the importance of being rectal!!!!

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damo123
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Date Joined Jul 2007
Total Posts : 714
   Posted 3/26/2008 3:03 PM (GMT -6)   
It seems to be a well established fact that UC begins in the rectum and spreads upwards. So my question is that for those people in remission why is it necessary to take oral maintenance meds. Are these not redundant if UC will always beging at the rectum, and therefore and extra toll on the body.
 
If UC begins in the rectum why aren't all maintenance meds in rectal form. Whats the point in taking a maintenance med that targets mainly the left, upper and even right side of the colon when there should not be any activity there in remission?
 
D
 
Asacol and Iron as Needed. <I've fallen back into unhealthy ways and really enjoying it, burb!>
 
"Whatever you do in life don't berate yourself too much nor contragulate yourself too much. Your choices are half chance. So are everybody elses'"
 
 
 
 
 
 
 


bbc
Veteran Member


Date Joined Mar 2008
Total Posts : 1580
   Posted 3/26/2008 3:43 PM (GMT -6)   
I would not stay in remission w/o the rowasa enemas as Asacol by itself would not do the trick (I have pancolitis) altough I haven't heard all UC starts in the rectum.

quincy
Elite Member


Date Joined May 2003
Total Posts : 30608
   Posted 3/26/2008 5:09 PM (GMT -6)   
That's a question you'll never have answered...as well, many UCers just don't get.

I preach to taper rectal meds to maintenance...go figure.

q
*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 !!!


dakotagirl
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Date Joined Apr 2006
Total Posts : 3402
   Posted 3/26/2008 5:17 PM (GMT -6)   
One important part of the oral meds is to prevent the spread of the disease up the colon. I don't know that just rectal meds would do that.

I think there would be a compliance issue. There already is one with oral meds - I don't feel sick, why take meds. I think patients are more likely to take oral meds when feeling well than they are to use the rectal meds. Who wants to stick stuff in your bum when you're feeling well??? Yes, there are those who would follow the directions - however, I think there are more that would not.

Good question!
Pan-colitis and GERD diagnosed May 2003
Osteopenia diagnosed Feb 2006
Status:  Flaring :(
 
Asacol 12 per day,  Azathioprine 75mg, Rowasa, Canasa, Aciphex, Forvia, and Pro-Bio
 
Co-Mod for the UC forum:  Keep HealingWell running smoothly:  www.healingwell.com/donate


pb4
Elite Member


Date Joined Feb 2004
Total Posts : 20577
   Posted 3/26/2008 6:02 PM (GMT -6)   
One of my friends as well as my mother both have UC and have rarely had much if any rectal involvement but still have disease activity in their colon.

Nothing is cut and dry when it comes to IBD in general.

:)
My bum is broken....there's a big crack down the middle of it!  LOL  :)


quincy
Elite Member


Date Joined May 2003
Total Posts : 30608
   Posted 3/27/2008 1:07 AM (GMT -6)   
It's more cut and dry with UC than with CD..

Oral meds for above the sigmoid...rectal meds for the rectum and sigmoid.

Comes in two med types....5ASA and steroid.


Pretty basic med regimen that most aren't willing to even try...and that includes the doctors.

I'd take any of the above than depending on pred....to me, that's the doctors' way of setting up their patients to fail with basic med regimens.

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 !!!


Red_34
Forum Moderator


Date Joined Apr 2004
Total Posts : 23551
   Posted 3/27/2008 6:12 AM (GMT -6)   
That is a very good question Damian! I've often wondered that myself but like Dawn said, I think it's more of a compliance thing. Many docs even hesitate to bring up rectal meds because most patients balk at the idea. Another thing that comes to mind is the oral meds have been proven to reduce the chance of colon cancer - not sure if the rectal meds have the same capacity.

But you know, I gotta see my GI in May - I think this is a question that I may have to ask him! Unless someone sees their GI first in order to ask.
 @--->--SHERRY--<---@
Moderator for Allergies/Asthma and Co-moderator for UC
~Left sided Uc-'92-Colazal(9 daily),6mp(50-100mgs),Prilosec,Biotin,Forvia,Pro-Bio**Unable to tolerate Asacol, Rowasa or Canasa**~Allergies-Singulair
~Secondary Reynauds Syndrome-'04-Norvasc~Fibromyalgia-'06~Sacroiliitis-epidural injections
To help Healingwell - click here: DONATE
 
 
 
 

 
 


princesscolon
Veteran Member


Date Joined Apr 2006
Total Posts : 733
   Posted 3/27/2008 8:42 AM (GMT -6)   
Is it definite it starts in the rectum? When I was first dx'd, I had all my ulcerations in my colon, none in my rectum. Now I only have them in my rectum...
Diagnosed with Left-sided UC in 1995 at age 15, Prednisone, Rowasa & Hydrocort. Enemas, Proctofoam, Sulfasalazine, Asacol, Probiotics, Fish Oil, Aloe Juice, Canasa, Enotcort, Colazol, Anamantle, Remicade, etc... had almost recto-vaginal fistula in 2004, put on Remicade, August 2007:Increased Remicade dosage-700mg every 6 weeks,diagnosed w/ Psoriatic Arthritis & Fibromyalgia Current meds: Clorazepate, Proctofoam HC, Glucosamine 500, Vitamin B, Lomotil,  Tylenol pm, Lyrica started 1/17/08


damo123
Veteran Member


Date Joined Jul 2007
Total Posts : 714
   Posted 3/27/2008 8:51 AM (GMT -6)   
If UC does always start in the rectm (or does so in the majority of cases) then WHY? What's the reason for this. Can't be conincidence. What induces the immune system to first attack the rectum. It's got 6 foot of colon to pick on. Why start beating up on the rectum first. And why dos the disease spread up the colon and not down it?

And as I'm going on a rant of questions....what's the black smoke monster in Lost!!!?
Asacol and Iron as Needed. <I've fallen back into unhealthy ways and really enjoying it, burb!>
 
"Whatever you do in life don't berate yourself too much nor contragulate yourself too much. Your choices are half chance. So are everybody elses'"
 
 
 
 
 
 
 


eliztopp
Regular Member


Date Joined Feb 2008
Total Posts : 46
   Posted 3/27/2008 9:07 AM (GMT -6)   
recital meds always seem to make my UC worse and irritate my colon. When I have used them it makes my D and urgency worse. So my doctor stopped prescribing them and just wrote it off as not working for me and when ever I go to him with a mini flare or issue the first thing he always says is "well suppositories make it worse so lets stay away from that..." which makes me feel better not only that he remembers but he doesn't want to even try different kinds. But it does make it difficult because I only take oral meds, when its the lower part of my rectum that my last colonoscopy showed as being still damaged and inflamed.
 
{[lizzielu]}
age 20, diagnosed december 2006
meds: Asacol 400mg 4 pills 3x a day; 6-mp 75mg MWF, 50mg SSTTH; iron supplament; one-a-day; protonix; prednisone 15mg (in the middle of a tapper, down from 40mg started 1/1/08)
low residue diet
Remicade????--pondering, next step


Eva Lou
Veteran Member


Date Joined Sep 2006
Total Posts : 3442
   Posted 3/27/2008 9:16 AM (GMT -6)   
I don't know the answer to your question, but I'm living proof that your rectal theory doesn't cut it. 2 years ago, I was only on Asacol, 2 tabs 4xday, with the occasional Rowasa enema prn. Felt great, no symptoms- decided to stop Asacol & just use Rowasa daily- my symptom-free remission lasted about one more month, then have been flaring ever since. Have been on every drug except Humira, nothing worked for any amount of time, & have surgery scheduled for May 7th. Sooo..... while it sounds logical, it's not gonna work. And I don't know if it is compliance, bcause I used those darn enemas daily!
diagnosed with UC '02
meds-
Asacol- 8 tabs/day
Remicade infusions
Imuran- 100mgs/day
Culturelle
 
 
 


bbc
Veteran Member


Date Joined Mar 2008
Total Posts : 1580
   Posted 3/27/2008 10:26 AM (GMT -6)   
Everyone is different, it depends upon exactly where in the colon your disease is active at the time and if your entire colon may be involved; for those that have pancolitis oral meds alone may not do the trick for the lower areas; the rowasa's have been a lifesaver for me vs. just the oral meds alone. I am in full agreement of treating the disease from both ends especially if the enitire colon is affected. I too had recent enema issues with regard to instertion, as my rectum was rejecting the tube only after the suggested BM; it appears that the rejection (sphincter spasm) may be caused by an old fissure acting up and I await an appt with my dr to confirm.

damo123
Veteran Member


Date Joined Jul 2007
Total Posts : 714
   Posted 3/27/2008 10:30 AM (GMT -6)   
Are we to deduce then that there is a signiciant amount of people out there for which UC doesn't begin in their colon or for whom that the rectum isn't where it starts and where is fionally needs to be cured!
Asacol and Iron as Needed. <I've fallen back into unhealthy ways and really enjoying it, burb!>
 
"Whatever you do in life don't berate yourself too much nor contragulate yourself too much. Your choices are half chance. So are everybody elses'"
 
 
 
 
 
 
 


hana24
Regular Member


Date Joined Dec 2007
Total Posts : 354
   Posted 3/27/2008 11:19 AM (GMT -6)   
I don't have UC in my rectum and my doctor says its about 5% of People with UC who don't. So a small percentage.
Jessica 26/F
Asacol 4pills /three times a day(from 2 pills/ three times a day)
Culturelle once daily
Tried (Entorcort EC 9ml/day and Prednisone)


pb4
Elite Member


Date Joined Feb 2004
Total Posts : 20577
   Posted 3/27/2008 12:04 PM (GMT -6)   
Like I said, 2 people I know with UC did not have it start in their rectoms but instead their colons and both have had little involvement with their rectom since getting sick with UC, reading some of the others that have chimed in about also not having it start in their rectom is why I said when it comes to IBD in general, it's not cut and dry.

:)
My bum is broken....there's a big crack down the middle of it!  LOL  :)


princesa
Veteran Member


Date Joined Aug 2007
Total Posts : 2204
   Posted 3/27/2008 12:17 PM (GMT -6)   
I agree with pb4. I still have questions about my health issues I don't suppose will ever be answered to my satisfaction. Namely, I have a "thickening of the bowel wall" on the upper right side and have often felt pain and discomfort there while a scope would reveal most of the inflammation is on the left.
 
I haven't taken any rectal meds in years and have been in remission most of that time. I manage my disease with a maintenance dose of sulfasalazine, dietary manipulation (primarily avoiding gluten and dairy), natural supplements, exercise and rest. That's what works for me, personally.
Diagnosed with ulcerative colitis spring 1999.
 
Maintenance dose sulfasalazine.
Probiotics, l-glutamine and fish oil caps. George's aloe vera juice. Oregano oil antibiotic, antiviral, antifungal.
 
 

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