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Rowasa causing diarrhea? Intolerance? help please!!

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Posted 5/20/2014 5:07 PM (GMT 0)
Hello! Hope you are having a great day!

I am having a hard time, and I want to curl up in a ball on my couch and just cry. That really wont help my situation, so I am calling my doctor and looking for your wisdom.

Started Rowasa enemas with the helpful suggestion on this forum. Within days, I felt so much better. I did not even realize the amount of pain I was in, until it was gone. It was amazing. . .but then, the diarrhea started. I have proctosigmoiditis, and the symptoms I have are gas, frequency, feeling bloated, crampy pain, and occasional nausea. I did have mucus, BM 5 plus times daily, and heavy blood loss. I never had serious diarrhea, but now that I am on Rowasa, I do. The first two weeks of the drug, I thought I had a stomach bug. Then I thought it was because I ate something bad. I stopped taking it for a week and a half, the and diarrhea gone, but rectal pain/bloating/cramps back. I started again. Two days in, I have diarrhea, not bloody type, not pencil type poops, but full-blown food-posioning type diarrhea. This morning I was trapped in the bathroom and my daughter missed preschool. I am so upset that I cant even get my child to school because of this. I keep hoping that I can get into remission and stay there, and that wont be a problem, but right now I feel exhausted and defeated. Anyone else have this issue?

One last question, I am allergic to the medication Bactrim, and often it is assumed I am allergic to sulfites. I think the enema solution has sulfites? Advice?

Post Edited (AlohaYankee) : 5/20/2014 11:25:40 AM (GMT-6)

Posted 5/20/2014 5:27 PM (GMT 0)
Yes, all but the sulfite-free Rowasa has sulfites as preservatives. However, I'm not sure if this is really the same as a sulfa drug like Bactrim. I think this would be a good question for a pharmacist. Call and explain that you're allergic to Bactrim, and ask if you therefore might also be allergic to the sulfite preservative found in most mesalamine enemas.

If the answer to this question is yes, I'd call your GI and request an RX for sulfite-free Rowasa.

Have you had any problems with Canasa? If not, then my guess is that the reaction is due to the sulfite and not the mesalamine.

I see your sig says that you're "supposed to take Lialda." Is there a reason you're not? Given your diagnosis, you should be on an oral med.
Posted 5/20/2014 7:01 PM (GMT 0)
I am allergic to Sulfa drugs but am able to tAke most mesalamines. I say most b/c I have to watch my dose. Anything above 2 lialdas makes my symptoms worse. I am also able to take regular Rowasa. I can't however take Canasa.

So, yes, it can be the Rowasa/mesalamine causing an intolerance syndrome. Trying the sf Rowasa may be worth a try. I guess my point is, you may not have to totally give up on the mesalamine drugs if you have a problem with one of them. Remember there is rectal steriods too.

Hope you feel better soon....this disease is very upsetting.
Posted 5/20/2014 7:47 PM (GMT 0)
Sulfa drugs and sulfites are chemically unrelated. Sulfites are a preservative and used in wine making and as a preservative in rowasa. Sulfa is a byproduct of sulfasalazine and contained in bactriim. You could be allergenic or intolerant to both I suppose.

I thought sulfites were no longer being used in Rowasa. I use the generic which still lists them.
Posted 5/20/2014 7:57 PM (GMT 0)
Initially after starting rowasa, you saw improvement, then you got worse and now you're having terrible D? When did you stop taking it? It sounds like you may have an intolerance. As fruitgirl mentioned, there is a sulfite-free rowasa you could try but it may or may not help with this situation. Are your symptoms manageable when you're not using Rowasa? If not, you may want to consider a steroid suppository or foam to get you back to normal, then taper off that. What are you using for maintenance of your UC?
Posted 5/21/2014 2:29 AM (GMT 0)

fruitgirl said...


I see your sig says that you're "supposed to take Lialda." Is there a reason you're not? Given your diagnosis, you should be on an oral med.

Yes, I was nursing my nine month old and didnt want to take an oral medication if possible. I was hoping that the Rowasa would work. I am going to start on Lialda tomorrow, after calling the doctor today.


You brought up a great question, regarding Canasa vs Rowasa. I did not have insane diarrhea with Canasa, only the location of insertion (can I say rectum on here? dont mean to offend anyone. I guess if you are easily offended you dont read the UC forum.) was quite irritated. More irritated than with UC.

Thanks a million for your help. I need tpo pick up my VSL#3 DS tomorrow, so perhaps I will ask the pharmacist about a sulfa allergy and the sulfites in Rowasa.
Posted 5/21/2014 2:32 AM (GMT 0)

hateuc said...
I am allergic to Sulfa drugs but am able to tAke most mesalamines. I say most b/c I have to watch my dose. Anything above 2 lialdas makes my symptoms worse.

Thank you for sharing this information with me, and for your well wishes and comfort. Much appreciated and needed.

Are there common signs for mesalamine tolerance?
Posted 5/21/2014 2:41 AM (GMT 0)

notsosicklygirl said...
Initially after starting rowasa, you saw improvement, then you got worse and now you're having terrible D? When did you stop taking it?

Right. After I started taking the Rowasa, the bloated feeling, which I guess is from the inflammation, the urgency, the frequency of BM, and the blood stopped, but diarrhea started.

I had a really bad cold, so I stopped taking the Rowasa for a few days. The cold cleared up and the original symptoms returned, but the crazy diarrhea stopped.


notsosicklygirl said...
Are your symptoms manageable when you're not using Rowasa? If not, you may want to consider a steroid suppository or foam to get you back to normal, then taper off that.

My symptoms are unmanageable without something. Canasa takes care of 80% of the problem, but I still have bleeding. Canasa also makes me feel very irritated.



notsosicklygirl said...
What are you using for maintenance of your UC?


I am trying to get into remission, I guess. Then I was told I can use Rowasa on Monday, Wed, and Fri for 6 months and then have a C/scope.

Any advice?

Thanks in advance for your caring and advice! I am very grateful!!
Posted 5/22/2014 3:14 AM (GMT 0)
Wanted to update this post, just ion case someone searches for this issue later and needs the info. Ask the pharmacist today about sulfa allergy and the sufite preservative in the Perrigo brand generic Rowasa enema. I was told it would be very unlikely for me to be allergic to the sulfite preservative, even with a sulfa allergy. Thank you so much to the person who said talk to a pharmacist. My doctor is out of town and my colon and rectal surgeon just had some type of surgery and wont be back in the office for weeks. His on call coverage provider never returned my call. You are a life saver!
Posted 5/22/2014 5:29 AM (GMT 0)
If you do well on Canasa, why not use that? waht do you mean it irritates? Is it when you insert it that it's irritating? I usually put the canasa under warm water to get it to soften and then insert it, that seems to help get it in without irritation. I have also use lubricant on the tip and that can help. Rowasa is just a pain but it does help. If you don't tolerate Rowasa, i would think you might have similar symptoms from Canasa. They are very similar, Canasa is 1g and Rowasa is 4g. Did you do well on Lialda? Are you still breastfeeding? Maybe Lialda is an option but with your symptoms from Rowasa, you could be intolerant to mesalamine.
Posted 5/22/2014 1:07 PM (GMT 0)
I responded to your other post about diarrhea and wanted to add something.

If Canasa works 80% for you but causes irritation, you may want to go back to Canasa along with hydrocortisone enemas. The enemas should help with the irritation so it's manageable.

Also, it's great that you're trying all kinds of options but pace them so you can tell exactly which one is helping (or not). When you start too many things at once, it's hard to know.

I'm so sorry you're going through this with a preschooler. My first bad flare-and 7-day hospitalization-happened when my son was 3.

Is there family, parents of your child's classmates, or babysitters that can help? My son adapted well to having others bring him to and from school even though that was new to him. And he has no memories of me being so sick or in the hospital. I was worried it might affect him but he's fine other than complaining that I leave the bathroom too stinky!
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