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Are rectal meds necessary?

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Ulcerative Colitis
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Posted 8/21/2013 2:05 AM (GMT 0)
I had been on Canasa for about 6 months. My doctor has taken me off of them thinking they are not doing much. I never thought they made a huge difference for me. I have been off them now for two weeks and not noticing any differences. I do have a prescription for hydrocortisone enemas but have not started them yet. My plan is tomorrow. I know I can only be on those a short time. Should I always be on some type of rectal med or is oral sometimes all you need?

My symptoms currently are 1-2 BM's per day. Some are more formed than others. I'm not sure if that could be from food intolerances or UC?

Posted 8/21/2013 2:10 AM (GMT 0)
Hi,

I don't think you always need a rectal med IF you are doing well without it.  I NEED it for certain.  I take one Canasa every night for almost 5 years now.  If I didn't I'd just lose blood.  My last GI doc said my rectum is fried.  I have ulcerative proctitis.  For me Canasa is NECESSARY.  If you are doing fine without it then you don't always need it.  GOOD LUCK!

Posted 8/21/2013 2:21 AM (GMT 0)
Thank you. I have proctitis too an worry about it creeping back in. With my current symptoms do you think the steroid enemas are necessary? I guess my GI was feeling like I still have inflammation with the loose bowels?
Posted 8/21/2013 4:49 AM (GMT 0)
I think a lot of us do better when we keep them in the routine, even if it's only a couple nights a week. I am trying to cut down, simply for convenience, and I haven't noticed a difference in symptoms but it's only been a few days :) Just pay attention to your symptoms. In my opinion, it's good to have rectal meds in the house in the case that you need them. i tend to use mine regularly to try to keep things calm. I've been in a long remission so perhaps it's working. 1-2x a day is good. Do you have any bleeding or urgency? Maybe you're in remission from Apriso and rectals are unnecessary.
Posted 8/21/2013 11:35 AM (GMT 0)
My UC was always worst in the rectum, but none of the rectal meds were effective for me. They're great if they work - but they don't work for everyone.
Posted 8/21/2013 12:35 PM (GMT 0)
Study after study shows that patients who use both oral and rectal meds gain remission more quickly and stay in remission longer than those who only use oral meds. So yes, I think they are necessary. However, I'm pretty sure that all of the studies I've read have focused on mesalamine enemas, not supps.

I think it would be worth trying mesalamine enemas instead of steroid ones.

I've been in remission for over 4 years using both Apriso and twice-weekly mesalamine enemas. I have no intentions of stopping, even though I probably could get away with it. It honestly doesn't bother me to use the enemas and I'd really rather not flare.
Posted 8/21/2013 12:45 PM (GMT 0)
Proctitis means you need rectal meds. Give the steriod enemas a try and see if that helps. I have no symptoms at this point but I still use rectal meds at least 2-3 times a week along with oral meds.
Posted 8/21/2013 2:40 PM (GMT 0)
I took rectal meds for a long time and they helped tremendously. Somewhere along the way my rectal inflammation went away and didn't come back. I have no idea why or when. I haven't used rectal meds in a few years, but I still have a box in my cabinet. If I see a spot of mucous on my stool I will be on them in a flash, no doubt.

There are other reasons you could be having problems with motility and while you might not buy into dietary changes sometimes they are worth exploring. I was having similar issues to you and my GI put me through a lot of diagnostics to find no reason why I was having urgency some days, some soft stool, some upper GI discomfort. A GF diet made a big difference to me. I also added psyllium after a while and that has helped a lot, too.

So yes, you might have beat the rectal inflammation into remission. I'd still keep some canasa in your freezer just in case.

Posted 8/21/2013 3:42 PM (GMT 0)
I have pancolitis and I take it that Asacol is managing the upper colon, as far as the rectum goes, the enemas are necessary, 5 to 7 nights a week for me.

When I was just using Canasas while flaring, Quincy told me I was just "skirting the issue" Canasas may not be enough for some people like myself.
Posted 8/21/2013 7:11 PM (GMT 0)
Dear UC and Me,

I'm not sure that you need the rectal meds. I was almost put on steroidal foams, but I never did that because I stayed on Canasa. I think if you are doing well w/o Canasa then you might not need it. I never take enemas...enemas are HORRID for me. I only can handle suppositories. I guess you should trust your instincts...and always ask your doctor.

I was on Asacol for 3 years before I was on Canasa. I would still BLEED badly with just Asacol so Canasa works for me. If you see no blood without Canasa you probably don't need it.

God bless to you :)
Posted 8/21/2013 7:38 PM (GMT 0)
Are they necessary? depends on whom you ask.

Considering UC starts at the rectum and that area will be inflamed during a flare...makes sense.

We all have "proctitis"....so whether it's limited or not, the concept of using them seems obvious.

Most don't want to use them...that's usually the reason for the questions. They are expensive as well.

Some have difficulty to retain them, there are options. To taper to a maintenance dosage during quiescent or remission times...logical.

There've been quite a few who fought the concept of treatment, only to eventually use it and find it useful. Go figure.

Some doctors don't believe they're helpful and refuse to prescribe them....don't get it.

If you use them and find them helpful...it's a commitment. It seems we all flare differently, and since the butt rules, we should follow suit to treat and maintain.
At least for as long as possible.

q
Posted 8/21/2013 7:43 PM (GMT 0)
You know, I meant to post a response here last night, but it's a good thing I didn't. What I was going to post was "Thanks for reminding me -- I would have crashed without my enema if I hadn't seen this post." Today I want to add to that: "THANK YOU a million times, my morning today was SO much better than if I had skipped the enema." *sigh*
Posted 8/21/2013 7:44 PM (GMT 0)
Yeah, the commitment of them sucks sometimes..lol. Good you had a better morning.
q
Posted 8/21/2013 7:45 PM (GMT 0)
oh and p.s. I cosign everything quincy says. Particularly this:

"We all have "proctitis"....so whether it's limited or not, the concept of using them seems obvious."


And my boss and his GI are simply blind to the benefits and refuse to even consider rectal meds.
Posted 8/21/2013 7:48 PM (GMT 0)
Thank you for all of the replys. My question now is should I use Canasa or steroid enemas? Should I try the steroid now to make sure inflammation is gone. And if so do I need to use it every day or can I alternate?
Posted 8/21/2013 7:50 PM (GMT 0)
^^ Can you not use the mesalamine enemas?

q
Posted 8/21/2013 7:53 PM (GMT 0)
My doctor has not prescribed those to my yet.
Posted 8/21/2013 7:57 PM (GMT 0)
Ask for them...but in the meantime use the colocort at bedtime and the Canada during the day.

What symptoms are you having?

q
Posted 8/21/2013 8:21 PM (GMT 0)

quincy said...


There've been quite a few who fought the concept of treatment, only to eventually use it and find it useful. Go figure.

q

No idea what you're talking about here! smurf
Posted 8/21/2013 8:21 PM (GMT 0)
rectal med treatment...clearer?

q
Posted 8/21/2013 8:22 PM (GMT 0)
I was being sarcastic!
Posted 8/21/2013 8:22 PM (GMT 0)
Things changed for the better in less than a week once I (wrapped my head around) started taking Canasa.
Posted 8/21/2013 8:23 PM (GMT 0)
Only 1-2 BM's per day occasionally more. Sometimes formed, otherwise loose to sem-formed mush. Very small amount of mucus.
Posted 8/21/2013 9:13 PM (GMT 0)
Hi UCandMe,
If it was me I'd use Canasa as I'm slightly frightened to use Steroids. I have similar stool...sometimes formed, but sometimes more soft. Sometimes just blobby. My GI doc said soft stool is a sign of inflammation.

Other things contribute to stool consistency such as fruits and veggies make stool softer. I enjoy fruits and veggies so I probably cause some of that.

Anyway, GOOD LUCK and God Bless :)

We will all get through this :D :D :D
Posted 8/22/2013 4:46 PM (GMT 0)
I have also been scared of the steroids but I am thinking I should maybe give it a try for the last bit of inflammation. Today my symptoms are slightly increased so I don't think I can go without some type of rectal med much longer :(
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