ulcerative colitis and breastfeeding

I am 29 years old and have had ulcerative colitis of the whole colon since I was 14 with a few flare ups during this time. I have seen the same specialist for 15 years and he is brilliant. However I fell pregnant November 2010 and around 6 weeks into the pregnancy my colitis flared up pretty bad. I spoke to my gp who said to take colifoam as my meds are asacol tablets and colifoam but he wasnt sure about the asacol tablets. So I took the colfoam and after seeing my specialist at around 30 weeks pregnant started taking asacol tablets as it is ok to take them too. My colitis has never fully settled down, the bleeding has stopped but I have to empty my bowels at least 5 times a day and when I have to go to the toilet, I have to go there and then, I have no control over my bowels at the mo. I had a colonoscopy in feb which showed that my colitis was active and the advice was to carry on taking 8 asacol tablets and colifoam twice a day. It didnt calm down so at my next review in april the advive was to try asacol foam instead of colifoam, this didnt work and I have just been back today for my review and he has told me I should be on steroids to control it. The probem is I am breastfeeding my 11 month old daughter and wanted to do so till she weaned herself off me. He told me that I cant take steroids while breasfeeding and has given me 1 more month of trying pentasa suppositories 1g, he didnt quite understand how important breastfeeding is to me and my daughter and I would just like some advice if anyone can help me, I understand he is saying he is trying to help me by sorting me out but there is my daughter to think about aswell.

I also breastfed while on asacol and rowasa enemas. I got a pump and pumped all the time, froze the milk and weaned when I started a flare. That way, I was free to up my meds or go on prednisone and had a stockpile of breast milk to give my baby. You can't take care of your baby if you are sick. I am not advocating stopping breastfeeding, but don't feel guilty if you do either. Take care of yourself.

Prednisone will not give your baby diarrhea. The risk in giving an infant (or a child) prednisone is that it can stunt growth and promote bone loss. Although prednisone does not pass easily into breastmilk, on a 40 mg/day dose the report cited in the link above shows that 1 or 2 g/day will get to the baby. That may be sufficient to affect the growth of an infant.

Babies and children can take prednisone if they need to, but it is a decision made by weighing the relative risks of whatever condition they are trying to resolve. Breastfeeding is not something that should INCREASE the risk to a child, so that's why it's not recommended to breastfeed while taking pred.

I have also bfed both my sons while on asacol, mesalamine enemas and pred for flares (still bfing my youngest at 22 months....he is down to nap and sleep times). My oldest bfed through one 3 week course of pred and my youngest has bfed through two slightly longer courses. Based on the research I have done, pred is ok for short term use. Actually, because it is widely used, there is a fair amount of research on it. You may try contacting Dr Hale in Texas. He is probably the worlds leading expert on bfing and meds. You can call his office and speak with a nurse who will in turn speak with Dr hale and give advise. You can find his contact info in the internet.
Good luck. I understand how difficult it is to make medication decisions while having to consider another life.

I was diagnosed when my baby was 3 months old and was immediately put on 40 mg Prednisone and Apriso at that time. (My baby was born 5 weeks premature so was on the small side already). I wrestled with whether or not to continue breastfeeding her once on meds. My GI doctor greatly discouraged me. But he was an old codger and not at all knowledgeable about current thinking about the benefits of breastfeeding. I consulted my OBGyn and my daughter's peditrician, as well as the Infant Risk Center. I spoke with them on the phone and they were able to tell me the times that the medicines peaked in my system, and thus *try* to avoid those feeding times. My daughter is now 15 months old, and I'm nursing 1x per day still (now on Lialda and Imuran, but no pred). There were times I was completely paranoid about her poop, since it was the mesalamine which I was told *might* cause her diarrhea. But at the early age, I can say that it was hard for me to know what was normal poop anyway ..a solely breastfed baby will always have looser stools. My initial goal was to make it to at least the 6 month mark, so I could have peace of mind that I gave her the most lifelong benefits of breast milk. Once we made it 6 months, there was really no reason to stop. I started Imuran shortly after her 1 year birthday and my current GI (different one than I started with), is supportive of me continuing to breastfeed.

I worried about the growth stunting side effect also, but her peditrician said that I could come for more frequent weighing/growth measurement by a nurse only. I did that only one extra time, until I got comfortable that she was following her previous growth pattern. She started at the 5th percentile for weight and about 50th percentile for height. At her most recent 15 month visit, she is still 5th percentile for weight but 70th for height. She was 5 weeks premature, so for me, it always seemed to make sense.