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Combine 2 Rowasa enemas to reach further?

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Ulcerative Colitis
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Posted 3/17/2016 10:25 PM (GMT 0)
First time here. Please go easy on me! :) Wondering if anyone has ever combined 2 Rowasa enemas (4g each) Thinking maybe they'll cover more ground that way. Or possibly use cortifoam early in the day and enema overnight? Would love any advice.

I have UC, moderate, sigmoid and descending colon, for the last year and a half. I previously had it controlled with Lialda orally (4.8g) and had been using the enema at night but only keeping it in for 30 minutes (per my GI Doc). Seemed to get things under control well (for 6-8 months) so I backed off on the nightly enemas. Went to 2-3 times a week still only keeping it in for 30 mins. Out of the blue I flared up horribly. Suddenly the enemas arent helping. I figured I should keep it in all night so the last few nights Ive kept it in all night and will continue to do so. Even with that it seems the flare is worsening, Im starting to bleed and thats never happened to me before. (I dont think the enema is causing the bleeding, just the flare worsening). Want to avoid oral steroids at all costs. They make me insane, and they barely touched the UC when tried previously. My GI doesnt have much in the way of creative suggestions and just wants to jump to Humira. Im not even close to that point yet.

Post Edited (ChrisC) : 3/17/2016 5:28:10 PM (GMT-6)

Posted 3/17/2016 10:51 PM (GMT 0)
One enema can reach as far as the splenic flexure, according to barium xrays. So, I don't think combining two is necessary. If you've been flaring for 1.5 years, mesalamine probably isn't enough for you, I'd try stronger medications. Often immunomodulators (Imuran, 6mp, or aza) are tried before biologics (remicade, humira, simponi, or entvyio).
Posted 3/17/2016 10:57 PM (GMT 0)
had been using the enema at night but only keeping it in for 30 minutes (per my GI Doc).

I never heard of this and question why a doctor would say to do this. Are you sure you understood him correctly? Bleeding should not be related to the mesalamine enema unless you are one of a minority that is intolerant of the sulfa in the liquid. There is Rowasa-sf available which is sulfa-free.

Using (2) 4 g. enemas together? I use 4 g when needed and 2 of those would be a lot at one time. A better idea would be every 12 hours but if you have the time maybe keep your legs/butt elevated for a while to send it higher up..

Good luck.

Post Edited (imagardener2) : 3/17/2016 7:17:05 PM (GMT-6)

Posted 3/17/2016 11:12 PM (GMT 0)
Thanks imagardener. Yes she absolutely said it...but after MUCH reading here Im learning alot. SO MUCH. Great suggestion about elevating. I just read about someone who uses an inversion table and had great success with it. Also success stories combining cortifoam in the am and enema at night. I actually feel hopeful now that I have some direction and techniques to try. :) I see a nurtitionist tomorrow to discuss diet and a consult with a new GI in 3 weeks.
Posted 3/17/2016 11:17 PM (GMT 0)
I have combined enema and suppository. Sometimes the enemas miss the end because the tip extends past.

I usually try to retain them all night.

As imagardner said, I think every 12 hours is better than 2 at once.

I also think combining with a suppository is a good option.

When it really comes down to it, there is no guarantee the problem is in that area. I know my last sig showed all the inflammation started after the rectum because the enemas were treating that area. How do you know the enemas are reaching the area where you're inflamed? Have you had a scope to check at all recently?

I use cortifoam when I can't retain liquid well.

those are my tips and ideas :)
Posted 3/17/2016 11:18 PM (GMT 0)
Wow leave in for 30 mins?? That made me laugh. It's one thing to be unable to keep it in because your so inflamed and many of us have been there but to purposely only retain for 30 mins is just silly. Keep it in overnight and you can either do another in the am after your morning trips to the bathroom (if there are a few) or get the cortifoam or other steriod enema and use in the am to avoid going on pred. I would give that a shot before oral steriods. I hate them too.
Posted 3/17/2016 11:21 PM (GMT 0)
ipoop (lol) thanks. I appreciate everyones info so very much. I hope thats not the case. Im hyper-sensitive to all medications and am trying so hard to avoid anything stronger. Even the rowasa makes my joints ache terribly. If I've tried everything, every combination of suppository and enema, every position, along with dietary changes, and they all fail only then will I consider the stronger meds. Long road ahead of me I know.
Posted 3/17/2016 11:36 PM (GMT 0)
notsosicklygirl...I havent recently because Ive been doing ok until 3 weeks ago. I have an appt. scheduled now.

sherbear46...Im glad I gave you a chuckle...unfortunately Im not laughin! :) I have ZERO problem holding it in all night, I just thought if the Doc said its only necessary for 30 mins well...that was that. But after reading many posts here and researching for hours I decided to start keeping it all night and to make an appt with a different GI.

QUESTION: If you use the enema in the morning...what do you do all day???? Not pass gas? Does it not come out if you need to pee? Im a massage therapist and am moving around in a VERY quiet room all day long. eeek!
Posted 3/18/2016 12:11 AM (GMT 0)
And before I shut down for the night I just have to say how GOOD it feels to actually talk (type) to people who understand!!! Thanks all. My poor wonderful loving boyfriend will be so very happy he's no longer the only one who gets to hear all about my poo. :)
Posted 3/18/2016 12:24 AM (GMT 0)
The majority of the enema liquid should be absorbed within 20-40 minutes of administration. A healthy colon absorbs liquids. I've taken them in the morning, layed on my side for 20 minutes (as the instructions say) and gone about my day without trouble. If you're badly inflamed then you might be unable to absorb that liquid, and might have more troubles.

Just be aware uc can spread when left untreated during a flare. And untreated inflammation is far worse (increases colorectal cancer odds) than any uc medication is. While you might not want prednisone, uceris is a delayed release steroid that has a lot less side effects. Steroid enemas are the same. It'd be good to get some of the relief without as much side effects. Something to ask about at your doctors visit.

I wouldn't assume you're going to get the same reaction to all medications.
Posted 3/18/2016 9:25 AM (GMT 0)
ipoop...Again, many thanks. I have used Uceris and it still made me depressed, manic, affects my sleep terribly, etc etc. But you make a good point re risk of cancer. I will definitely ask about the steroid enemas. I feel strongly what doesnt work for one, may still work for another, so i hope to find a doc who will at least be open to trying out a few of the lesser evils first. :) If nothing else at least I'll feel I tried every possibility before medicating more strongly.
Posted 3/18/2016 6:37 PM (GMT 0)
I'm missing the point of keeping it in for 30 minutes...that's usually the minimum. Are you trying to eliminate it after 30 minutes?

Are you on any probiotics? and have you tried using fibre supplements?

q
Posted 3/18/2016 9:08 PM (GMT 0)
I just read about someone who uses an inversion table and had great success with it.

Read up on inversion tables before investing. I too thought they sounded like a great idea but they can cause problems ranging from dizziness due to inner ear problems to possible strokes. I knew someone that had problems due to using one but she was also overweight and drank a lot. I'm sticking to yoga poses for temporary inversion and not a full headstand.
Posted 3/18/2016 9:15 PM (GMT 0)
Hi quincy...yes i was to eliminate it after 30 minutes...and have been following that routine (with success fortunately) for at least 6 months. Until now. Now that I am again flaring and its not improving, I keep it in all night. Not sure what her (my GI) reasoning was for using it for 30 minutes. Seems to me, after learning more about it on my own, it wouldnt have hurt and surely may have helped me avoid this current flare had I been keeping it in all night. I got complacent bc my symptoms disappeared, so I didnt question her instructions. I havent seen her in a while bc I havent needed to, but I now have a follow up scheduled. As well as a consult w another GI.

No probiotics yet. Fearful my gut wont handle them well at this point. Saw my nutritionist today who wants me to begin saccharomyces boulardi. Fiber...not yet. Im starting a revised sort of phase 1 version of the SCD and she said the "psyllium is loaded with cellulose and lignin which some bacteria thrive on"...so to hold off for now.

Had a spectracell nutrient deficiency test done a few months ago and have since added:
L-Glut 10g a day empty stomach,
Vitamin A 10000iu every other day,
selenium,
Vessel care (B complex),
Vit D 5000 every other day,
chelated Zinc
panothenate (for stress)
manganese
chelated chromium

and lavender capsules for sleep.

My immunity against viruses and such has improved since adding most of the above. Best winter season yet, knock wood.

Its OVERWHELMING. I welcome any input, advice, opinion anyone has. I have found SUCH helpful information here on this forum. Today I am trying to use cortifoam during the day and rowasa enema held all night. Will continue and hope this flare improves.
Posted 3/19/2016 5:04 PM (GMT 0)
Keep us posted how you're doing.
And you should be on an oral 5ASA as well.
q
Posted 3/19/2016 5:59 PM (GMT 0)
So it sounds like you have left-sided UC rather than pancolitis. I found out the hard way that medicating the descending colon is very tricky; for me, nothing has worked there but steroids or brandname Colazal. (And we are not supposed to stay on steroids longterm due to their many potentially dangerous side effects.) From my own experience I would doubt that Rowasa can heal your descending colon-- just beware! Good luck & let us know how you're doing if/when you change meds. / Old Hat (35 yrs with left-sided UC; presently in remission taking brandname Colazal)
Posted 4/4/2016 9:26 AM (GMT 0)
Quick Update: IMPROVED!!!! :) I added Cortifoam daily and continued the Rowasa enema nightly (kept in all night) and Lialda orally and within a few days my flare started to improve. No more pain or cramping, no more blood or mucus, no more morning incontinence. I decreased the cortifoam to every other for a few days and now once a week, still using Rowasa and Lialda, and still holding strong. Also 1 week dairy free, almost no refined sugar and beginning to plan for grain free. Hope this helps someone else! <3
Posted 4/4/2016 11:02 AM (GMT 0)
Glad you're feeling better :-)
Posted 4/4/2016 3:07 PM (GMT 0)
Yay...don't taper the rowasa for for at least a few more weeks. Your butt will tell you if it's too soon or not anyway.
Keep us updated.
Oh...give your doc a refresher about the retention time of the enemas.... other patients will be doing the same thing possibly.

q
Posted 4/4/2016 11:54 PM (GMT 0)
That's great. Nice to hear you're doing better!
Posted 4/5/2016 5:01 AM (GMT 0)

ChrisC said...
Quick Update: IMPROVED!!!! :) I added Cortifoam daily and continued the Rowasa enema nightly (kept in all night) and Lialda orally and within a few days my flare started to improve. No more pain or cramping, no more blood or mucus, no more morning incontinence. I decreased the cortifoam to every other for a few days and now once a week, still using Rowasa and Lialda, and still holding strong. Also 1 week dairy free, almost no refined sugar and beginning to plan for grain free. Hope this helps someone else! <3

Obviously steroids are not a long term medication, but am I reading this right, you started tapering after 3 days? Purely personal, non-scientific opinion here: if you're in a flare, I suspect you need far more than 3 days of medication to heal the colon. Remember, just because your symptoms go away doesn't mean you're in remission and safe to get off medication. When I was flaring and started rowasa, the very next morning my symptoms were completely gone. Regardless I kept taking rowasa every night for about three months before even entertaining the idea of tapering off. How long did your doctor recommend you take cortifoam?
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