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Morning frequency and urgency.

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Ulcerative Colitis
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Posted 3/27/2014 4:29 PM (GMT 0)
Yesterday I started imuran after being on prednisone for about 2.5 weeks. My ulcerative colitis has improved immensely since starting prednisone... no more blood, stool is for the most part formed, absolutely no abdominal pain, I have 4 BMs per day. I still take 4g mesalamine enema every night as well. My doctor however wanted me to stop the Mezavant because she says at this point she is more concerned with how I respond to imuran.

The only remaining symptoms I have are morning frequency and urgency... I always have to go three times in the morning... the first time in the morning the stool is 100% formed, then the two subsequent times it comes out formed but disintegrates easily with a flush... then no more BM's throughout the day until once before bed (I try to make sure I don't have any urge to go before doing my enema just to make sure I'll keep it in throughout the night, which I have been successful with keeping it in for at least 6 hour intervals).

So, basically just wondering if anyone has any tips for reducing morning frequency and urgency... I know this disease is so different for everyone, but if anyone has noticed any tips or trends that work to push them out of this last stretch towards remission, I would be really grateful.
Posted 3/27/2014 4:43 PM (GMT 0)
I'd love to know the answer to the frequency and urgency issues too as those have always been my major complaints...I even tried fibre supplements which did cut back some of the frequency but did nothing for the urgency for the 10 yrs I took fibre supplements.

I know my very first GI told me that even if I did ever reach remission, there was a good chance that it didn't mean I'd necessarily ever be like I was before getting sick (very depressing).

I could somewhat handle having to only go 3 times (even with urgency I guess) first thing in the morning if it meant I'd be symptom free the rest of the entire day, that I would take and be happier with but this disease is so ugly and cruel and it's main goal is to intrude on life and daily activities...not to mention, it loves to humiliate us.
Posted 3/27/2014 4:54 PM (GMT 0)
Yeah, compared to my symptoms in late February to early March, 3 BMs in the morning is amazing... but I can't help but long for that one year I had of remission where I had absolutely no symptoms except for the odd loose stool due to stress... I'm hoping to be able to get back to that eventually. :(

I do take one teaspoon of metamucil with every meal, and it has definitely helped. As of today I have decided to try to up my metamucil intake since I was tolerating three teaspoons per day so well.
Posted 3/27/2014 5:47 PM (GMT 0)
I'm glad you're not having issues with the powdered fibre supplements...they usually contain a lot of junky stuff that can irritate us specifically (especially with sugar substitutes and un-necessary fillers) I always used tablet form (Prodium fibre bulking stool therapy).

There is a slight chance that maybe the issues you are still having could be linked to some of the ingredients of the powdered metamucil you're using...I wonder if you tried a pill form that contains very little ingredients (especially the offending ones) if that might resolve the current issues with urgency and frequency? I know for me it didn't but everyone is different (plus I'm a bad example anyways because my IBD has always been complicated).

Anything with sugar alcohols in it (sorbitol, and anything ending in "tol" is a sugar alcohol) can cause gas, bloating and D for those that are very sensitive to it.
Posted 3/27/2014 5:54 PM (GMT 0)
Hmm, I never thought of taking capsules. Maybe I will try that instead, my huge container of metamucil is almost empty so I have to buy more anyway. Thanks for the tip, hopefully they sell them at costco.
Posted 3/27/2014 5:58 PM (GMT 0)
It's just a thought, based on what I know about sugar alcohols and those that are sensitive to it, but yeah, definitely see if taking pill form that doesn't include all that junky stuff might just be what you need to rid you of your current issues, worth a shot trying and it would be great if it actually made the difference that you're looking for.

Good luck!
Posted 3/27/2014 6:14 PM (GMT 0)
Is sucrose a bad ingredient as well? I looked at the ingredients list on my metamucil container and the only ingredient listed other than psyllium fibre husk is sucrose.
Posted 3/27/2014 6:28 PM (GMT 0)
This is what I found out about sucrose....

Side Effects
Sucrose can have some undesirable side effects when overly consumed. Eating foods that contain sucrose can lead to tooth decay, obesity, insulin resistance, elevated triglycerides, high blood pressure, hypoglycemia, yeast infections, inflammatory bowel disease and the hardening of the arteries. Consumption of sucrose in excessive amounts can cause the body to store the sucrose in the form of fat inside the organs, body and blood. This is the leading reason why overindulgence in sucrose makes people fat.
Posted 3/27/2014 6:54 PM (GMT 0)
Annadee, morning frequency and urgency is caused by UC active inflammation especially when it is present in the rectum. The only way to treat it is to get your UC inflammation under control.

You are taking enemas nightly which is great for reducing rectal inflammation. You've been on prednisone for 2.5 weeks and you said you're healing and having less bms a day, so you're certainly on the right track. I would give more time to both your Prednisone and Imuran. The Imuran takes 2 plus months until it reaches therapeutic levels in your body. Sometimes it takes a bit longer than that to reach full effect.

You should be in regular contact with your GI about your progress and current symptoms. Some GI's start you at a low dosage of Imuran, and then later boost that dosage once you have some good bloodwork back. What dosage are you on?
Posted 3/27/2014 7:01 PM (GMT 0)
IDK, even when my rectum was fine (no inflammation) I still suffered with urgency and frequency.
Posted 3/27/2014 7:26 PM (GMT 0)
Ph4, my urgency and frequency has varied considerably based on my uc inflammation.
Posted 3/27/2014 7:42 PM (GMT 0)

iPoop said...
Annadee, morning frequency and urgency is caused by UC active inflammation especially when it is present in the rectum. The only way to treat it is to get your UC inflammation under control.

You are taking enemas nightly which is great for reducing rectal inflammation. You've been on prednisone for 2.5 weeks and you said you're healing and having less bms a day, so you're certainly on the right track. I would give more time to both your Prednisone and Imuran. The Imuran takes 2 plus months until it reaches therapeutic levels in your body. Sometimes it takes a bit longer than that to reach full effect.

You should be in regular contact with your GI about your progress and current symptoms. Some GI's start you at a low dosage of Imuran, and then later boost that dosage once you have some good bloodwork back. What dosage are you on?

Yes, I'm planning to stick with the nightly enemas for the foreseeable future, right now I have been prescribed enough for nightly use for 4 months.

Actually as of Saturday according to my GI's schedule I will be tapering off of prednisone. Last time I saw my GI was on March 14th, and when I told her my symptoms then she said I was on the right track. My next appointment with her isn't until April 14th though, that's the earliest I could get.

As of yesterday I started 50mg imuran in the morning. Then after two weeks I'm supposed to increase to 75mg and then two weeks after that up to my maximum dose my GI wants me on, which is 100mg. So I still have a long ways to go. My GI has placed me on a schedule where I started prednisone at 40mg per day for three weeks, then (as of this Saturday) taper 5mg per week. So I am supposed to be on prednisone for a total of 10 weeks. Hopefully by the time I'm finished with prednisone the imuran will have kicked in.

Thank you so much for your input.
Posted 3/27/2014 7:44 PM (GMT 0)
I have found morning frequency and urgency are always the last symptoms to resolve. I've also found that even though I've been in remission for almost three years on Imuran, things aren't quite like they were pre-UC. I also sometimes felt mesalamine enemas made morning frequency/urgency worse. I hope the imuran works and with time this will improve for you. Good luck.
Posted 3/27/2014 10:18 PM (GMT 0)
cjgk, could you describe what you mean by things weren't quite like before? Do you still have symptoms? Foods you can't eat? When I was in remission I felt completely normal.
Posted 3/28/2014 2:24 AM (GMT 0)
My new normal seems to be 1-3 bms per day depending on how much coffee I drink. It would have been unusual for me to go more than once per day previously. Also, bms seem softer/less formed than before. Otherwise, no symptoms. I eat whatever I want. My last two colonoscopies have shown no evidence of colitis, so I am definitely in remission. I think there is a psychological part, too, and we have to retrain our bodies to make things less urgent. That seemed to take a while for me.
Posted 3/28/2014 5:19 PM (GMT 0)
Okay, well that still sounds pretty good I think. As close to normal as I hope I will be able to get. Right now food doesn't seem to affect me, I just stay away from high fibre because although it's gotten much better, the other day I had some spinach and the green stuff still seems to go through me for the most part. I definitely think there's a psychological part to it too... when I don't think of my UC I feel much better. I'm trying to manage my stress levels as well, I used to stress out over my school, work, etc but now I'm trying to have a more relaxed approach. Stress is a big factor for my UC, and seems to have been a trigger for my last two flares.
Posted 3/28/2014 5:55 PM (GMT 0)
When I started taking fiber supplements, I was able to tolerate eating fiberous foods quite well, and even though I've stopped taking supplements, I still tolerate eating fiberous foods well. I started eating fiberous foods after my system initially adjusted to the supplements.
Posted 3/28/2014 8:41 PM (GMT 0)
I do seem to tolerate high fibre foods better now, just not like normal. Before when my flare first started, I'd eat green stuff and it'd come out same way it came in... now it comes out still but in teeny tiny pieces. It's strange! I'm not sure but I think that's a good sign. =P
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