Enemas effectiveness for pan colitis flare

Dear all! I've been following your forum since I was diagnosed with UC and it's been very helpful. https://www.healingwell.com/community/emoticons/yeah.gif

Being on azathioprine for 1.5 years, I had a relatively good time with only one mild flare in the summer of 2013 which was quickly resolved with "combo" enemas (3mg beclomethasone and 1gr mesalazine).
Now I developed another flare over 2 weeks ago which is slowly getting worse (toilet visit 6-7 times a day, very gooey, liquid pap-looking like stool with lots of mucous (sorry about the details!!!), but no blood, and frequent cramps).
I've been using daily the enemas again for 10 days now with no improvement.

I'm wondering whether you had previous experience with enemas where they started working after 2 weeks or longer? Can I wait longer for them to work or am I making it worse? I'm thinking now, it's not as bad as my previous serious flares when I had to use the toilet over 10 times a day with lots of blood, so maybe I can wait?

I'm afraid that if enemas don't work I have to start on prednisolone, which was not very effective for me in the last flare and has terrible side effects. That's why I'm really hoping for the enemas to work...

On the other hand if the flare is all over the colon then the enemas are probably not as effective since they will not reach everywhere.

Anything else I could try besides prednisolone? I just heard about Budesonide (aka cortiment, entocort, symbicort, uceris) which may be as effective but less side effects so I will discuss it with my doctor.
Anything else perhaps?

Finally, I also have a constant mild fever around 37.8-38 Celsius and the fact that this flare is not going as quickly bad as previously, makes me think there might be bacteria involved... But since I live in Netherlands, it takes long for the doctors to take extra steps so will give a stool analysis on Monday and then it may take another few days for results...

Thanks a lot for your help!!!

I could not tolerate mesalazine enemas, but I have experience using pred enemas ane they worked immediately (and I have pancolitis).

If the mesalazine doesn't work for you I would really recommend steroid enemas, so effective and virtually none of the scary side effects of taking the steroids orally because it's not absorbed in the bloodstream.

Thanks Malaika, these enemas have however steroids as well (beclomethason) so its mostly steroids and a bit of mesalazine... I reacted to them good in the last flare and the flare before that as well. Now i just dont see any effect.

So bottom line... Will have to start taking oral prednisolone?

Are biologics under consideration? Uceris is another short term solution, like Pred. Save Pred for an emergency, as long as it didn't work that well for you in the past, it probably isn't your long term answer anyway. You may be right about the bacteria, a fever isn't "traditional". A course of Flagyl has helped some(antibiotic), but it is not without side effects. My daughter was helped ,short term, on Tacrolimious. It is an old drug, easily available, but also has a long list of trade offs. I'd also consider 6mp/or Imuran, or Remicade if it is available to you. My 2 cents....

Thanks everyone. Regarding some of your questions: i dont see a point in taking mesalazine enemas as there is some already in my enema (1gr) plus i take 4gr mesalazine orally daily.
Im already on azathioprine (imuran) for 1.5 years...
I hope i dont have to go on remicade yet, which is again a level up in the medication ladder.

My doctor wants to do a sigmoidoscopy on tuesday, i dont hnderstand why not colonscopy? Most likely it is the whole colon inflamed, not just the last part of it so not sure how mucb she can see...

So i guess we see afterwards what to do next and its a waiting game in the meantime.