Can rectal meds create some UC-like symptoms?

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emory
Regular Member


Date Joined Aug 2008
Total Posts : 327
   Posted 2/4/2009 10:58 AM (GMT -6)   
A question for people who've used rectal meds for a while:

Do you think they can actually cause some symptoms to seem worse? I feel like the rectal suppositories increase frequency for me; there was a definite decrease in frequency once I started tapering off my morning hydrocortisone suppository, while still using Canasa every night. Also, it seems like suppositories may cause "juicy gas" (sorry, I don't know how else to describe it) and low-down rumblings. It would make sense that the body would want to get the foreign substance out, right?

Am wondering about this because frequency of BMs is the main thing keeping me from feeling like I'm in remission now -- most days I go twice, but sometimes it's as much as 5. (Every once in a while one will be kind of loose, but mostly they're solid, well-formed.)

I also worry because I seem to have problems with mesalamine, and now it's the only thing I'm taking. What if the hydrocortisone was keeping symptoms down, and now the Canasa will actually make them worse again?

Thanks for any thoughts --
emory
41, female
Dx ulcerative proctitis, 3-5 cm, June 2008. Still flaring? Not sure.
Canasa 1000 mg suppositories and 1 tsp smooth texture Metamucil nightly
25 mg hydrocortisone suppositories (tapering) and 1 Garden of Life Primal Defense Ultra in a.m.
Effexor 37.5, Remeron 30 mg, and Trazodone 75 mg for sleep/anxiety (clonazepam as needed)
2.5 mg methimazole for thyroid
Had some success with acupuncture
Osteopenia and other assorted ailments


pb4
Elite Member


Date Joined Feb 2004
Total Posts : 20577
   Posted 2/4/2009 1:23 PM (GMT -6)   
My experiance, if you feel that the meds are making things worse, then chances are the med just aren't working at all and the disease is progressing so it's not actually the meds making it worse, it's just they aren't helping so the disease is getting worse...

I've never had any success with anything other than cortifoam (steroid meds)....I've had to be on them daily for as long as a yr before tapering off and had no side effects what so ever.

Your BM frequency pretty much tells me that your not in full remission yet...unlike many on here, I believe in only using the rectal meds when neede and not indefintely, there is absolutely no guarantee that using rectal meds when not needed will keep you from getting disease activity, if anything your rectom may become immune to the meds, especially when being used when there is no activity.

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


RyanF
Regular Member


Date Joined Jan 2006
Total Posts : 358
   Posted 2/4/2009 1:29 PM (GMT -6)   
emory--

I'm not sure any of what I have to say will help much-- but I take rowasa (and supplemented by canasa as needed) nightly during a flare, which I'm in one now, and I have noticed a few things.

If I'm flaring badly, the rowasa is just too much-- its painful and I have no ability to hold it in. As my flare gets a little better, I'm able to use them without too many issues-- but I have noticed that I can feel crampy if the enema is not warmed up a bit (the ulcer is sensitive to the cold). Also, and I learned this one really fast-- if you don't get rid of the air (or gas in you) before taking the enema it can be painful. The next morning I can expect a few things-- urgency to go to the bathroom, unable to go to the bathroom or I go once and feel fine the rest of the day.

Other things I do is the use of a heating pad to help ease my stomach.

With the exception of cramping and the occasional feeling of urgency, I do not find canasa or rowasa exacerbating my symptoms. I have had the best response on rectal meds thus far.
Ryan


Meds:

Began Humira on 10 Jan 2009

Second injection: two pens on 24 Jan 2009


RyanF
Regular Member


Date Joined Jan 2006
Total Posts : 358
   Posted 2/4/2009 1:36 PM (GMT -6)   
pb4 said...


...unlike many on here, I believe in only using the rectal meds when neede and not indefintely, there is absolutely no guarantee that using rectal meds when not needed will keep you from getting disease activity, if anything your rectom may become immune to the meds, especially when being used when there is no activity.

:)


pb4-- what is your take on other mesalamine (hope I spelled that right) oral meds. They are designed to remain intact until entering the colon and there the meds do their work. It is the same as using rectal meds only coming from the other direction. I would say more people than not use oral meds as a maintenance drug during periods of no flaring. If I follow the logic, the oral meds should become ineffective, too.

I don't and won't use rectal meds on a continual basis just because of the discomfort of putting something up your bum-- but I can tell you the moment I recognize any symptom, I begin using them again. Coincidentally, I've had zero luck with oral meds of any kind.
Ryan


Meds:

Began Humira on 10 Jan 2009

Second injection: two pens on 24 Jan 2009


pb4
Elite Member


Date Joined Feb 2004
Total Posts : 20577
   Posted 2/4/2009 3:17 PM (GMT -6)   
My experiance with oral meds is that I'm either allergic or non-responsive to them, but I suppose any meds can stop working (which could explain why so many get flares even while on their meds), and I don't know if you can necessarily compare oral meds to rectal meds either, although I'm sure they could become ineffective as well, but I do know that using rectal meds continuously will not guarantee that it will keep disease activity at bay.

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


emory
Regular Member


Date Joined Aug 2008
Total Posts : 327
   Posted 2/4/2009 4:45 PM (GMT -6)   
Thanks for your replies, RyanF and pb4 --

I think I kind of muddied up a couple of questions in my initial post. I don't think the hydrocortisone suppositories were making things worse; I guess I just suspect that they cause a few side effects (some urgency, maybe an extra BM or so to get them expelled, some weird gas) that make it harder to know whether remission is near.

I DO, on the other hand, feel wary about Canasa. I tried to take Lialda twice and got really sick after just a few days each time (strong nausea, increased bleeding, frequency, urgency, the works). And I actually got worse after I first started taking Canasa in June, though as you point out, pb4, maybe the medicine wasn't doing enough and the flare was just increasing on its own.

Yeah, pb4, I agree, I'm probably not in remission. Rats! The 5 BM days only come once a week or so, though, and they really don't bother me. (Except for the low-grade anxiety of wondering if things are going to get worse, which I'm coming to learn is just a fact of life with chronic illness...)
41, female
Dx ulcerative proctitis, 3-5 cm, June 2008. Still flaring? Not sure.
Canasa 1000 mg suppositories and 1 tsp smooth texture Metamucil nightly
25 mg hydrocortisone suppositories (tapering) and 1 Garden of Life Primal Defense Ultra in a.m.
Effexor 37.5, Remeron 30 mg, and Trazodone 75 mg for sleep/anxiety (clonazepam as needed)
2.5 mg methimazole for thyroid
Had some success with acupuncture
Osteopenia and other assorted ailments


gaff
Regular Member


Date Joined Jul 2006
Total Posts : 442
   Posted 2/4/2009 6:03 PM (GMT -6)   
Rowasa stops my bleeding but gives me incredible D.
gaff
left-sided UC since 11/05
 Rowasa, Colazal, Calcium, Centrum
Natren Healthy Trinity Probiotics


kops2da
Veteran Member


Date Joined Jun 2008
Total Posts : 2865
   Posted 2/4/2009 6:19 PM (GMT -6)   

This is what my NP and I determined from using the enemas and foam.

I had a full scope October and it showed some improvement from May scope.  In that time I had tried about every oral medication in the mesalamine group AND Canasa. (cannot tolerate any of them long enough to help)  After that scope (which doc said showed confined to rectal area) I was on Proctofoam for a few weeks - stayed about same - daily bleeding and mucous but only 2 or 3 bms - never more.

BUT, because I was not getting into remission doctor prescribed hyrocortisone enemas for two weeks.  I gradually got worse - more blood, more urgency more cramping.  So, yesterday I had a sig scope and yes the UC has moved about 4 inches up the colon - left side.  Either the enemas made it worse or they were just not doing anything and it spread - no way to tell for sure.

I will start prednisone on Saturday and a taper for three months starting with 40 mg. for two weeks. Then maybe 6MP. Wish me luck and I sure hope you will also get help!

ElaineNY


68 yr. old granny
New diagnosed with proctosigmoiditis - 6/2008
 Colonoscopy 10/28 showed only few cm. left to heal in rectum - tried Proctofoam for weeks - no luck.
Probiotic Align, Prilosec for GERD
Inderol for hypertension,Xanax,Lipitor, multivitamin, calcium w/D, Tylenol
Tried hydrocortisone for two weeks with no change.
2/3/2009 - sigmoidoscopy showed about 30 cm. involved but mild - starting on prednisone only 40 mg. taper on 2/7/2009.
 
 
 
 
 
 


Sara14
Veteran Member


Date Joined Mar 2007
Total Posts : 4201
   Posted 2/5/2009 2:25 PM (GMT -6)   
I think that sometimes rectal meds can create some UC-like symptoms for me. I'm talking about Rowasa and Canasa. The Rowasa stops my bleeding, but can make me have more gas and sometimes pain. Sometimes I also feel better the day after I don't use an enema.
Diagnosed with UC March 2007; Asacol 4 tablets 3x/day; Rowasa; Canasa; Viactiv; Metamucil wafers; multivitamin; sublingual allergy drops


Meesh
Veteran Member


Date Joined May 2006
Total Posts : 619
   Posted 2/5/2009 3:11 PM (GMT -6)   
I do notice the Roweasa and Canasa can cause some UC-like symptoms, but overall they do help. I've been sticking with the Canasa lately and am finding that it works a lot better for me, besides just being easier to deal with. I do find that if I pass gas during the time the suppository is in it's most melted state then it can make a little waxy mess. Nothing too awful. Rowesa gives me D in the mornings and I have a harder time keeping it in (yeah yeah yeah, I expel the air, I warm it up, tried all the helpful hints). Even though my GI said the Rowesa is more effective, for me the Canasa has been better. At least for now.

Meesh
46 yr old female, dx'd UC April 27, 2006; mild arthritis in lower back, dx'd May 2008; Osteopenia dx'd 6/08 Finally achieved remission mid October 2008!!

13 Remicade infusions: 1st: 7/21/07; most recent: 1/21/09; Current meds & supplements: Lialda, 4 tabs in the morning; Xanax as needed (rarely); Rowesa and/or Canasa; multivitamin w/folate; Culturelle; Fish oil capsules, calcium chews and/or Tums; Vitamin D;

Past meds: Prednisone 4/06-4/08; Entocourt EC; Asacol; Colazal; Venofer (iron) injections Dec '07; Imuran (extremely bad reaction 2/07); Protonix; Lexipro


Mitzo
Veteran Member


Date Joined Dec 2007
Total Posts : 536
   Posted 2/5/2009 5:32 PM (GMT -6)   
I have found that both mesalamine and cortisone enemas give me stomach aches, bloating, and a big increase in D. Plus, they do nothing to deal with my symptoms.
23 years of UC which started after quitting smoking. In and out of flares which are usually triggered by antibiotics. Latest issue is endless diarrhea without blood or mucous.
  • Psyllium powder
  • Culturelle probiotic  
  • Cortenema
  • L glutamine


emory
Regular Member


Date Joined Aug 2008
Total Posts : 327
   Posted 2/5/2009 9:12 PM (GMT -6)   
Thanks, everyone -- your experiences make me think I'm not completely barking up the wrong tree...
emory
41, female
Dx ulcerative proctitis, 3-5 cm, June 2008. Still flaring? Not sure.
Canasa 1000 mg suppositories and 1 tsp smooth texture Metamucil nightly
25 mg hydrocortisone suppositories (tapering) and 1 Garden of Life Primal Defense Ultra in a.m.
Effexor 37.5, Remeron 30 mg, and Trazodone 75 mg for sleep/anxiety (clonazepam as needed)
2.5 mg methimazole for thyroid
Had some success with acupuncture
Osteopenia and other assorted ailments


bookworm21
Veteran Member


Date Joined Mar 2008
Total Posts : 1766
   Posted 2/5/2009 9:42 PM (GMT -6)   
Canasa has given me UC-like symptoms. When I took it last year, I was only having bleeding (no D); Canasa stopped the bleeding but gave me diarrhea. So then I tried all the steroid rectal meds (except for the enema). That didn't get rid of the bleeding, so I alternated between Canasa and Anucort. I stopped Canasa cold-turkey and then tapered off the Anucort.
Female, Age 20
9 Asacol, Rowasa1000 mg Canasa, Proctofoam, Rifaximin 2/day
Digestive Advantage (Crohn's & Colitis)1 Florastor, 50 mg 6MP,1 Primadophilus reuteri, Remicade (6 infusions), 2.4 g Lialda, Forvia, 6 Colazal, 1 Anucort, Culturelle, Fish Oil, Calcium/Vit D supplement, 20 mg Prozac, VSL #3
 

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