Oral plus rectal delivery is the best way to put the fire out. I have been using balsalazide and nightly mesalamine enemas for the last 1.5 years. It was fine until July, when I took a round of antibiotics and experienced a flare shortly thereafter. Since then, it seems that one or both of these medicines are not agreeing with me anymore. I am thinking it is the balsalazide. I read a study that balsalazide is not cleaved efficiently in those who have recently taken antibiotics and have an altered microflora (balsalazide is cleaved in the colon to produce 5-asa). For a while after July, when I would used both, I would get cramping and urgency would increase. Not to mention the diarrhea. My doc says that diarrhea is a common side effect with these drugs, but that worsening of colitis is rare. I don't buy that.
I have since gone on Remicade and still use nightly mesalamine enemas. I dropped taking the balsalazide for a while and tried to reintroduce it (1 tablet, twice a day) on a number of occassions. Even with this low dose, my bleeding increases after 1.5 days of starting back up on balasalazide. I want to try Lialda or go back to Asacol in order to see if I have better success with another oral mesalamine.