Worried...First flare

I've had Crohn's Colitis for now close to 2 years.

Since the past one month, I've been experiencing my first flare. It started with small streaks of blood mixed with my stool. I talked to my GI and he first increased my Lialda from 3.6 g to 4.8g. However, after 2 weeks there was no improvement. Then he prescribed Canasa, however still no progress. I now have an appointment with him the day after tomorrow.

My questions to you experienced Crohn's patients are:

1)Along with the above symptoms,  I have a good appetite and no other pain other than occassional queasy feeling. Are these symptoms-bloody stool and occassional queasy feeling common for Crohn's Colitis patients? In fact what are the common symptoms for Crohns of the colon only?

2) Will my next progression in medication be Prednisone or some form of biologics? I have read that Prednisone has an exit strategy while biologics don't. 

3) Is conservative way of treating this flare-up preferable (with say reducing flare using Prednisone), or should I jump to biologics?

Any other suggested questions for me to ask my doctor?  

Thanks in advance for all your help and advice.

Hi. My husband has crohn's colitis. Normally when in a flare, he has diarrhea several times a day (sometimes with, sometimes without blood), abdominal pain and cramping, night sweats, slight fevers, fatigue, some joint pain, and if his rectum is involved, extreme urgency. He's basically quite miserable. He is also unable to tolerate most foods, and has to go on a low residue diet, or just drink ensure/boost to give his bowels a break.

It sounds like right now you maybe having a small flare up, or it even just be internal hemmies. Has the doctor done any blood work to see if you have any inflammation? I'd recommend doing a CBC, ESR and CR-P test to see if you are showing any elevated inflammation markers. When you do have blood in your stool, if it is bright red streaks on the stool, it could well be from hemmies, because normally bright red blood comes from the lower end of the digestive tract.

To me, it doesn't sound like your symptoms are very severe, and to be honest, this may not even be a flare up - it could just be internal hemmies. So, I think it warrants more information before upping your medication. In addition to the blood work, your doc maybe able to do an unprepped flex sigmoidoscope, to see what the state is of your colon. They've done this for my hubby several times when they've suspected the inflammation is lower in the colon.

Once you have determined you are in a flare, then you can decide on the course of treatments. If this is a flare up, it sounds to me like Asacol is keeping your flare up mild. So, you may just need a short course of pred, or even just steroid suppositories to stop this flare up and just continue your maintenance on asacol. However, the best person to offer this advice is your doctor - based on blood work, and findings in a scope, and based on your symptoms.

Good luck. I hope you aren't in a flare, and this is something as simple as internal hemmies.

((Hugs))
PV