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Used Mesalamine Enemas for Years, Now This…?

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Ulcerative Colitis
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Posted 10/1/2022 8:10 AM (GMT -8)
I’ve used mesalamine enemas for years with little issue, but that has changed lately.

It used to be that I’d squeeze the contents in and hang out on my left side until I fell asleep. The next morning I’d have a normal BM. Never was my stool loose as a result of the enema - the suspension liquid would just absorb over night.

Now though, as soon as I get the 4g in there, I have an immediate urge to release it. Last night I contained it for 5-ish hours until the urgency was too much and had a messy accident on the way to the bathroom. And it was the enema that came out, not stool.

Any thoughts as to why I don’t seem to absorb it as I’m used to doing?
Posted 10/1/2022 10:30 AM (GMT -8)
Are you flaring? That can slow absorption and make retention difficult. Laying on your left side longer than the 20 minutes helps, prop yourself with pillows to stay on your left side while sleeping. If you're too inflamed then Prednisone would tame it down enough to resume enemas.
Posted 10/1/2022 10:58 AM (GMT -8)

iPoop said...
Are you flaring? That can slow absorption and make retention difficult.

I don't know why I've never noticed your signature, but that is hella funny!

Yes, flaring, so I imagine that active inflammation could slow absorption, I've just never experienced this before. Don't want to do pred, but may have to.
Posted 10/1/2022 1:04 PM (GMT -8)
Questions as always...what was the schedule of the enemas before you started using them at this point?
How many bms daily?

It's not the enemas...you're flaring. Normally, stool sitting in the sigmoid or above will absorb most ofnthe enema...but it's not usually 100% absorbed.
You could use the enemas daily and nightly for a bit...if you have enough on hand and an get refills. Or.. rather than prednisone, you could request a steroid foam enema to use during the day, and use the mesalamine at night.

q
Posted 10/1/2022 3:26 PM (GMT -8)
You don't have to do prednisone if you don't want to. There are other options. Budesonide for example.
Prednisone ruined my spine and I will not take it unless it's an absolute emergency.
Posted 10/1/2022 4:35 PM (GMT -8)

poopydoop said...
You don't have to do prednisone if you don't want to. There are other options. Budesonide for example.
Prednisone ruined my spine and I will not take it unless it's an absolute emergency.

Budesonide has never had an effect on me. Years ago I took oral Uceris, with no effect, and then Entorcort, which did help. Of course, Entocort has been discontinued by the manufacturer, or so I learned when I tried to get an Rx filled a couple of months ago.

Even though I've had UC for almost 30 years, I never had to take Pred until just about a year ago. Moving from Hawaii has not been good for my UC.

@Quincy - I've always taken enemas in the evening as I'm getting ready for bed. Daily BMs ~4-6, good day is 3, but the worst symptom right now is the urgency. And yes, as I noted I am indeed flaring. It's a good suggestion to use the steroid foam enema during the day and mesalamine enema at night. I still have some Uceris foam. But sheesh - all these medications, and I was so hopeful that Remicade would help. Started Infliximab in April, insurance switched to Remicade after the three initial doses of Infliximab (?!), second maint dose was this week. Still holding out hope...
Posted 10/1/2022 11:22 PM (GMT -8)
I didn't realise you were on Remicade. Hopeful it helps.
Did you have a covid booster shot over the past few months? Some have had a flare somewhat after the shot.

I used cortifoam only once for 2 weeks, but it definitely helped when I wasn't able to get the mesalamine from another GI.
I was thinking maybe consider asking for a stool sample testing kit if you haven't already.

q
Posted 10/2/2022 8:28 AM (GMT -8)
Hoping the remicade will kick in soon for you. I’m curious—when they switched you to remicade from infliximab, you have to do the loading dose schedule again? Not that it’s a bad thing, I was just curious that since infliximab is a biosimilar to remicade, I thought they could just change it out. Interesting!

I always found uceris foam to be soothing so you might give that a try during the day. There was one time I couldn’t hold it in and had to expel it right after but that only happened once. Good luck and keep us updated! 🤞
Posted 10/2/2022 9:10 AM (GMT -8)

FlowersGal said...
I’m curious—when they switched you to remicade from infliximab, you have to do the loading dose schedule again?


No, it was treated as though the first brand name Remicade infusion was simply a continuation of the previous three Infliximab. In other words, the first Remicade was also the first maintenance dose.My insurance is weird.
Posted 10/3/2022 3:53 PM (GMT -8)
It's hard for me to retain them while flaring. This is not uncommon. I hope you get to feeling better soon.
Posted 10/8/2022 9:04 AM (GMT -8)
For what it's worth, once I got the really bad inflammation under partial control, I indeed had less of an issue with retention of the mesalamine enema. Not that it's especially beneficial, but at least I know I can continue to use it.
Posted 10/22/2022 8:54 PM (GMT -8)
Why not try the mesalamine suppositories? I’m going through a terrible flare now, cannot retain enemas, but i can retain the suppositories. (Not hydrocortisone supps)
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