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Rowasa Enemas or Suppositories

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Ulcerative Colitis
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Posted 8/3/2010 5:48 PM (GMT 0)
Hi guys,

As you know, I had surgical removal of my colon two weeks ago (ileorectal anastomosis), in which I had my small bowel connected to my rectum.  I've also been dealing with a wound infection.

I notice a major difference--no more abdominal pains and no blood--although, I still have some sense of urgency and frequent, soft, powdery stools (I've told this is normal right after surgery--takes a while for the body to adjust--and I still have some inflmmation in my rectum, which may be having an effect.

I was thinking of using Rowasa enemas or suppositories for a temporary time while my body adjusts and helping to combat the minimal inflammation in my rectal area.  Are the enemas better than the suppositories?  What's the difference?  And is Rowasa more effective than hydrocortisone suppositories or enemas?

Thanks,

CollegeGrad85

dx with UC in 11/2008

colon surgery - ileorectal anastamosis, on 7/13/2010

dealing with some urgency, frequency issues, runny BMs, but no more blood and no more pain

Posted 8/3/2010 9:16 PM (GMT 0)
Rowasa will reach higher while the suppositories are for the rectum. Whether or not it's more effective then the steroids, I guess it depends on how bad off you are and how quickly you heal. The steroid supps and enemas are quicker though.
Posted 8/4/2010 12:32 AM (GMT 0)
What did the doc suggest? what have you used in the past?

I guess it would depend on how much is involved, how much urgency, etc. The foams would be good, but only come in steroid in North America. I think 5ASA would be best to start if you had success with them in the past.

The other option would be to use something like proctocedyl if it's only minor inflammation and not UC-related.
Were you the one who the doc made promise to use rectal meds?

q
Posted 8/4/2010 2:10 PM (GMT 0)
Hi Quincy--
No, I've used hydrocortisone suppositories in the past, but my GI never recommended anything. In fact, when I first proposed the idea of rectal meds, my GI literally said "that's gross, why would you want to put something up your behind when you could take a pill?" I don't see him anymore--he's obviously uninformed and unhelpful.

Keep in mind I only have a rectum now--the rest of my colon is out. So maybe I should take cortifoam or hydrocortisone enemas instead of Rowasa? I guess taking a suppository vs. an enema doesn't matter?
Posted 8/4/2010 2:39 PM (GMT 0)
I would think the enemas might be too much liquid possibly...the suppositories, either Canasa (5ASA) or hydrocortisone would work. You can use them more than once a day if needed. But a foam would be getter than a liquid if you do the enemas, just for comfort. But that leaves you with steroid only.

WOW...weird GI you had. sigh.

q
Posted 8/4/2010 3:43 PM (GMT 0)
Yes--my GI was of no help. Never recommended anything, just told me to go online if I had questions or wanted to try something. And he knew nothing about probiotics--when I brought them up, he told me just to buy some yogurt!

My GI right now is SO much better--he's a fan of Probiotics, recommended some to me that were backed by research and clinical trials, and he stays on top of the latest UC research.

In the past, oral 5ASAs really haven't worked for me, but maybe the rectal ones will? Based on the lack of success with the oral meds, I don't know if I should stick with the steroid suppositories or try the rectal 5ASAs.

On another note, since I'm on a high dose of amoxicilin now, I've noticed more frequent and loose, diahrrea-like stools, which I did not have after surgery. Could I attribute this to the antibiotic? The listed side effects include 'mild diahhrea.'
Posted 8/4/2010 4:04 PM (GMT 0)
The steroid enemas and suppositories aren't really ideal for maintenance meds because they thin the tissues. So, I think you should try the 5ASA rectals. The enemas are a lot stronger than the suppositories, they reach higher, and there's a generic (mesalamine rectal suspension). The suppositories (Canasa) are less medicine, should be sufficient to treat just the rectum, and IMHO are easier to retain, but there is no generic. I find that the steroid rectals are "stronger" but as I said they aren't really meant for long term use, so I think it's worth trying the 5 ASAs because if they work for you, you can use them as long as you want or need to. That's my 2 cents. :o)
Posted 8/4/2010 9:36 PM (GMT 0)
yes...I agree with Jennifer. The 5ASA would be best to start with longterm.

Having meds "work"...probably the oral 5ASA didn't because you still had lower inflammation that wasn't being touched by the oral meds...so basically, not a "both ends approach".

Yes, the antibiotic could be causing loose stool...if you have probiotics, good to use them.

You might want to put out a specific post to suebear regarding those issues.
She might not have taken a look at this thread.

q
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