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When to try Prednisone

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Ulcerative Colitis
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Posted 5/19/2015 2:47 PM (GMT 0)
Hi Everyone,

I was diagnosed with proctosigmoid UC about 3 months ago. I feel like I've been in a mild flare since my diagnosis. Had 1 week of terrible cramps, very painful D, blood/mucus. Once I started Lialda and mesalamine enemas everything improved significantly. I still have some "butt discomfort" most days and left sided abdominal discomfort. Overall, I don't feel horrible but am getting a little annoyed with these mild symptoms. I have 2-4 BM's in the morning usually, some more normal than others. Not much urgency anymore. Would you move on to stronger meds at this point?
Posted 5/19/2015 2:59 PM (GMT 0)
No. Be patient. Stick with your meds, especially the rectal meds. Proctitis is a stubborn ******.
Posted 5/19/2015 3:10 PM (GMT 0)
Lialda should be dosed at 4 pills a day (4.8 grams) and enemas nightly, if you're still experiencing uc symptoms.

You might need stronger medications (like immune suppressing medications like Imuran) to eliminate all symptoms.
Posted 5/19/2015 4:08 PM (GMT 0)
How do you take your Lialda and enemas? You should be doing the 4 pills Lialda per day plus the enemas 7 days per week right now. If you aren't doing this then that would be my first step. Since these treatments are working I would not give up on them and try a stronger med right now. However, Prednisone is meant for short term only and can kick start a remission (along with your current meds) and hopefully after that the meds you are currently on will be good enough to keep you in remission after you taper down and off the pred. Sometimes your meds need a little help from the steroids. The trick is that you have to go into it knowing your pred will be short term only and taper down and off them and if your symptoms return DO NOT go back on the pred. It is somewhat like an addictive med in that it can work miracles but if it doesn't work after tapering lower or off we are suckered into wanting to continue with the miracle. Using pred long term will destroy your body. Uceris is another option instead of the pred.

I was in a similar place about two years ago and tried pred. I was sure it would put me into remission and then I would just have to worry about whether I would stay there after tapering off. Even though the pred made me much better I was surprised that it actually never put me into remission. Once tapering off I returned to my original condition. But, pred does help many achieve remission.
Posted 5/19/2015 4:59 PM (GMT 0)
When your disease is much worse than it is currently.

Basically you take Pred when your flare-up is so bad you can't function in daily life anymore. It's *usually* a short-term solution, which works for most people. However, it's not something you want to mess with, because a) Pred has a list of short and long term side-effects longer than your arm, and b) the more times you take it, the more likely you are to become resistant to it. It may only work partially or not at all. Ideally, you don't want to have a course of Pred more than once every few years. If you need a course every year, that's a sign that regular meds are not controlling your disease adequately.
Posted 5/19/2015 5:28 PM (GMT 0)
I'm doing the Lialda 4 pills a day with nightly mesalamine enemas as well. I appreciate the helpful info everyone. I think I'll just stick with what I'm doing unless things get worse or the doctor suggests otherwise.
Posted 5/19/2015 5:58 PM (GMT 0)
Your siggy says enemas 5x/week. Make it 7.
Posted 5/19/2015 11:54 PM (GMT 0)
I'm a big believer that you have to shut down flares quickly and decisively. If you've plateaued, your body may need a little more to get 100%.

You could try a week of hydrocortisone enemas along with the enemas you're doing now. They have fewer systemic effects than oral Pred and are a low dose. I doubt you'd see any side effects from one week of hydrocortisone enemas. They work like a miracle for me.
Posted 5/20/2015 12:04 AM (GMT 0)
I agree with kiptyn. You still have some inflammation that needs to be addressed. Sometimes it just needs a quick knockout punch. That's aftually the best use for steroids, either oral or rectal. Just accepting it as it is could increase your odds for colon cancer.
Posted 5/20/2015 2:54 PM (GMT 0)
I would ask for a steriod enema or suppository which may get you where you need to be. They cannot be used long term though.
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