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Tolerating mesalamine enema? Also - general enema question!

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Ulcerative Colitis
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Posted 6/8/2011 12:12 AM (GMT 0)
Hi all -

I have been on 6mp (50 mg) for about two years and doing well, until this past week when i seem to be at the beginning of a flare. I cannot tolerate the 5-asas and have tried pretty much all of them, which is what led me to 6mp. Anyway, my gi wants me to try a mesalamine enema. I am concerned that I'll have the same reactions to the enema as I did to the oral medication. Anyone find this not to be the case (i.e., sensitive to 5-asas orally, but fine with the enema?)

Secondly - I have never used an enema, other than preparing for a colonoscopy. Are there any tricks to this? The directions seem sort of scary. How do I deliver it and then stay in the same position for 30 minutes? Am i just supposed to lie on the bathroom floor? Is this stuff going to stay in or should i wear a pad to bed or something? Will a pad be enough? thanks for any and all advice!
Posted 6/8/2011 1:22 AM (GMT 0)
You retain the enemas overnight by lying on your left side, inserting and squeezing...then fall asleep :) It's best to retain them for at least 30 minutes but overnight is better.

Btw, I can not do mesalamines in any form - oral or rectal. However, I do okay with Colazal which is a basalazide but it's still a 5-ASA.
Posted 6/8/2011 1:31 AM (GMT 0)
Thanks for your response, Sherry! I am afraid that i won't tolerate the enema either. But honestly - don't think i can tolerate giving myself an enema in bed with my partner lying right next to me! i think i will have to head off to bed super early. Does it come rushing out of you in the morning then?
Posted 6/8/2011 2:31 AM (GMT 0)
Hi.  I don't know about the not tolerating oral but tolerating rectal meds but I can help you on the enema procedure.

I do the enema in the bathroom, stand up, quick rinse of hands and go lay down right away, on my left side...that's what I'm doing now actually.  I wore pads at first because I was unsure but I don't anymore.  If it makes you feel better, go for it.  As far as in the morning, when I'm flaring it is a bit more explosive but in remission the enema just becomes part of my BM.

Best of luck.

Posted 6/8/2011 2:47 AM (GMT 0)
i always did my enemas in bed right before going to sleep. i tried to go to the bathroom as much as possible before laying in bed though!! just try to hold it in as long as possible. i know a lot of people wake up in the night to go to the bathroom and i did, too. sometimes, if i had to go and it was too soon after, it would be a milky substance coming out but i figure at least it was in there for a little while. it helped me most to stay on my left side for the whole 30 minutes. if i shifted onto my back, it was almost guaranteed that i would be running to the bathroom.
Posted 6/8/2011 11:12 AM (GMT 0)
They aren't bad at all. I take them nightly and for the most part can't even feel/sense them inside me anymore. I take them at 5-6:00pm after my shower and hold them until the next morning without issues. At first they feel really awkward but over time it gets easier. Some say to start out with half bottles and to do that for maybe a week. I didn't have to but its a tip that might help. I don't do them in bed because i don't want that stuff to get on my sheets. I go into the bathroom and get on my knees in the bathroom, insert , clean off then jump into bed.
Posted 6/8/2011 11:45 AM (GMT 0)
Retention enemas are designed to be absorbed unlike the ones you would use for a scope. When you are sleeping, majority of the med will absorb into the colon. I have never had any issue with leakage.

But if it makes you better to do them elsewhere besides the bed, you can go to the bathroom and do it there but then you will want to lie down immediately so the med will distribute evenly along the colon. If you walk around after administering, you may feel more pressure on the rectum and get leakage.
Posted 6/8/2011 12:09 PM (GMT 0)

Red_34 said...
Retention enemas are designed to be absorbed unlike the ones you would use for a scope. When you are sleeping, majority of the med will absorb into the colon. I have never had any issue with leakage.

But if it makes you better to do them elsewhere besides the bed, you can go to the bathroom and do it there but then you will want to lie down immediately so the med will distribute evenly along the colon. If you walk around after administering, you may feel more pressure on the rectum and get leakage.

I never lie down after after filling up. I put it in, then get up and do whatever i want. There are times where i had to go out to the store afterwards and never had an issue/leak.
Posted 6/8/2011 12:24 PM (GMT 0)
Wow, Dsm - I'm impressed!
When I've had to do them twice a day, I've added a morning one besides doing one at night: I've stretched out on the bed for 30 minutes after doing it, lying on my left side and ... I usually read for that 3o minutes, then get up and go on with my day.

For the night one - I've almost always done it in bed, dear hubby next to me (usually we've turned off the lights by then and he';s turned the other way.) I just shake it, carefully squeeze the air out, and, stick it in and squeeze.
In all these years, so far no leakage.......
Posted 6/8/2011 12:37 PM (GMT 0)
I'm impressed as well :) But that is why I said MAY to the OP.

Usually when I do mine, if I get up I get cramping and a heaviness feeling. Depending on my inflammation, sometimes it triggers a bathroom run.
Posted 6/8/2011 1:08 PM (GMT 0)
I would like to add to all the above, I used to not tolerate the enemas but after receiving a tip to squeeze out all the air possible, it has made things much better and I am able to easily tolerate them. I squeeze the bottle until the liquid comes out and keep the pressure on the bottle to prevent air from going back in and then proceed with the enema. It has helped my crohn's colitis considerably.
Posted 6/8/2011 4:39 PM (GMT 0)
I have no problem. I use mine before bed and go on to bed and sit up and read for a while. I have no leakage problems, do not have to lay on my side at all. Most of mine is absorbed by morning, I pass very little.
Posted 6/8/2011 7:08 PM (GMT 0)
Thanks for all the tips everyone. Unfortunately, I am feeling much worse this morning and I don't think I can tolerate the enema form any more than i can the oral. I have a call in to the GI so we'll see if he makes me do another night of it. If so - i will remember to squeeze out the air and not worry too much about doing it in the bathroom first then transferring myself to the bed.
Posted 6/9/2011 8:22 AM (GMT 0)
there are steroid liquid enemas and foam enemas if you cannot take the mesalamines. Worth a try.

What are your symptoms from the 5ASAs?

q
Posted 6/9/2011 5:01 PM (GMT 0)
I am going to ask about the steroid enemas when i get a call back from my gi today. In general, the 5 ASAs just worsen all my symptoms - so if I had diarrhea before now it just is like water. Cramping gets worse, I get totally bloated, very gassy. The last time i was on one I had such terrible heartburn that i almost went to the ER for it (before i realized what it was from). I don't have an allergic response, they just don't work the right way. Anyway - thanks for your suggestion - I will bring it up with the dr today.
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