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using rectal meds 2x a day

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Ulcerative Colitis
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Posted 3/8/2012 4:19 PM (GMT 0)
QUESTION: If I do rowasa nightly, do you think it would be helpful to add another rectal in the am? what would be best? another rowasa or would it be helpful to alternate it with the hydrocortisoe enema? also would canasa get up far enough (sigmoid is only area affected) 

 

** I did this yesterday, rowasa at 10 pm and then at about 5 am, i did a hydrocort enema and went back to sleep till 630 when i had to get up for the day. i had 3 bms, still urgency and less blood.*** i am thinking i will continue this to see if i get an improvement, thoughts?????

 

symptoms: 3-5 bms a day, some days trace blood, recently some days more blood/pain, mild urgency. Same flare since 9/2008, with only a couple blood free weeks here and there.

UC: isolated 4 inch inflammation in my sigmoid

Meds: lialda max dose, budesonide/entocort(but weaning off), rowasa EVERY night ( i have not been able to get better than above while on rowasa for 2+ years). I recently tried hydrocort enemas instead of rowasa. Had 5 great days, then the same or worse than before. gi says switch back to the rowasa.

* tried vsl3 ds for 9 months, no changes

*trying slippery elm, no changes , in fact i think i was worse the next day, but still trialing

*i have been gluten free for 2 weeks, with no changes, in fact had 2 really horrible days (alot of red blood and PAIN) which i suspect 1 is from red meat and the other from sneaking some chocolate(i am also lactose intolerence)

* I am about to be part of a study to try budesonide rectal foam, that should start in a few weeks.

*tried pred (first time) in 2010, blood came back 2 weeks after weaning

thanks everybody!

 

Posted 3/8/2012 5:36 PM (GMT 0)
My symptoms are a somewhat milder version of what you have described, although I have only been dealing with this since Sept 2010.

My diagnosis was pancolitis, but the inflammation was very much like urs - most severe at the sigmoid. I find that doubling up the rectals (Canasa for me) as very helpful. I usually do so for a week maybe, and my symptoms become manageable to the point that I can go back to once daily.

The only other med that I'm on is AsacolHD 3200mg daily. I can't speak to the efficacy of it, but I do notice that symptoms come back if I try to get off that dose.
Posted 3/8/2012 6:21 PM (GMT 0)
Whenever I'm prescribed rectal meds my doc requests that I do it twice/day in the am and pm, but my am's are soooo bad that it's wasteful for me so I just use it in the pm...if you're having success doing am and pm then definitely stick with it.
Posted 3/8/2012 8:32 PM (GMT 0)
Thus I asked some time ago about Canasa twice a day. When I had some symptoms back in Dec, I did as I read here. And took Canasa in the evening, right before the bed, and during the day. Maybe not mornings, as I usually have my bathroom trip somehow before noon. It was rather @1-2pm, if I had like half an hour to lay down. Because I do similarly as with enemas, I take Canasa and lay down on my left side, with my bum slightly higher.
And well, it helped, a lot. So even though my GI prefers taking one a day, if things go wrong, I'll take two.
Sorry, but can't help with other rectal meds. I just don't remeber which enemas I was taking, it was s few years back.
Posted 3/8/2012 8:49 PM (GMT 0)
One doesn't have to lay down with the suppositories, but if you notice you have any urgency to expel it, maybe it's a good idea to calm the rectum down.

i l c....maybe alternate with the steroid enemas during the day and the 5ASA at night.

What about changing your oral 5ASA to Colazal?

q
Posted 3/8/2012 9:00 PM (GMT 0)
I do it if I'm feeling a flare-up coming on. In fact I started getting a little sick while on vacation last week and started up the mesalamine enemas twice a day (was doing them only at night).  Also I'm weaning off Prednisone so I feel its a way to help me get off of that without going back into a flare. I'm not going to take then twice a day/every day  now that I'm back home but still plan to do it twice a day for a few days each week after the day I taper my predinisone for that week. 

I've done it often in the past (I've had this for 17 years) and it always seems to help me.  My old GI never said it was an issue - new GI doesn't like me taking any enemas but i've had this long enough to know that they help me and I'm doing what helps me.  Just make sure to always get your liver and kidneys tested when you go to the GI.

Posted 3/9/2012 2:47 PM (GMT 0)

thanks everybody so far

i did the rowasa at 10pm, and then at 4 am, did hydrocort enema , then woke up at 630 am for the day.    only 1 bm ,kinda watery, no blood i can see, had  some urgency, no pain.  I think i'm gonna try the rowasa night  and cort enema morning thing for the next week or so and see how things go.

Quincy: what is different about colazal? do people have more sucess with that with the sigmoid?  also do you think canasa gets up to the sigmoid?

MN Beach gal: in the past with a bad flare i will do mesalamine enema at night and then a mesalamine supp like canasa during the day. ive never done 2 enemas like this.  i never thought i could retain it to be about to go along with my day.  but i always wake up around 4 am to go to the bathroom , so i figured i could do the enema then and have 2 hours for it to absorb before i have to get up for the day. 

Posted 3/9/2012 8:56 PM (GMT 0)
Canasa doesn't get to the sigmoid..it's not a liquid and has NO volume. it's a good thing to use in support of the enemas, however.

The colazal is a different form of 5ASA..it's not a mesalamine..it's ozalazine. I'm just suggesting it as an alternative that you haven't tried. Some do better with it than the mesalamine.

It's touted as the "left-side oral"..some mistakenly believe it's released in the left side...but the fact is that it releases throughout the entire colon. It's been noted that left-sided UCers have good success with it. So...it's something you haven't ried..that's it.

Do the hydrocort enema after your morning bms. A foam would be better to retain during the day..but if you can do the liquid, that's awesome. again...another option for you to try.

q
Posted 3/10/2012 1:56 AM (GMT 0)
thanks Quincy.

and i spoke too soon for my last post, i ended up with my usual 4 bathroom trips.  the first 2 bms i couldnt see blood, the third, i saw trace blood and the fourth a clump or two of blood.  i was soooo bummed.

i will ask my gi about colazal, but i have a history of right sided uc.

my active time for bm's is from about 9-1130 am, and i work full time, I can't do the retention liquid at work.  i have never used a foam.  does the foam go up to the sigmoid, and would it be something i can put in the bathroom at work, and then go back to work?

Posted 3/10/2012 2:59 AM (GMT 0)
I started using Canasa about a year ago. My GI had suggested I try the mesalamine enama for better coverage. He suggested that I could use the enema at night and then use a Canasa in the am after I moved my bowels. I should do this when having more symptoms and then back off on the Canasa once things settled down. I follow this now. I normally use a nightly enema but will add a Canasa if my frequency and urgency start to go up.
Posted 3/10/2012 9:23 AM (GMT 0)
i l c....the colazal will treat the right colon as well...like I said, it's a different 5ASA other than mesalamine.

The only foam in Canada and US is steroid...but Cortifoam would cover the sigmoid. I don't think you have to lie down after using it unless you can't retain it. I think it can be inserted while standing with one leg up or on the toilet..? I used the proctofoam or cortifoam for 2 weeks 23 years ago...I think I did it in the bathroom, not in bed if I remember correctly.
q
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