Enemas? Plus a few other things..

I am currently on Mesalamine enemas.  This time around with them I have had a lot of trouble retaining them. 

I have heard of other types of enemas used for colitis.  Does anyone think they could give me a run down of the difference/uses...do you think I should consider using a different type or both?  My doctor has not brought this up at all but I thought about requesting something different.

Also,  My doctor has only tried Asacol, the meselamine enemas, prednisone, and now remicade (starting January 2013).  I was better immediately after first remicade treatment but the following treatments did not seem to work so well.  Treatments are 4 weeks apart now and after 3 weeks bleeding has returned.  Doctor has mentioned surgery a few times, but I just feel I should try some other things first.  I am looking into trying a gluten free diet and may try that for about a month and see how that works.  Any thoughts?  I love reading all your posts.  There are so many people with lots of good information/experience here.

Generally, there are two types of enemas used for uc.

First, there are meslamine-based enemas (Rowasa, SF Rowasa, and there is a generic meslamine enema as well) all of which come in 60ml bottles with a liquid inside that coats the rectum and all of the sigmoid colon. These enemas can be difficult to hold for long if you have a lot of active inflammation in your rectum. As the inflammation decreases, it is much easier to retain.

Second, there are steroid-based enemas (Proctofoam HC, Entocort EC) which have the same active ingredient as prednisone. With the enemas the steroid is placed topically on the walls of the rectum and the rectum only (doesn't go as far as meslamine enemas). Many say the steroid enemas are easy to retain (unlike the meslamine enemas there is no liquid sloshing around creating discomfort); it is a foam. You are dealing with a steroid so the same side effects as pred are present, albeit at much lower dosage and much lower systematic absorption than pred since enemas are applied topically (like a 10% systematic effect with the enema).

You can mix and match these. For example, some use meslamine enemas in the morning and steroid at night, or vice versa. The steroid enemas, like pred, are meant for short term use; use them to get out of flares or for the occasional blip or bad day. The meslamine enemas can be used daily, indefinitely.

Which mesalamine enema exactly...including how much mesalamine in the enema?

How long have you been on them recently?

Are you using them at night?

The other enemas would be steroid...they can help as DB suggested. They come in liquid and foam.

The other option would be to try suppositories.

How many times a day are you going? and is it loose, diarrhea, formed?

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