and then the Rowasa? Maybe something for hemmoroids that you can put in to calm the area first? I guess you'd have to ask your doctor about that.
-------
UC for the last ten years
Current Meds: 6MP since 2006, Cortifoam
Past Meds: You name it; I've tried it. (Asacol, Colazol, Pentasa, DiPentum, Rowasa, Canasa, Cortenema, sulfasalazine)


Sara14
Veteran Member


Date Joined Mar 2007
Total Posts : 4034
   Posted 3/22/2008 4:34 PM (GMT -6)   
Julee70 - For me, the suppositories are way easier to use than the enemas. I don't feel them in there after about 3 seconds. It's kind of like having a tampon in (for me at least) where you can't feel it's in there at all. With the enemas, yes, the tip is only in there for a few seconds, but all that liquid almost always makes me feel like I have to expel it and I can't get up and walk around. I still use the enemas, but find the suppositories much easier.

bbc - You're right that the Rowasa directions say "best results are achieved" if you have a BM right before using them, but you don't have to. I hardly ever do, because I rarely have BMs at night. But the enemas still help me. Can you keep the enemas in at all? Even if you just keep it in for a little while, it usually gets easier. Do you do them before bed and lay still right afterward? This helps me. I think the suppositories (called Canasa) also have been helping me a lot. I use one in the morning and a Rowasa at night.
24 years old
Diagnosed with UC March 2007; yet to go into complete remission
Asacol 4 tablets 3x/day
Rowasa (generic) - nightly; Canasa (1,000 mg) in the morning
Nature's Way Primadophilus Reuteri 2/day; Chewable multivitamin; Metamucil; Viactiv


bbc
Veteran Member


Date Joined Mar 2008
Total Posts : 1580
   Posted 3/22/2008 5:54 PM (GMT -6)   

Thanks all.

I have no issues getting the tube in at all (except for some painful spots) and I normally don't have any issue getting the fluid in and holding it.

My problem is sometimes after a BM and only after a BM after I get spasms in my sphincter/rectal area which in themselves are really no big deal but creates an issues not for getting the tube inserted, but not allowing the fluid to go in as it causes great discomfort and my rectum wants to "spit the tube out" and it becomes too uncomfortable to continue. I have to wait about 4-5 hours for things to settle down then all is well and I can use the enema without issue.

I was not having this issue when I was using the enemas every other night so I really think some of the inflammation just in the rectum has returned causing this issue. I will start using the rowasa enemas every other night again and ask my proctologist if a suppository might be better since the inflammation is returning primarily in the rectum.

 


Post Edited (bbc) : 3/22/2008 7:30:42 PM (GMT-6)


quincy
Elite Member


Date Joined May 2003
Total Posts : 30384
   Posted 3/23/2008 2:20 AM (GMT -6)   
Hi..I would suggest you start using them nightly for at least a week or more...then start to taper to every second night.

The suppositories are only 1/4 of the med dosage..but are easier to insert. Just don't expel gas..for they do leak and you won't feel it.

You can use them up to 3 times a day...so, it could be a good option for you now to get some fo the inflammation down....then go back to the enemas.

quincy
*Heather*Status: mini flare Dec 28... tapered to every 4th night
~diagnosed January 1989 UC (proctosigmoiditis)
~5ASA: Asacol (6 daily) + Salofalk enemas (increase for flares tapered to maintenance)
~Bentylol (dicyclomine) 20mg as needed
~vitamins/minerals/supplements 
~Probiotic 3(Natural Factors Protec) bedtime + 1 (Primadophilus Reuteri) occasionally
~multi-digestive enzymes as needed ....zymactive 3 - 5x daily
~Ranitidine,Pariet (reflux) Effexor XR 75mg;  Pulmicort/Airomir (asthma)
~URSO for PSC (or PBC) 500mg X 2 daily (LFTs back to NORMAL!!)
My doc's logic.. "TREAT (FROM)BOTH ENDS"  worth it !!!


bbc
Veteran Member


Date Joined Mar 2008
Total Posts : 1580
   Posted 3/23/2008 1:05 PM (GMT -6)   

Thanks Quincy. 

I used a Rowasa enema last night but w/o a BM first and had no problem at all, but I know they really should be used just following a BM for best results. 

I will ask my MD to prescribe the rowasa suppositories. 

I am also going to go to see my proctologist to see if the old fissure was acting up causing the sphincter issues.

Thanks again to everyone...a very thoughtful and helpful place! :-)


quincy
Elite Member


Date Joined May 2003
Total Posts : 30384
   Posted 3/23/2008 1:33 PM (GMT -6)   
If you don't have to have a bm....don't have one...simple.

There are nights where I have the slight urge and wait till I have one...but that's really not the norm for me.

Never force one.

Besides...it'll be OUT by morning. It's good you can hold it overnight.

Use them nightly for at least a few weeks....then consider to taper if everything for you has been normal for a whole week.

Any questions for tapering...ask. It's a learning process...it took me a while to learn how to juggle.

You really don't need the suppositories if you can hold the enemas...it's better the amount of med compared to the supps. Save them for either enema support during the days, tapering or for maintenance.

quincy
*Heather*Status: mini flare Dec 28... tapered to every 4th night
~diagnosed January 1989 UC (proctosigmoiditis)
~5ASA: Asacol (6 daily) + Salofalk enemas (increase for flares tapered to maintenance)
~Bentylol (dicyclomine) 20mg as needed
~vitamins/minerals/supplements 
~Probiotic 3(Natural Factors Protec) bedtime + 1 (Primadophilus Reuteri) occasionally
~multi-digestive enzymes as needed ....zymactive 3 - 5x daily
~Ranitidine,Pariet (reflux) Effexor XR 75mg;  Pulmicort/Airomir (asthma)
~URSO for PSC (or PBC) 500mg X 2 daily (LFTs back to NORMAL!!)
My doc's logic.. "TREAT (FROM)BOTH ENDS"  worth it !!!


bbc
Veteran Member


Date Joined Mar 2008
Total Posts : 1580
   Posted 3/23/2008 4:18 PM (GMT -6)   

Thanks.

The only reason I have a BM at night is per the directions on the rowasa enemas as it says it makes the treatments more effective.

Per my GI,  I was on once per night, then after a month went to every other night, then twice a week and other than the sphincter stuff I've been doing very well (thank the lord :-) )...I'm not sure if the sphincter issue is from my UC or an old fissure acting up as my stool has been so large, firm and solid (sorry for the nasty description) that it may have opened up the wound a bit causing the spasms...I guess my tail end needs to get used to having normal stool again.

Off the the butt doctor I go, high ho... tongue

Post Edited (bbc) : 3/23/2008 4:23:19 PM (GMT-6)


BigLucy
Regular Member


Date Joined Mar 2007
Total Posts : 413
   Posted 3/23/2008 7:45 PM (GMT -6)   
Because the suppositories don't have as much medication as the enemas do, they didn't work for me in controlling my bleeding. So, something to consider, if you're paying for the meds out of pocket ask for a small trial amount; even if you have insurance, the pharmacy won't take unused meds, it would be a shame to throw them away if you have to go back to enemas.

bbc
Veteran Member


Date Joined Mar 2008
Total Posts : 1580
   Posted 3/23/2008 7:57 PM (GMT -6)   

Thanks Lucy :-)

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