Pain/discomfort when starting to have "normal" BMs again?

I have been recovering from a flare and went from watery stools to solid. I still have a bit of discomfort when passing the solid stools and it stems from the fact I still have moderate to severe inflammation in my sigmoid colon and rectum (confirmed from recent flexible-endoscope). It could be that you are healing, thus the more solid stools, but still have a bit of inflammation in your rectum which you feel when passing the solid stools?

I know I have inflammation in my rectum, and I think I might have some just above it as well. I see you take 5g of Lialda, which I'm guessing is four pills? I currently take two. My doctor has suggested I try more, but I am hesitant because I feel like I may not tolerate 5ASAs very well, even though they provide me relief at the same time. How well do you tolerate 5g? Did you ever take a lower dose of it?

Zigzag, I have been taking 4 Lialda pills in the morning, since my initial diagnosis. I have never taken less of them. I have never had a side effect from meslamine based medications, they are very well tolerated by most, and what little side effects are listed for the medication are not really of much concern. I think you would do fine on more Lialda a day, the few who have negative reactions to it (a meslamine intolerance) know right away and stop taking it immediately. If your GI has recommend 4 lialda a day then try it as the benefits far outweigh the risks.

If you still have inflammation then it seems to me you would have a few options, increasing the Lialda dosage (from 2 pills a day to 4), increasing the 6mp dosage (if possible based on body weight), or increasing the frequency of your Remicade infusions (from every 8 weeks to every 6 weeks). 6mp is given in a 1mg-1.5mg per 1 kg of body weight basis. So, if you are on the low end of that scale then you could be boosted to the high end of that scale (e.g., I weigh 132 pounds or 60kg; 50mg of 6mp puts me on the low end of that scale; 75mg of 6mp puts me on the high end of that scale). Or you could consider Rowasa instead of canasa if your uc extends beyond your rectum into your sigmoid (no benefit if it doesn't). Canasa frequency could also be increased. If you are already on remicade though, I wonder how much good the meslamines are doing at this point (lialda, canasa) as lot of GIs cut them off once you hit remi.

There are a number of posts about tips to hold in the Rowasa. In short it takes time, and practice to retain them. Just don;t get frustrated if you cannot hold it in. Keep trying for a couple weeks and you will get better at it. Generally with Rowasa you will want to:

• Use it after a bm to ensure you are empty
  
• Warm the bottle up to body temperature before using it (put it under an armpit to warm it up fast)
  
• Squeeze all of the air out of the bottle before administering (as injecting air will cause discomfort and increase the odds you have to expel it fast)
  
• You will have some immediate discomfort and need to evacuate the liquid but ignore the sensation as it passes within a couple minutes time and things will settle down.
  

At least you have some options. Try them out with your GI and I hope you find the right combination to finish your healing. Good luck.