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Ulcerative Colitis
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Posted 12/6/2013 5:41 AM (GMT 0)
Inflammation always starts in the rectum yes? If so why aren't suppositories always prescribed by doctors?
Posted 12/6/2013 6:25 AM (GMT 0)
while the butt meds may be more effective, patient adherence not so much - pills tend to be administered faithfully, squirting stuff up the butt, not so much -
Posted 12/6/2013 7:15 AM (GMT 0)
So for the people that are not bothered by using rectal medication daily dont get the more effective treatment or aren't given or told about that option because of a doctors assumption?

The method of maintenance treatment was not even discussed with me.

Post Edited (Jessicaaa) : 12/6/2013 12:20:27 AM (GMT-7)

Posted 12/6/2013 8:52 AM (GMT 0)
Does that mean when you go into remission you can take the maintenance meds as a suppository only? That would be a great thing to look forward too. I hate taking oral meds for a long term, a daily suppository would be so much less 'invasive' to life. Thanks for raising this, I'll put this on my 'ask the doc' list
Posted 12/6/2013 9:52 AM (GMT 0)
@ cayro - Thats just what I though too, hence made this thread. Seems stupid to take tablets hoping that it reaches the rectum when you could apply a suppository to coat the area and preventing any inflamation to form. That is if colitis always starts at the first part of the rectum.

I don't get why this isnt highly recommened by doctors. Isn't it literally like putting a solution/cream always directly on the part that will flare up first and therefore never allowing inflamation to travel?

Like putting a cream on a cut on your skin rather then randomly putting it on the area blindly, hoping you applied it to the right place.

Post Edited (Jessicaaa) : 12/6/2013 3:41:48 AM (GMT-7)

Posted 12/6/2013 1:40 PM (GMT 0)
A good analogy I read on here once "swallowing a pill to treat rectal inflammation is like pouring a bucket of water on your head because your toes are on fire." GIs are spotty on recommending rectal meds, mine did right away, but not all do. I think the above posters are correct that it is partly a patient compliance thing but I think the initial embarrassment or negative reaction from patients "I gotta shove what up my butt?" is also a part of it. Doctors are avoiding extra tension, an awkward situation or whatever.
Posted 12/6/2013 1:57 PM (GMT 0)
I think a lot of doctors have noticed an uninterest or noncompliance regarding rectal meds so they have basically given up trying. It's kind of like doctors used to always tell their smoking patients not to smoke and their overweight patients that they should lose weight and it usually always fell on deaf ears. One thing though is that UC often starts in the rectum but many people ignore their symptoms until much later, after it has already spread to the point where you need more than just rectal meds.
Posted 12/6/2013 3:11 PM (GMT 0)
I have done that and unfortunately it didn't work that well for me. I was on rectal meds and no oral meds in the beginning of developing UC. I was actually diagnosed with proctitis at the time. Even with using the rectals 2x a day, my proctitis spread. Later in time, I flare up while using rectal meds and wasn't able to get back to remission without oral medicine. If it works for you, that's great! it's definitely a good idea and worth trying.
Posted 12/6/2013 3:17 PM (GMT 0)
Doctors are just people. Some are good, some are not. Some are squeamish, even. Crazy, I know. Thank goodness for forums like this one where you can ask around and figure out best practices, even if your DR does not adhere to them. Rectal meds for UC are a best practice, hands down.
Posted 12/6/2013 7:22 PM (GMT 0)
It shouldn't really be only rectal meds....and I'm pretty much a naysayer regarding suppositories for a treatment unless it's used in support or for tapering.

Would I use suppositories for maintenance alone? no, because I don't believe that the oral 5ASA will deal with the area between the sigmoid and the rectum.
My initial diagnosis was into the sigmoid, so I'm liking the area to be totally dealt with.

Suppositories are better than nothing, so if that's all a patient can tolerate, then it's a huge start.

Enemas and suppositories come in 5ASA and steroid...options for the rectal regimen.

nssg's doctor was neglectful in not treating above the affected area, and her non-success wasn't because of the rectal meds...it was because it wasn't enough medication in general. Enemas could have been of help, but enemas plus oral 5ASA would have given her the best coverage.

All that, however, isn't to say that her UC wouldn't have spread beyond the original diagnosis anyway.  Insight would have been clearer based on biopsies pathology beyond the rectum and throughout the entire colon.

Regarding doctors not offering them.....

They're expensive
They require patient adherence
Patients are butt-phobic
Some GIs might be butt-phobic
Doctors believe that oral 5ASA will fully treat the rectum...I don't.
Patients believe that oral 5ASA will fully treat the rectum...experience from what I see here pretty much proves they don't.

Some doctors use the "anal"ogy that rectal meds don't go through the entire colon, so there's no use in offering them.

Some doctors say some patients "don't need them because their disease is too severe or not bad enough".

Doctors don't realise that some patients will make their own enemas and get some relief.



I'll push them regardless, much to the disgust of some members here.

While I may have others' butts in my best interests....I continue to do what I've done, and I'm grateful for my doctor's prescription for me to use them.

According to him, I'm one of few who use that regimen for this long.

If I had gotten the "other" doctor....I would have been on prednisone first thing and never offered 5ASA oral or rectal or both.....this I know for fact.

q

Posted 12/7/2013 4:54 AM (GMT 0)
I had to practically beg my doc for him to prescript me some enema. Told me enemas weren't necessary because of the oral med. He really wants me on remicade because imuran and lialda are not putting into remission. Been flaring for about 2 years now.

Quick questions for Quincy and others:
I finally got some rectal med but it isn't rowasa. It's a generic by the company 'Gavis.' What is the consensus on generic rectal meds? I remember reading here about how the generic ones are not comfortable to use.

How long does it generally take for the enema to work (if it works)? Tonight I'm not feeling well, so I'm hoping to begin the enema tomorrow night. If side effects occur, do they occur the next morning or can they occur days later? I really don't want to face any side effects when at work.
Posted 12/8/2013 4:45 PM (GMT 0)
Sorry for not getting back to this thread to answer your question.

There are others who use it with no problem..some do say they've had a harder time to squeeze the med out of the bottle.

The mesalamine enema medication time to work is pretty subjective. You should see some improvement in about a week.....it's a progressive improvement, however. I was once on nightly enemas for 4 months...but that wasn't the norm for me.

I never had any side effects the next day...except more concentrated gas for the morning bm.

Keep us posted as to how you're doing on it.

Maybe put out a separate thread as well.

q
Posted 12/8/2013 5:59 PM (GMT 0)
When a suppository alone wasn't completely eliminating symptoms for me, I went to a GI who's supposed to be an IBD specialist. He suggested adding Lialda to the mix. I asked why he didn't suggest an enema first, and he said patients are more compliant with oral meds (as has already been mentioned here). However, when I told him I'd like to have RXs for both, to determine what worked best, he wrote them for me.

The combination of Lialda & Canasa ultimately did the trick for me, so I never filled the enema prescription. I know many people have stated, very logically, that Lialda shouldn't be very effective with ulcerative proctitis but that combo did work for me.
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