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Acute Ileus From Steroid Withdrawal

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Ulcerative Colitis
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Posted 7/22/2011 3:06 PM (GMT 0)
Hi. I am a long-time UC patient who recently had a flare treated with enemas and sulfasalazine through a community clinic. The enemas resolved the urgency and diarrhea, but I had a skin rash reaction to the sulfasalazine. As the reaction occurred overnight, I stopped the sulfasalazine and decided to fill a prescription for prednisone that my doctor had previously written for me as a precaution. I took a one time 60 mg bolus (and a Benadryl) and the rash and headache subsided.

I dropped down to 40 mg the following day (therapeutic UC dose) and have tapered to 35 mg and 30 mg over the next 5 days. During this time (particularly after the reductions), I experienced constipation and abdominal distension/bloating immediately upon eating and most of the day. I am not having any diarrhea, bleeding, or urgency further down. More diffuse abdominal firmness.

I do not have a regular GI doctor and will not see one until next week.

Has anyone else experienced this acute transition to ileus (pseudo-obstruction) like symptoms upon prednisone withdrawal. How was it treated? Were you instructed to go back up to a higher dosage for a short-term? X-ray needed to rule out other causes of partial obstruction?

I understand this may also be inflammation returning to a bowel that probably already has some scarring and narrowing. Acute (non-toxic) megacolon can present this way, especially for long-time untreated disease. My colon actually does feel a bit distended and dilated. There is also definitely low normal motility. But, the quick progression of things suggest this is probably medication related. Acute paralytic with acute dilation of colon can result from prednisone withdrawal.

Any thoughts so I need not have to go through an emergency room (I do not have insurance). The doctors at the clinic have not been particularly helpful. This is understandable as they do not know the state of my disease and they are not GI or prednisone treatment specialists.
Posted 7/22/2011 4:49 PM (GMT 0)
Silversky, thanks for your post - you have managed to describe how my bowel feels most of the time. I'm going to steal these words when I next meet with my GI.

My abdominal distension/bloating/ileus is not acute but chronic. My motility has been slow for years and I typically wait it out. You might consider going to a liquid diet for a few days until this blockage resolves. I sometimes massage my belly to try and move stool along, and that helps a bit.

I recently adopted a gluten free diet to see if this would change my bowel issues, and the motility problem appears to be resolving. Before my diet modification I'd typically have 2-3 days in between bowel movements, and on the active day I'd have a lot of spasms, cramping and pass a lot of stool, starting out solid and trending to diarrhea. Now that I've been off gluten for almost 2 months, the cycle has shortened so I'm having about 1.5-2 days between bowel movements, the stool is all solid, the spasms and cramping are significantly reduced. No test has ever identified me as having celiac, but gluten sensitivity appears to be a significant concern among IBD patients according to recent studies so I thought I'd explore that a bit. Turned out good for me, no way to say whether it's something you might want to consider.

My inflammation on scopes has been limited to the rectum, cecum, minor ulcerations in the TI, gastritis and esophagitis. I just had an abdominal CT yesterday to see if I have stricturing anywhere, which might also explain the masses I collect occasionally in my upper right quadrant.
Posted 7/22/2011 5:25 PM (GMT 0)
I usually taper by 5mg every couple of weeks, that may have been a little too quick. Not sure. Call your GI, maybe they will move up your appt?
Posted 7/22/2011 5:50 PM (GMT 0)
Thanks for the replies.

I know the prednisone taper was unusually fast. I think I'm going to stay with a longer, slower schedule the remainder of the way. I'm otherwise stable and no acute obstruction, etc.

I suppose I just wanted to see what peoples' experiences were when tapering prednisone. Do you usually also get some rebound inflammation and constipation? Does it usually fade away in a couple of days?

I'm trying to determine what may be normal and expected vs. that which is enough of a concern to start back higher on the prednisone and come back down again. In other words, if the rebound inflammation, ileus, and constipation is fairly mild-moderate, is it much of a risk to just remain on the taper (although slower)?
Posted 7/22/2011 6:54 PM (GMT 0)
Seeing that you only took 60mg once, and then 40 mg down to 30 mg over 5 days, I'm not sure this is a rebound issue. I've taken 5 day bursts of pred for asthma a few times, where you start at 60 and get to zero in 6 days. The one time I took oral pred for IBD I was at 60 for 3 weeks before starting my taper. What you're doing sounds more like a burst protocol and may in fact be inadequate to reduce the bowel inflammation.
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