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How to treat diversion colitis?

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Posted 10/20/2017 11:56 PM (GMT 0)
Hi, I had a colectomy surgery 18 months ago and have been battling with diversion colitis in my rectum (which is diverted during the surgery) for a year.

Obviously, if I have an anastomosis surgery to attach my rectum and remaining part of my colon, the diversion colitis will disappear; but my rectum is not in a good shape and that's why I can't have an anastomosis surgery.

I've been using 6MP since the surgery, and it's not helping with the diversion colitis. I asked my GI doctor about using mesalazine enemas, and he said they are ineffective at treating diversion colitis.

Do you have any suggestions? Any experiences with this?

Thanks in advance.
Posted 10/21/2017 2:03 AM (GMT 0)
As long as you have your rectum it is likely you will have the problems you have right now, barring finding medication to treat it. I've never heard of being unable to do the next step because of rectal inflammation. I'd imagine everyone who has a 3 step has some level of inflammation in their rectum between the first 2 steps.
Posted 10/21/2017 4:44 PM (GMT 0)
Mine is not 3 steps, it's 2 steps. I have narrowing in my rectum (and inflammation) and that's preventing the anastomosis.
Posted 10/21/2017 10:28 PM (GMT 0)
Are they making the pouch and reconnecting in step 2? We had a member from england who had it done that way and he had fantastic results. Usually people have the colectomy and the pouch created in step 1 and stop 2 is a simple reconnect.
Posted 10/22/2017 1:30 AM (GMT 0)
I have Crohn's, so no pouch for me. It would be just a regular anastomosis between my colon and rectum. They can't do it because I have strictures and inflammation on my rectum, which would result in serious problems if I get an anastomosis.

NSSG, the anastomosis isn't an option for me. I want to know if there is a way to treat the rectal inflammation right now. My GI doctor says mesalazine enemas wouldn't be effective in this particular case.

Anything else I can try?

Post Edited (xy123) : 10/21/2017 7:39:05 PM (GMT-6)

Posted 10/22/2017 3:15 AM (GMT 0)
Oh, sorry. I didn't realize that for some reason. How about steroid suppositories? Or steroid enemas? Why does the GI say mesalamine won't help? I know i'd want to try anything, especially the stuff with the least side effects... There is also foam, like uceris, or cortifoam. I know with pouchitis, some people have to resort to using regular drugs to reduce immune response, since you're already on 6mp, maybe a biologic or prednisone?

That stinks. I am sorry. I wish you could be cured & not need to worry about treating it. I am sure in time you will be able to get it managed and reconnected. I think strictures are typically dilated with a quick outpatient procedure. I've heard it's not comfortable so you would want to be sedated.
Posted 10/22/2017 11:26 AM (GMT 0)
Thanks for bringing those options up. I will ask my doc about rectal steroids and dilation.

He said, since I've tried all the biologics without much of a response, he doesn't expect them to help me in the rectum. Despite the Crohn's diagnosis, my most difficult and problematic area is the rectum.

My GI says mesalazine enemas won't help because the nature of the diversion colitis is vastly different than that of regular inflammation. He said, inside of the
diverted bowel becomes a mass after the diversion, and the diversion colitis doesn't respond to mesalazine. We expected from 6MP to do the trick (and it's been very helpful in other parts of my GI system) but it hasn't done anything noticeable on my rectum.
Posted 10/26/2017 1:45 PM (GMT 0)
I was prescribed rectal mesalamine for diversion colitis. I didn't take it as the bleeding mostly only once a day. My treatment was proctectomy. We made the decision to forgo the j pouch and have a permanent ileostomy.
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