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Ulcerative Colitis
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Posted 2/21/2013 4:58 AM (GMT 0)
I am about to start Rowasa for my UC. I will be doing it once every day. I am pretty nervous to start an enema instead of the Canasa (suppository) tablets I have been on the past couple of months. I am especially concerned because I am a college student and I don't have a lot of privacy or time, or a comfortable place to do it. Any suggestions or information is appreciated!
Posted 2/21/2013 5:21 AM (GMT 0)
It's tough being a college student with UC! I had my first flare in college; while I had a room to myself, sharing a bathroom with an entire floor of underclassmen was terrifying/embarrassing.

I take enemas lying down on my side (you are supposed to lie on your left side, but for some reason, I CANNOT take them on my left side, so I take them on my right), and it's pretty much the last thing I do before going to sleep. If you have a roommate, and you don't want to tell them what's going on, you could try to make sure to take the enemas before they come back, or after they go to sleep. You can keep a trashcan next to your bed, or stick the used enema in a drawer (you can recap them quite easily), and then throw them out the next day.

It might be easier to tell your roommate what's going on, like, "Hey, I'm pretty embarrassed to tell you this, but I have to take some medicine before going to bed every night. If you're awake and still in the room when I have to take them, is it okay if I ask you to leave for about 2 or 3 minutes while I do that?"

It really doesn't take more than a couple minutes total, just make sure you do it while you're already lying down to go to bed.

I think the enemas should work better than the suppositories, since they can spread through more of your colon, but I also hate suppositories, so I might be biased!
Posted 2/21/2013 6:49 AM (GMT 0)
I don't think it matters how the enemas are taken, as long as they get in there and you can lie down shortly afterwards. Whatever works for you. If it's standing on your head or however ;-)

For me, I insert them while in the toilet in a bent over position. The reason for that is sometimes I can't hold them first go. Sometimes they trigger a BM and it takes a second try. So I take two in with me.

I believe they work best if you can lie on your side or belly afterward. That way they are free to flow around the sigmoid region to the descending colon and may reach as far as the splenic flexure.
Posted 2/21/2013 1:42 PM (GMT 0)
Thanks for the suggestions! Luckily have a great roommate who knows what is going on, but the sharing of a bathroom is still a concern. I heard that with Rowasa you need to lay down for about a half hour, and you cant have another BM for at least 8 hours, is there any truth to that?
Posted 2/21/2013 1:51 PM (GMT 0)
I lay down on the bathroom floor (on an old towel, to catch any drips, because the enema liquid will stain) to use the enema, then get up, wash my hands, and head to bed. My GI said it's fine to do that.

As for not having a BM for 8 hours, yes, it's *best* if you don't have one, but sometimes that can't be helped! If you can retain it even for a couple of hours, it's doing some good. When I first started using them I was flaring very badly, and wasn't able to hold it all night. However, things improved very quickly and I was soon not having BM's overnight any more. Since being in remission, I've never had a problem retaining it.

I always make sure to squeeze all of the extra air out of the tip of the bottle before using it and also use a bit of vaseline on both my bum and the nozzle so it slides in easily. The tip is lubricated, but a little extra definitely helps.

If you have trouble retaining the entire enema, you can just use half.
Posted 2/21/2013 3:42 PM (GMT 0)
It can be tough to retain enemas at first. When I first started using them, I couldn't get even half the bottle in, and I couldn't hold them for more than 30 minutes. But that's better than nothing, and eventually, it got easier (both in terms of technique/getting used to them, and in terms of my colon slowly improving, making them easier to retain). So if you can get through the whole night, great! But even 15-30 minutes of meds is better than none.
Posted 2/21/2013 3:48 PM (GMT 0)
No, it isn't necessary to lay down for 20-30 minutes before leaving the bathroom. Always take the enema near the toilet. You can take the enema, wait a minute or two just to make sure the liquid is settled and will stay in you, and then go straight to bed. You will know within a minute or two whether the enema is coming out unexpectedly, as there will be lots of discomfort that doesn't go away after a couple of minutes. A little discomfort is normal but it fades quickly. An enema might come out if you had gotten some air in there (make sure you squeeze all of the air out of the bottle before taking), the enema may come up if you have a little bit of poop in your rectum and you didn't know it (try to take the enema after a poop to limit the chance of this), the enema might come out if you have a colon muscle spasm (best to relax as much as you can before administering).
Posted 2/21/2013 3:55 PM (GMT 0)
I've only layed in bed....stayed quiet for half an hour when first using them...such as the first few years. never any accidents.

I did have a bag near the bed and a cloth to wash my hands with.

If you can retain for half an hour afterward when you start..that's a huge plus.

Just wait out the urge to go...it should pass. But, there might be times it's impossible to do so...you'll just have to let it go on the toilet.

If you're female, it's difficult to urinate with it in sometimes...you'll get good muscle control eventually..lol.

q
Posted 2/22/2013 11:04 AM (GMT 0)
Rowasa is great, it made a huge difference for me. As far as those type of meds go I like it much much more than canasa. Canasa caused gas and oily residue stuff which rowasa caused none of for me, I discontinued canasa completely and don't have plans to go back. I administer rowasa bent over the side of the bed, you just need to be relaxed and go slow. If you are flaring now it might be a little trickier to retain it, but I have only not been able to retain it once or twice. As you improve it will be no big deal.

Thanks to all those that tout this medication, it made me normal again in combination with oral meds. If it works for you it still may take a while to kick in so don't get discouraged, maybe even 2+ months everyday (from my experience).
Posted 9/27/2013 12:33 PM (GMT 0)
I was just diagnosed with UC proctitis (sp) and was started on Apriso ER 4 in the morning and a Rowasa enema every night at bed. I used my first one last night but could only retain it for about 40 mins, did that do anything for me and any tips on retaining longer? 8 hours? I don't know how I'd ever do it!
Posted 9/27/2013 12:43 PM (GMT 0)
Jahayley, the first thing you need to know about retaining Rowasa enemas is it takes practice and time to get good at it. Some tips:

  • It is best to take it before bed and after your last poop. Sit on the toilet and try to squeeze out any gas or poop you have left in you.
  • Warm the enema up to body temperature.
  • Squeeze all of the air out of the enema bottle before administering (as putting air up your tract leads to discomfort, urgency, and ultimately expelling the enema).
  • Be close to the toilet before administering. The enema can come up quickly, unexpectedly, and it stains horribly. You might want to put down an old bath towel on the floor just in case you spill some of the fluid.
  • When administering, squeeze the bottle slowly but steadily (too fast and it will be uncomfortable and hard to retain).
  • Do half the enema bottle at 1st. Some find it easier to retain this way, less liquid, etc. You can administer the rest later on. And should you expel the first half of the enema right away, you can try the 2nd half of the bottle -- better retaining some rather than none.
  • Retire to bed and lay on your left side. Try to remain still for 20 minutes while the enema soaks in.

If you have a lot of inflammation then the enema is going to be much harder to retain. Just keep at it, not all of the liquid escapes when you evacuate so it is still working. The more you heal, the easier enemas will be to retain.
Posted 9/27/2013 1:02 PM (GMT 0)
Do you guys think rowasa spreads on its own or does it simply pool on one side of your colon since you are laying down? I was just curious about this.
Posted 9/27/2013 1:18 PM (GMT 0)
Siregumby, the fluid spreads when you lay on your left side. Take a look at a diagram of the large intestine and it should make sense. When you inject the enema fluid it is in the rectum, as you lay on your left it goes into the Sigmoid Colon and then the Descending Colon. It doesn't take much of a slope for liquid to spread and move around. Some dye-based studies have shown that a Rowasa can spread all of the way to the Splenic Flexure.
Posted 9/27/2013 2:46 PM (GMT 0)
Ok thanks for that but I also meant "reaches" as in all the way around the tube of the colon. Like the top and bottom of the tube. Seems like the only way is to roll around in bed or does the rowasa naturally spread around the entire circumfrance of the colon.
Posted 9/27/2013 3:07 PM (GMT 0)
Rowasa is meant to treat inflammation in the rectum and sigmoid colon, sirgumby. I suppose you could do a bunch of headstands, etc. to get it up higher in the colon, but there's only 4 g of med in there. Oral meds are supposed to cover the descending and transverse colon or even the right side, leaving the rest for the enema.
Posted 9/27/2013 3:55 PM (GMT 0)
I apologize for maybe not being clear enough. I know it reaches up there but i was wondering if anyone ever wonders if it goes all the way around the sides of the colon wall. Think of a pipe with water flowing through it. Does the ceiling of the pipe ever get hit with the water or in this case the rowasa or does only the bottom of the pipe. I guess it somehow does because rowasa totally works but i was just curious about that
Posted 9/27/2013 4:08 PM (GMT 0)
My understanding is the colon tubing is collapsed (one side of the intestinal wall is touching the opposing side of the wall) when there isn't anything inside of it. So the enema liquid doesn't have any trouble coating everything as it trickles through our piping, so to speak. An intestine is quite different than copper/iron/pvc piping with rigid walls, like we use in our plumbing. The intestinal tubing can expand and contract based on what is passing through it.
Posted 9/27/2013 7:29 PM (GMT 0)
Oh that makes sense!
Posted 9/28/2013 1:24 PM (GMT 0)
Thanks for the advice ipoop! Last night I was able to do 3/4 of the bottle for 4 1/2 hrs a lot better then 30 mins. Gonna try for the whole bottle tonight
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