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Chronic Proctitis

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Posted 8/5/2011 2:21 PM (GMT 0)
It looks like my diffuse constipation may be due to chronic proctitis and resulting scarring/narrowing. On CT scan, both rectal wall and lower sigmoid were thickened.

For those who may have had rectal and/or sigmoid narrowing from chronic procitis, what do you think is the best long-term treatment option for mucosal healing?

I don't think I have active inflammation currently (no urgency, blood, or diarrhea). The abdominal distention and constipation remains. I am alternating mesalamine enema, cortifoam, and steroid suppository. I am tapering prednisone.

Does continued treatment help with mucosal healing from longer term scarring/fibrosis? Has Canasa or steroid suppository (Anusol) worked better for you to reduce swelling and narrowing?
Posted 8/5/2011 5:18 PM (GMT 0)
This seems to be a problem I have, my scans always show constipation. I use Canasa every day, but am currently having narrowing/swelling. I see a new GI next week, so if I get any new meds/advice I'll pass it on.
Posted 8/5/2011 6:28 PM (GMT 0)
Thanks, BeachGirl.

I think the most difficult thing to determine is whether the constipation and lack of motility is truly due to scarring/narrowing in the rectum and sigmoid or actually new onset inflammation further up and around the colon (which is always possible in progressive disease).

The other important question for many of us with potential scarring is how much continuing active topical treatment helps. In some cases (such as with Remicade), healing of mucosal inflammation actually sets down yet another layer of scarring and fibrosis.

From a purely science perspective, fibrosis anywhere in the GI tract doesn't recess that much once there. However, I'm hoping continuing treatment and holding off new swelling (hopefully also some reduction in scarring) may help day-to-day for those of us with motility issues due to bowel thickening/narrowing.
Posted 8/5/2011 7:16 PM (GMT 0)
SilverSky...just to clarify..you have Crohn's colitis, correct?

You should also check out the Crohn's forum.

q
Posted 8/5/2011 7:20 PM (GMT 0)
I have indeterminate Crohns-Colitis actually. My symptoms are UC in nature. That's why I'm on this forum.

I thought people would be more supportive (if you suffer the same condition they do). I'm sorry I don't have a more precise diagnosis for you, quincy :) I'm really more concerned with getting help and helping others with useful information and insight.
Posted 8/5/2011 7:30 PM (GMT 0)
Well, the fact that you have more than likely Crohn's colitis, you can balance your questions in both forums to get both perspectives.

You have scarring and thickening, it's indicitive of what's happened as a result of the chronic inflammation and most likely CD.

Regarding your biopsies, does it state how deep the scarring goes? Does it state exactly the shape of the cells from the inflammation? That as well can be indicitive of what's going on.

Is your rectum inflamed at this point? or do you have no inflammation with the thickening and scarring?

If you think we're not supportive, then your perspective is skewed.

I've explained to you that if there is scarring and changes within the rectum, the rest of the colon will not receive appropriate messages regarding peristalsis, etc.

Keep asking questions and we'll keep asking questions until we both understand what we need to know in order to have you satisfied.

By the way, we're not doctors, but many of us do lots of research in order to make suggestions and help others understand what's most likely happening.

Are you on rectal meds?

Once you have cellular changes caused by thickening, it goesn't resolve itself I don't think. But that would require research. I don't have CC...so the cellular changes in my rectum due to chronic inflammation haven't reached the thickening stage.

q
Posted 8/5/2011 8:14 PM (GMT 0)
Most of my biopsies in the past have shown more of a UC pattern. You're right, Crohn's would have more wall thickening. Although both conditions can have rectal/sigmoid scarring of course.

So, probably just more interested in sharing and getting others' collective experiences with otherwise quiet disease that has progressed to some scarring and bowel narrowing. I think this is probably an important topic for many of us long-term.

Anyway, sorry if my questions were a bit technical. Although I have a science/medicine background (and understand that stuff well), I try to share and exchange on some topics that I think may have real and future importance for a lot of people.

Everyone's been supportive. I've only asked a couple of questions (and have always given complete information actually). I just thought some of your responses have been a little aggressive (not sure why). Anyway, we're all in this together and we should be supportive and open to everyone. But, I know you are trying to help.

Anyway, getting back to the topic, perhaps others will contribute. Should I find out more from my GI about anything helpful on the distal disease/scarring/constipation issue, like BeachGirl, I'll definitely share.
Posted 8/5/2011 8:22 PM (GMT 0)
Please check out the CD forum. Most of us here will not have the thickening you describe unless we have consistent unrelenting inflammation.

UC and CD differ, so if you fit into that category and expect more sharing, it seems limited on the UC forum since only a few of us are contributing.

I don't have the thickening, and still ask questions, trying to understand your point and offer some suggestions.  Do they not make any sense at all...or am I frustrating you even further?  There are only a few reasons why things in the colon/rectum don't work in tandum.  Some things cannot change, some can. 

If you're asking scientifically, maybe clarify on a level that others can understand.

Since you do think on that level, it seems that you would find the information by searching more indepth.

Aggressive? well, I would ask the questions point blank since I have asked so darned many in the 8 years of being on here, and with you being here for over a year and hopefully reading other threads that don't necessarily pertain to your situation, you'll see that I'm the same across the board.

as always and continuing to support in many aspects. You don't seem to need emotional, so I'm not responding in such.

If this helps, I feel your frustration in not getting the answers you need...hugs to you.
q
Posted 8/5/2011 10:30 PM (GMT 0)
SilverSky,

I would recommend your adding: L-Glutamine 15 grams daily at least - it is known to  help with colonic repair.

What do you think?

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