4cm moderate flare - enemas not working...

Hi, just a brief intro. Had UC for about 3 years now since diagnosis. Pancolitis. Currently taking Azathioprine for the last 2 years and 4g Pentasa again for the last year.

I’ve been on enemas for almost 5 months now. Started off last year on nightly Salofalk retention ones for 1 month because of slowly rising calprotectin levels, then 1 month every other day. Things weren’t improving after also noticing blood on bm and paper. So it was back to nightly enemas.

During the time my GI did inspect the area and said there was a recent hemorrhoid and that was causing the gush of blood I had that morning and the dripping previous days. So there was a suspicion that the blood is simply from that.

In the middle of all of this I have been having genital issues (male) which my urologist diagnosed as prostatitis. After 4 months taking pills and herbs for that without improvement I saw another one who reckons its tense pelvis muscle and not prostatitis so Im on tranquilizers too nightly.

Problem is every time I have to do the enema I get that perineal pain provoked only from what I can imagine is from “holding it in” and tensing that muscle more, its like a vicious cycle.

Back to the colitis. I had a sigmoidoscopy 3 weeks ago and it turns out I have a moderate flare in the last 4cm. Rest that was viewed up to 30cm was healthy.

Salofalk retention enemas replaced with mesalazine 1g foam enemas for nights and intestifalk (budesonide) in the morning. Was doing that for about 10 days then had the checkup again, I was still seeing blood.

1 pill of Clipper 5mg (beclometasone dipropionate ) was added in the morning. Apparently this is a slow release steroid for UC. Been on that for about 10 days now and still seeing blood.

First bm in the morning is literally liquid. But feels like only whats in the rectum. Could this be the nightly mesalazine and doesn’t absorb like the retention ones did? I skipped it one night and it didn’t happen in the morning so I guess so...

2nd bm is maybe a bit better but still mushy, 3rd if I have one will be solid but thinner that usual and streaks of blood on bm and paper.

I notice a lot more blood if I push but on the sigmoidoscopy my GI said there was no sign of an active hemorrhoid.

Sorry for the long post. Im just lost and not understanding how after 5 months of enemas I have inflammation and blood going on..

Really appreciate any feedback.

Thanks.
1wish

Ask for suppositories.
Is there any way this could be a hemorrhoid Or a fissure?
q

I have a hemmie that bleeds sometimes and it always freaks me out. I use a steroid suppository for a couple days and that takes care of the issue. Worth a shot to give them a try.

Try mesalamine supps during day and steroid supps at bedtime.

q

Hi @Quincy, cant seem to get hold of the suppositories lately here. I'm seeing my GI tomorrow. Unfortunately still bleeding even after 2 boxes of Budesonide foam enemas every morning, that's 28 doses. I read on here that it causes thinning of the colon?? is that true?

I haven't read that anywhere else and has me worried.

@David1991 so 2 urologists simply put it down to my meds I take and not enough water but then the 3rd said it was prostatitis so I took meds for that for 4 months only for another urologist to tell me my prostate is normal size and he reckons its referred pain to the genital area. I get the burning but its a short while after urinating not while. Then I get weird sensations in the perineal area.

He put me on tranquilizers for 3 months and stopped the prostate meds, I'm a month in and I have to say its a lot less, hardly ever. But I fear all these enemas I take just make it worse because I tense the muscle without realizing.

Hi, I will bring this up with my GI.

I just got my lab results back and calprotectin is 400.. So I'm not very pleased about that..

Also a few other points worry me that weren't there before.

Low uric acid (3.1), high Sodium (147) and high TSH (4.48)