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rectal or oral medicine

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Ulcerative Colitis
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positivityIsCure
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Joined : Feb 2021
Posts : 14
Posted 2/5/2021 5:12 AM (GMT -7)
I am diagnosed with UC in Aug'20. The doctor diagnosed as proctities and left sided colities. Since then i am on 3.2g oral mesalazine (Asacol). In between, I tried enama foam and suppository. but I think it is not suiting me. When I took suppository, I started getting abdoninal pain, bloody diarrhea and was not feeling well for 3-4 days so I stopped it. I am generally ok with oral medicine.
Is this common to get this symptoms with suppository ?
Which medicine are more effective for my type of UC? rectal or oral medicine?
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quincy
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Joined : May 2003
Posts : 32567
Posted 2/5/2021 11:00 AM (GMT -7)
Hi...welcome to the forum.

Are the rectal meds mesalamine or steroid?

You're better to be using retention enemas than just suppositories. Using both or steroid and mesalamine is helpful. You're still flaring...discomfort with rectal meds is a usual for some of us.

How long were you on the rectal meds exactly?

How have your symptoms changed since diagnosis?

q
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positivityIsCure
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Joined : Feb 2021
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Posted 2/6/2021 9:15 AM (GMT -7)
Hi Quincy

Thank you for the response. I take Asacol 3.2g mg and also cortiment 9mg (Corticosteroids/budesonide) both orally. Initially I used to have 5-6 bloody motions. I started with asacol 4.8g and cortiment 9mg oral. My motion reduced to 3-4 after sometime. After that doctor reduced asacol to 3.2g. At present I have ~5 to 6 motions a day which include bledding 2-3 time. In between I tried salofalk suppository. But my dierria and pain increased. So I stopped after 4 days. How long it take suppository to adjust? will the pain and dierria go after we use suppository for few days? or my symtopms are unsual?

Thanks
Mukesh
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quincy
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Joined : May 2003
Posts : 32567
Posted 2/6/2021 10:31 AM (GMT -7)
You can call your doctor and ask for steroid enemas and to increase the oral mesalamine back to 4800mg. It really shouldn't have been decreased until you were in remission...but it's something that can be experimented with.
Are you on the 400mg dosage asacol?

Are you still on the cortiment?

Regarding diarrhea...is it all water or loose soft stool? Is it mostly in morning or throughout the day?

How are you eating...some foods can loosen stool as well.

q
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positivityIsCure
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Posted 2/6/2021 11:24 AM (GMT -7)
Yes I am still on cortiment since September.
I take 2 x 800 mg asacol two times a day. Doctor decreased it to avoid side effect. Will it have side effect if we are on 4.8 g for few more months. ?
As for effect after suppository, it was mostly watery stool in day time and regular soft stool in morning but with blood. I guess for some people, rectal medicine are suitable and for some oral are more effective. Is it true?
Will steroids based suppository help with my condition. I have proctitis and left sided (lower left side) colitis.
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quincy
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Posts : 32567
Posted 2/6/2021 12:31 PM (GMT -7)
Some here have had side effects to the supps and enemas and simply cannot use mesalamine.

I think that if you had firm stool in the morning and diarrhea during the day...it's not the supps. But how are bms at this point exactly compared to when on the supps?

Have you had stool tests done recently to see if something else is going on?

q
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positivityIsCure
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Posted 2/7/2021 1:11 AM (GMT -7)
May be it could be due to suppos as I was doing well with oral mesalazine even at 3.2 g dose. My symptoms were like this: 1-2 bloddy motions in the morning (very lesss blood) and 2-3 during the day with little or not blood.

After I took suppos , the motions frequency was increased and also pain. No sure shot weather it was firm in moring and watery during that, it was irregular. So I has to stop.

Now I am getting back to earlier stage but little bit blood increased with stool and more pain in rectum while passing the stool.
Shall I wait before trying something new?
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quincy
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Posted 2/7/2021 8:22 AM (GMT -7)
I wouldn't wait...when did you last use the suppositories? I would try them again for at least a week and document your symptoms.
Where was the pain exactly? And when exactly?

q
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positivityIsCure
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Posted 2/8/2021 2:22 AM (GMT -7)
I used suppos last week for 4 days and everyday there were some or other symptoms. like abdominal pain, nausea, fever like feeling n all. I stopped it and now all those symptoms are done except my UC symptoms.
When I was diagnosd with UC, the sergon prescribed pentasa 1g (mesalazine) suppos and i used it for 15 days before going to GI. GI stopped that and started asalcol oral as I mentioned before.

I am confused now as to what to do. One thing I know is I was better with 4.8g asacol and symptoms reduced by 50% in 2 months.
But then GI reduced it to 3.2g and form enama which didnt suited me so I stoped and only on 3.2g asacol. After a month again I started feeling well. (very less bloos throughout the day)
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quincy
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Posted 2/8/2021 11:08 AM (GMT -7)
I would ask ask for steroid rectal meds and see how you do on them. I suggest foam enemas which seem ro be easier for people to retain.

Do you not have a GI?

q
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positivityIsCure
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Posted 2/9/2021 2:13 AM (GMT -7)
I have GI, but I dont have kind of confidence.

It is happening to me since last 2 months that i feel very much better for 4-5 days. (in terms of very less blood while passing stool, though frequency is 4-5 times a day) and more bleeding for 3-4 days. Again there is a period where I feel better.
Is this good sign that situation improving?
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quincy
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Posted 2/9/2021 11:30 AM (GMT -7)
You aren't getting worse, so that's a good thing. What you don't want is to not treat the rectum.
Raising the bar for acceptance as it's OK is NOT the best place to go.

Either try the mesalamine enemas again this week to confirm your reaction or ask the doc for steroid foam enemas to deal with rectal healing.

As an aside, I seemed to do worse before things improved when I started the enemas. I was going up to 10 times daily at that point, but it had improved when I started oral asacol from 20 when diagnosed.

q
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positivityIsCure
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Posted 2/11/2021 9:55 AM (GMT -7)
Yes, it's like on and off for now with only oral asacol. Let's see otherwise i will ask my GI to change medication.
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quincy
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Posted 2/11/2021 10:21 AM (GMT -7)
I'm encouraging you go reconsider rectal meds..oral mesalamine won't be enough treat the rectum.
There are topical steroids oral and rectal.

Keep us updated as to how you're doing.

q
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positivityIsCure
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Posted 2/11/2021 10:52 AM (GMT -7)
I am also taking oral steroid. Which rectal one is effective - mesalazine or steroid based?
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quincy
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Posted 2/11/2021 11:18 PM (GMT -7)
Depends....but for many it's helped tremendously.
I've only used steroid foam enemas once at in 1989, but that was given by another doctor while mine wasn't available...he wanted to out me on prednisone and I refused, so he OK'd the enemas. I was in a bad flare, and it definitely helped. I was only on it for 2 weeks , then back on Salofalk once my dr was back.

If I was in a flare and Salofalk didn't seem enough, I would request steroid foam (easy to retain for day use) and use Salofalk at night.

Both end approach...UC starts in the rectum...you have options.
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positivityIsCure
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Posted 2/12/2021 4:20 AM (GMT -7)
I talk to GI, he suggested 1g mesalazine suppos along with oral. Let hope it will do better.
Sometimes he also talk about biologics. Do you have any idea about it. Worth trying it?
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quincy
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Posts : 32567
Posted 2/12/2021 11:45 AM (GMT -7)
Here is my perspective...if you can get things controlled controlled on the lowest tier meds...stay there. That would include mesalamine oral and rectal (and steroid topicals if needed).
The thing is that it takes commitment and eventual understanding of symptoms comes as how to use them effectively.

My 32 years of use has paid off to show normal c-scopes biopsies...and I didnt realise mesalsmine use had the ability to heal to that level.

My flares are extremely minimal, and to the point where some would say it's not a flare, but i have no patience to wait it out to get worse to prove it to someone else. I know my body and symptoms. I have no desire to go backwards.

In saying that...all hell could break loose based on life or illness events. I'm doing the best I can and hope it continues.

You do what is best for you. Some cannot take mesalamine and dont want the commitment. Some do well on immunomodulators, others do well on biologics and ilk. Some are on biologics and still use mesalamine...and on and on. Some don't do well on any and decide to have surgery.

Put out a question and ask those who are on the high tier meds what you need to know.

In the meantime...use the suppositories. I would suggest after bms in the day and at bedtime.. start with one and ask the doc to rx 2x daily if needed.

Keep me updated.

q
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positivityIsCure
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Joined : Feb 2021
Posts : 14
Posted 2/13/2021 2:22 AM (GMT -7)
Thanks Quicy for kind words. Yes patience is the key and I have that very much . Not only in UC but I have observed it in lots of other life experience.
As I mentioned before , since last 1-2 months there are times when very less blood in stool for 4-5 days and again bloody motion for 2-3 days and it same till today. So I hope mesalazine is suiting me.
With suppository I am hoping to best results now.
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quincy
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Posts : 32567
Posted 2/13/2021 8:51 AM (GMT -7)
Let me know how it goes with the suppositories.
q
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positivityIsCure
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Joined : Feb 2021
Posts : 14
Posted 2/17/2021 3:27 AM (GMT -7)
I started suppository since a week. So far no side effects like cramp like last time.
If it is suiting my body, how long it takes to see better results?

general question - once we get remission, and after few months/year if get flare again, will it take same long time as first time to get remission again or less?
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quincy
Elite Member
Joined : May 2003
Posts : 32567
Posted 2/17/2021 11:25 AM (GMT -7)
Good on the supps.

Regarding remission...it's a maintenance state for most of us, and a slippery slope regarding recognising symptoms that arent quite obvious to tell us things are awry. It took me about 3ish years to start recognising those symptoms and eventually how to use my meds more efficiently. Mind you, I've been at this a long while. Certainly worth it to me.

My suggestion...while impatiently waiting for actual remission, recognise ALL the symptoms while you are healing (because they will change). I do urge you to try the enemas again since you have sigmoid involvement.

You will see how you do at this point, and always have the option to increase to enemas if your symptoms are not as they should be. You have many options regarding use, and hopefully your GI will be willing to go along with the trials of scheduling and dosaging.

Don't have high expectations...just understand what the meds do and that mesalamine is not an immediate thing. It does its magic through continued use, so give it a fair try.

If you cannot use it or it's not enough...there are always topical rectal steroids to use.

Keep me updated 😊
q
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positivityIsCure
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Joined : Feb 2021
Posts : 14
Posted 2/23/2021 1:26 AM (GMT -7)
10 days into suppos, the rectal pain has reduced and also bleeding. I am still going for motion 4-5 times a day.

One question here, most of the time(in the mornings) I notice brown color water. I think this is coating of Asacol (masalzine) tablet. Because during bleeing water turns bright red and pink.
Is the brown water is tablet coating? or I am missing something here.
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quincy
Elite Member
Joined : May 2003
Posts : 32567
Posted 2/23/2021 11:35 AM (GMT -7)
Not from the coating. It is just stool that is still watery and soft enough to colour the water.
Do you still have the enemas available?

q
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positivityIsCure
New Member
Joined : Feb 2021
Posts : 14
Posted 2/23/2021 11:38 AM (GMT -7)
No I don't have enama now.
I was asking about stool color as it is same as coating on the tablet.
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