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How long do mesalazine enemas take to work?

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Posted 9/15/2014 4:38 AM (GMT 0)
4gr mesalazine enema. How long does it take to work for left sided moderate to severe UC/Crohn's colitis generally? When did you notice improvement?
Thanks.

Post Edited (xy123) : 9/14/2014 10:43:14 PM (GMT-6)

Posted 9/15/2014 7:54 AM (GMT 0)
I'm using these enemas. I've needed them because my symptoms were worsening. I've noticed great improvent after using them one week. Unfortunately I'm in my 5th week on then and I do not seem to get better, can't get rid of the bleeding. I think you should notice improvement in the first two weeks.
Posted 9/15/2014 11:19 AM (GMT 0)
They work pretty quick, 2-3 weeks for improvement. If they don't work by then, then you likely need stronger uc medication.
Posted 9/15/2014 4:20 PM (GMT 0)
Thanks.
Posted 9/15/2014 4:22 PM (GMT 0)
You should have some improvement within a week....but you might need to be on them for a month or even more nightly before you can start to taper them.

q
Posted 9/15/2014 6:51 PM (GMT 0)
Thanks again.
Posted 9/17/2014 3:46 AM (GMT 0)
I get mild headaches (not migraine type) in the mornings when I wake up. I know this is a known side effect of the mesalazine enema. I've been taking oral mesalazine for more than two years and I don't experience this side effect from oral mesalazine; but whenever I add rectal mesalazine into my regimen I get headaches. Does this mean I can't tolerate too much mesalazine? Will this side effect ease in time?
Second question: I have two different mesalazine enema brands. One is 4gr 60ml, the other is 4gr 100ml. I'm in Eastern Europe, only these two brands(Salofalk enema and Asacol enema) are available. Using 60ml enema is very easier for me than 100ml enema; but I don't know, would 100ml enema be superior for the disease? Is there a significant difference regarding their efficiency? I guess 100ml enema can reach higher parts of the colon. Which one should I use? What is the capacity of your enemas?
Thanks in advance.
Posted 9/17/2014 8:52 AM (GMT 0)
I wouldn't worry too much about those headaches, just comment it to your GI. I think the headaches will fade when your body adjust to the increased medication. When I started with the enemas I had some clay colored stools and mild abdominal pain and I was worried if they were pancreatitis symptoms but at the moment I feel fine having the same medication.

I've only used the 60ml enema and I don't know if the other kind is more efficient.
Posted 9/17/2014 1:52 PM (GMT 0)
Thank you.
Posted 9/17/2014 2:12 PM (GMT 0)
they take some time you have to be patient with them, back when my calprotectin was 2800mg/kg, when i started using a single 4gm mesalazine enema daily (along with my previous other meds) they kept reducing my calprotectin with ~700mg every 2 weeks
Posted 9/17/2014 2:45 PM (GMT 0)
I too have been on oral mesalazine (Lialda 4.8gs / day) for about 2.5 years and just recently started using mesalazine enemas (generic rowasa 4g 60ml).

I started seeing improvement after about 1-2 weeks in the form of formed stools and going 1-2 bms / day, no blood or mucus, but I still had urgency. After about 2.5-3 weeks the urgency has started to get better. I'm now 4 weeks in and the level of urgency has been at its lowest since I was diagnosed with UC 2.5 years ago. I recommend you keep with it, for me it's been very effective.

There's a very good read on it here - https://www.google.com/search?q=what+is+distal+ulcerative+colitis (click on the 2nd link from Wiley). They say it takes about 4-6 weeks to see improvement. I found this paper interesting.
Posted 9/17/2014 3:02 PM (GMT 0)
the 40ml difference is really small. it is less than 3 tablespoons. likely less since not all liquid gets squeezed out of the bottle. I think both have the same 4g dose.

I think inflammation, retention time, and posture will affect how high the treatment reaches more than the extra tablespoon or two. But, yes, a little more liquid may reach higher if retention times are equal.

I was helped for several weeks with a lowering of symptoms. Then I had some bleeding that seemed related to the enema, and I suspected the sulfate in the suspension solution. I got the more expensive sulfate-free version, and it seemed to help. Over a few months, I tapered down to very occasional use as my symptoms improved.

They are easier to use when you are not flaring so much. I think the enemas were able to make a dent because I did a course of pred to keep down symptoms and help me retain. I also did some cortisone enemas for a week or two before trying to retain the 5-asa ones. I am still trying to work out how infrequently I can do them. I would rather have them help prevent flare, rather than be back in the position of trying to introduce them while flaring.
Posted 9/17/2014 5:35 PM (GMT 0)
Thank you everyone.
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