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Ulcerative Colitis
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Posted 9/25/2015 6:24 AM (GMT -7)
Can you all give me your opinion on the best rectal med option that my GI is giving me in this response? I've never used any of these in the past but I think I should due to the location of my disease...


"I am fine with trying Asacol in place of Lialda. Asacol HD is double the strength of normal Asacol and thus allows us to use fewer pills per day. 3 pills twice a day for a total of 6 per day is the maximum dose. One pill 3 times a day for a total Is the maintenance dose. I am willing to try whichever of these dosages you prefer at the current time. Because your disease is limited low down on the left side, you certainly may benefit from enema or suppository therapy or foam. The enema would coat all the extent of your last known disease and is a form of the mesalamine-like products such as Lialda and Asacol HD. It is called Rowasa enema. The suppository is a form of a steroid but will only reach the very lower portion of where your disease is, although sometimes this helps patients symptoms anyhow. It is called Canasa. The foam is also a steroid which you inject per rectum. It is called Cortifoam. I await your consideration in these regards"

Thoughts please?
Posted 9/25/2015 6:38 AM (GMT -7)
the foam is not available everywhere.

there are Canasa is not a steroid, but in fact a mesalamine. there are steroid suppositories however.

the enemas come in regular and sulfate-free - some people need the sulfate-free, sfRowasa, which is brand name and pricey.

if you can manage with Canase, it is less mess and fuss. Otherwise sfRowasa.

Steroids are only for short term use. If you want a maintence med, you need a mesalamine form.
Posted 9/25/2015 8:00 AM (GMT -7)
If you have left sided UC I would go with the Rowasa.
Posted 9/25/2015 10:30 AM (GMT -7)
The answer depends on how far your ulcerative colitis goes. If your uc is limited to your rectum (ulcerative proctitis) then a suppository or foam would suffice. If your ulcerative colitis extends to the sigmoid colon (proctosigmoiditis or pancolitis) then an enema would be much better.

Anti-inflammatory medications are Rowasa enema or Canasa suppository, the same active ingredient as in Asacol HD or Lialda. Steroids are available in suppositories, foams, and enemas (the enema is the only one to go beyond the rectum, to the sigmoid colon and beyond). Typically, you'd start with the anti-inflammatory's and if they are not enough then add a steroid as well.

I'm surprised you'd want asacol hd over lialda. Because lialda is a once a day medication, asacol hd is taken multiple times a day.
Posted 9/28/2015 12:00 PM (GMT -7)
Thanks everyone!
I would also like to see quincy's opinion as well :)
Posted 9/28/2015 1:34 PM (GMT -7)
Rowasa enema
Posted 9/28/2015 3:17 PM (GMT -7)
Hi...just saw this...good it was brought to the first page, lol.

I like your doctor!

I'd suggest the Rowasa enema for sure. It comes in 2g and 4g...start with the 4g.

You can use the Canasa suppository as supportive therapy during the day if you want to quicken the rectal healing if you're having lots of urgency and rectal pain/tenesmus.

The foams in the US would be steroid only. An option if the Rowasa hasn't kicked in as quick as you would like. It can be used in conjunction during the day and the Rowasa at night.

Make sure your doc gives you a prescription to use the enemas nightly and to give you lots of refills. Revisit after a month of nightly use.
Should you get much worse as the weeks go on, it's time to switch.

Keep us posted what you choose and how you're doing with them. They will be your best friend.

q
Posted 9/29/2015 4:55 AM (GMT -7)
Thank you!!
I have the rowasa, now I just need to know how to do them properly. I assume before bed? Do I need to be laying down a certain way or any special tips? Will I need to use the restroom after administered?
I'm a guy and the idea of something going in my bottom doesn't really excite me too much (not gonna lie) :(

I also want to mention that I do not have urgency and the 50 times a day D or bowel movements. My main issue is mucous and blood (mainly on the TP)
I do get better, formed bowel movements later in the day. If anything, I feel more constipated.
I should also note that I drink 2-3 beers three to four times a week as well. Does beer impact this disease that much?
My disease is not severe and I rarely have symptoms. However I've been dealing with this round for about 2 months...
Other than that, I workout 4-5 days a week and my diet is decent. I also struggle with sweets and candy as crazy as all of this sounds :
Any help is much appreciated! sad

Post Edited (icanrace) : 9/29/2015 6:02:26 AM (GMT-6)

Posted 9/29/2015 5:35 AM (GMT -7)
Yes - do the enema laying in bed, on your left side. You want to retain the enema for as long as possible, so try to go to sleep after administering or at least lay in the same position for 30 minutes. Unlike saline enemas, the rowasa doesn't have a laxative effect but if you have active disease then it can be difficult to retain. Give yourself the best shot possible by remaining horizontal after administering the enema.

Alcohol aggravates the GI tract and dehydrates you, so cutting down on alcohol may be helpful.
Posted 9/29/2015 6:39 AM (GMT -7)

icanrace said...
Thank you!!
I have the rowasa, now I just need to know how to do them properly. I assume before bed? ideally, yes.Do I need to be laying down a certain way or any special tips? See my tips further down.Will I need to use the restroom after administered? Likely, it takes practice to retain them, and ignoring the urge to evacuate them. I would sit on the toilet seat, raise my butt just enough that I can reach beneath and insert the enema, stay inches above the toilet seat, while administering and for a couple minutes afterwards (which is the time one is most likely to need to execute, after that the urge subsides). It might take a number of times to be able hold it for extended periods of time.
I'm a guy and the idea of something going in my bottom doesn't really excite me too much (not gonna lie) :( Believe me, no one is excited to use enemas. However, it's all about results and this gets the medication to the problem area.
I should also note that I drink 2-3 beers three to four times a week as well. Does beer impact this disease that much? Very individual. Some avoid alcohol like the plague as it dramatically worstens their uc symptoms. Others, like me, have no effect at all. I enjoy a beer on about 3-4 nights in a given week. It's all about moderation.


Tips for using meslamine/rowasa enemas:
  • When you first start using enemas, use them in the bathroom very close to a toilet as they can come up very quick and unexpected. As you get better at them, and more confident, you can administer them in bed.
  • Add extra Vaseline (petroleum jelly) to the tip of the enema.
  • Warm the enema up to body temperature before administering. Put it in a pocket for a while before using, or warm it up under an armpit.
  • Squeeze all of the air out of the bottle before administering. You do not want to inject any air into your bowel as it will both be uncomfortable and make it likely you will need to urgently evacuate the enema fluid.
  • Lay an old towel down as any drips of the enema fluid can stain clothing, carpet, etc.
  • Use one of the positions described in the instructions.
  • Administer the enema slowly, too quickly and you will be less successful. If you wish, you can do one half the bottle first, wait a few minutes, and then administer the rest.
  • Stay reclined on your left side for about 20 minutes to allow the enema fluid to be absorbed. Retire for the night.
  • It takes practice to hold the enema in for 7 hours. Do not get discouraged, and keep trying. Even if you evacuate part of the enema, some will likely remain and heal you. As you heal, it will be easier to retain them for longer lengths of time.
Posted 9/29/2015 11:23 AM (GMT -7)
I always just laid on the bathroom floor to do enemas - I was too afraid of drips and the possibility that the enema solution could stain my bedding (and it DOES stain). I'd just do it, get up, wash my hands, and get into bed. Even when I was flaring badly I was able to do that. I also just used a half a bottle at first, since I was flaring so badly, to make it easier to retain.

My best advice is to not get in a mental tizzy over using it - it'll just make it that much harder to do. It's really not a big deal.

And do you think that we women like the idea of sticking something in our bums?
Posted 9/29/2015 2:11 PM (GMT -7)
So I did my first one laying on my left side, in bed. It's been about an hour and I don't really feel anything. I don't feel full or even have the urge to go to the restroom. Is this normal?
Posted 9/29/2015 2:20 PM (GMT -7)
I definitely felt the liquid go into my colon when I would do them, and then after administering them I wouldn't feel much. If I was flaring terribly then it would be a little difficult to hold it in, otherwise I had no urge to go to the restroom afterwards. As I mentioned, it's very different from a saline laxative like a fleet enema.
Posted 9/29/2015 2:24 PM (GMT -7)
Yeah, I felt the medicine as well (I think)
All I know is that little bottle was empty and there wasn't a drop anyplace. I must have done it right :-
Posted 9/29/2015 2:37 PM (GMT -7)
Good job! Sounds like it was uneventful - how it's supposed to be. Hope you get over the flare soon.
Posted 10/1/2015 4:36 AM (GMT -7)
Is it normal to have a little medicine left in the bottle? I get it mostly out but there's always liquid left in the bottle
Posted 10/1/2015 4:47 AM (GMT -7)
Yes, it's common to have some leftover in the bottle. If my mom were doing these, she'd have a container under the kitchen sink that she would use collect all the remaining liquid that she drained out from each one. There it would stay till the end of time !
Posted 10/1/2015 4:51 AM (GMT -7)
Thank you.
I know when I'm done squeezing the bottle, I can pinch the bottle to where both sides of the bottle are touching one another.
Posted 10/1/2015 10:10 AM (GMT -7)
after squeezing most of it out, start folding the bottom up like you would do a paper bag...then you'll get more out.

I lay in bed to do mine..

you can keep a garbage can or bag next to your bed, some tp to wipe your butt afterward as well as a wash cloth or wipe for your hands.

you'll figure out a process for yourself.

Make sure you use them for at least a month nightly...keep us posted how you're doing.

q
Posted 10/2/2015 8:10 AM (GMT -7)
This is the message I sent my dr today:

Quick update- I have done 1 enema per day for the last 3 days. Blood / mucus is gone. Bowels have "tightened" up. I have more of a constipated feeling now. The small bowel movements I've had, have been formed.

He suggested that maybe I cut the enema back to every other day. Thoughts?
Posted 10/2/2015 12:25 PM (GMT -7)
Uh....nopers on that one. Nightly for two weeks then and see how you do. A flare inflammation is in increments...and you are no way near done.

That's my expert opinion on this one. Unless you think better otherwise to try it his way. They can always be increased if symptoms you and your doc deem as a flare. My experience differs greatly on that....but I learned through a process as well.

q
Posted 10/2/2015 12:29 PM (GMT -7)
I feel the enema's have increased constipation by quite a bit. Why would that be?
Posted 10/2/2015 12:51 PM (GMT -7)
It makes sense you would think it's the enemas, but its the inflammation. You need to stay on the enemas until that phase is done.

Remember this state well because when you are doing fine and on maintenence enemas....and start with constipation, there's your symptom of very mild limited inflammation.

I suggest 2 weeks, but you'll probably need longer. If its confirmed bt you that poos are making you happy, stay on nighty for a few more days and then go to every second night.

some docs only see blood as a flare symptom....I never wait that long, because that only means increased progression of inflammation.
q
Posted 10/2/2015 1:08 PM (GMT -7)
As you are healing it is likely that your stools are becoming more formed and it feels like constipation. I would increase fluids and slowly increase fiber intake. As you increase fiber you MUST increase water. Because increasing fiber without water will actually make you more constipated
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