Foam enemas vs. liquid - need advice

Hi all. I'm popping in from the Crohn's board. I've been lurking here for a while since so much here applies to me. I have Crohn's Colitis - my entire colon is affected and I'm really having a hard time right now.

Can't seem to get my flare under control. Lots of urgency, blood, mucus. High doses of pred aren't doing very much, so I'm down to 10mgs/day. I'm also on 9mg of budesonide (which i dont think helps at all because my small intestine isnt affected), asacol, and enbrel for RA. Don't know if the enbrel helps or not. GI decided I need to be on mesalamine enemas, but I'm struggling with retaining them. Also, night time sucks for me because that's when my guts are the worst, so inserting the enemas instantly makes me have to go. I hate the enemas, but I don't want to give up if they could help.

So, my question is this: are there foam enemas that are not steroidal? Do any of you have experience with foam enemas? Are they easier to retain? The liquid of the mesalamine ones puts such a strain on my guts. I'm not sure what the next logical step is. Any thoughts, suggestions, advice would be welcome!

Stef

I have only used cortifoam too. I think there may be foam mesalamine available in Canada and other places but i don't think it's available in the US. Too bad too because it is so much easier to retain. The liquid mesalamine enemas are hardest for me to retain, even harder than the cortisone enemas. It sounds like you don't want steroid or I would say you should try cortifoam or cortenemas.

Is it possible to eat a smaller dinner or have it earlier in the day? That may help the nighttime blues but may mess with other parts of the day.

I too have crohn's colitis, and when I get proctitis then cortifoam is the only rectal med that's ever worked for me....you have to do something to treat it though, my CD now affecting my rectum is so bad off (I also developed a rectovaginal fistula) so my doc just started me on Humira (said cuz my inflammation was pretty deep in some spots of my rectum now that rectal meds wouldn't do much at this point). So you have to get it under control...hope the rectal meds help you out.

No foam mesalamine in Canada.....

I believe the foam cortifoam treats into the sigmoid and the proctofoam treats only within the rectum.

I used one or the other once 24-ish years ago for about 2 weeks (prescribed by another doctor who was very anti-5ASA oral/rectal and very pro systemic prednisone). It helped get me stabilised, but I ws soon back on Salofalk enemas once my own GI represcribed them.

q

yeah, having to use the meds sucks...the enemas are my very best and loyal friend.

Smaller amount starting is a good suggestion...but I'd suggest using the suppositories as well.

Are you using them at night or during the day?

q

In your situation, I'd recommend the foam enemas for a bit and then switch to the liquid enemas (steroidal). The steroids will help heal ulcerations pretty quickly, and they're absorbed into the tissue, whereas non-steroidal topical drugs (mesalamines like Rowasa and Canasa) take a bit longer to take effect (usually weeks, not days) and operate topically (so if you can't retain them, they don't help very much).

Meanwhile, the foam enemas are SO much easier to retain than the liquid ones. They don't go up as far, but they aren't as irritating and the foam sticks very well. I highly recommend it if you're really sick to the point where you can't retain enemas.

Ok, so I saw my GI today and he thought that since the enemas made me feel so uncomfortable (all of my inflammation is on the left side of my colon) that I should try the suppositories instead. He sent me home with two weeks worth of Canasa suppositories. I have to say that I like that idea much better than a big bottle of liquid.

So.... Now I need the help of all you experts - Quincy- and anyone else who has experience with the suppositories. How in the heck do I get these things in? Best method of insertion? I actually pilfered a few rubber gloves from the exam room when no one was looking! Lol! How far up do I need to stick this thing? I have small hands and short fingers. Sorry if that's just too gross, but I'm just wondering how far up I need to put it.

Quincy - I tried the enemas at night, but I instantly had to "go" and wasn't able to retain for more than a few minutes. I thought I might have more success if I used them in the morning after my kids go to school and I can lay around and watch t.v. Or something. My guts empty out pretty well in the a.m. so I thought that might work better?

Pluot- I'm open to trying a different biologic. I've already done remcicade (6years), Humira (2 years, did nothing for me and awoke my lifelong dormant psoriasis), Cimzia (2 years which did more than Humira, but needed 6mp as a back up to calm everything down), and simponi which worked amazing on my RA, but instantly caused a huge break out of psoriasis from head to toe. So... Right now I guess my only other option would be Stelara? Or maybe xeljanz? I'm totally open to suggestions.

Thanks everyone for your help. I truly appreciate the feedback. My hubby is helpful, but it's nice to run this stuff by people who have "been there, done that".

Also-GI says my Vit. D levels are 22, should be at least 30 so he wants me on 4000IU of D3/day.

Post Edited (Stef17) : 2/19/2014 5:30:46 PM (GMT-7)