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Ulcerative Colitis
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Posted 5/19/2016 10:36 AM (GMT 0)
I am in a bad postpartum flare. My GI put me on a rapid taper of steroids going from 40 down by 10 mg every 5 days. Ofcourse after a couple days on 20 my blood in stool is increasing so I'm going back up to 30 today and will just taper more slowly.

My question is for any mothers out there who had a post partum flare. Do you get out of the flare and not have another for a while ? They're talking of putting me on biologics already but I've had UC for less than a year and was pregnant or postpartum during this time. I've never seen what my disease is like in a normal state , or maybe I have and it was so mild I didn't notice it. If that's the case I'm hoping after this flare I can go back to that and maybe avoid biologics for longer.
Posted 5/19/2016 11:44 AM (GMT 0)
What uc medications and doses are you currently on?

"They're talking of putting me on biologics already but I've had UC for less than a year" If your uc is severe and unresponsive to lesser medications then biologics make a whole lot of sense. Some really get caught up in, there should be long periods of time between medication A and B, there's no okay amount of time between them. It's whatever your uc needs to be controlled and give you the best quality of life. Consequently, some sprint up the uc medication ladder, rather than have a leisurely climb. If your uc hasn't been normal or in remission at all, it seems reasonable to me for immunomodulators or biologics. I'm in remission now thanks to remicade. And, if you can get into remission then you'll have more time to spend with your infant :-)
Posted 5/19/2016 1:56 PM (GMT 0)
OH, man! Sorry to hear about your flare, especially when you're trying to care for a baby. When did this post partem flare start, was it right after birth? A few weeks after? Did it coincide with stopping breast feeding? Were you in remission at all during your pregnancy? Maybe if you can determine what set this off you can better guess at if it will stabilize when your body returns to normal non pregnant state. However, if things aren't being managed well and your GE suggests bio logics, that might be the best option, unfortunately. I wouldn't want to keep suffering waiting it out...
Posted 5/19/2016 2:34 PM (GMT 0)
Hi GMSAF

I am so sorry to hear about your flare. I don't have much advice as I am new to this and have been pretty lucky lately, but I can empathise with your situation as I also had a post partum flare. As if caring for a newborn and dealing with lack of sleep and crazy hormones isn't enough.

I flared about 2 months post partum, I think it was caused by lack of sleep, stress, final reduction of pregnancy hormones. However I was lucky in that I could still keep nursing (only on ASA meds right now) and so my hormones haven't gone too crazy, though my GI did warn me that when weaning I might have another flare.

I hope you get some relief soon. My kids have gotten used to me spending a LOT of time in the bathroom (and we only have one in the house and a potty training toddler). I ended up putting a baby chair in their so it was easy to make a run for it and have somewhere safe to put the baby down.
Posted 5/19/2016 8:09 PM (GMT 0)
I hope everyone hasn't lost interest but I wanted to elaborate a little... I'm not sure if I have moderate to severe UC. I have cramping and diarrhea every morning with blood and mucous but after I pass them in okay for the rest of the day (on the steroids). Before I was placed on them I was okay for 2 weeks after the birth of my child as well. Then I started having increasing diarrhea (5-6 a day) and cramping and eventually needed bentyl for the pain which is why I stopped breasfteeding as well as this prednisone taper. But on the taper it's just the morning hours and the blood. Is this considered severe ? He won't scope me yet because he considers me actively inflamed. The diagnosis was with a flex sig during pregnancy in November showing moderate lesions in the transfers and left colon, very well controlled on my long prednisone taper during pregnancy.

I guess I'm just new to the disease and can't really gauge how serious of a case I am. Maybe I'm in denial(?) but I can't help but feel like I'm a very mild case that just got triggered with this third pregnancy/GI bugs and then tapered off but then got into a flare again bc of postpartum hormones. I don't want to jump the gun on biologics without atleast seeing how my body is without all this going on but I also don't like that I've been on prednisone since last December (except for those 2 weeks after birth).
Posted 5/19/2016 10:09 PM (GMT 0)
Your gastroenterologist is the best assessor of whether you're a moderate or severe case.

Extent: Ulcerative colitis is classified by how far it extends from the rectum into the large intestine. The least extent is ulcerative proctitis which includes only the rectum. Next is proctosigmoiditis which includes the rectum and sigmoid colon. The most extensive form of uc is pancolitis which includes all of the large intestine. As your active disease goes past the sigmoid into the transverse colon (and your flexible-sigmoidoscopy wouldn't be able to look further) that likely gives you a pancolitis diagnosis.

Severity: Severity of uc is measured based on how much inflammation is seen during a colonoscopy, flexible-sigmoidoscopy. It's also determined based on number of bms per day and symptoms. Mild is less than 4 bms a day. Generally 4 or more bms a day is moderate. If you have 6 or more bms a day it is considered to be severe. 4-6 puts you on the border of moderate and severe.

I'd guess you're a pancolitis patient (greatest extent of uc) on the fine border between moderate and severe.

Whether it's hormonal, I can't say. You can always try to wait longer and see. Just be careful about the prednisone, long term usage (a gray area) is bad. So if you choose to wait, I certainly wouldn't wait an extended period of many months. As you've already been on pred a while.

Often immunomodulators (Imuran, 6mp) are medications tried before biologics. That's certainly another option you can discuss with your gastroenterologist. I don't believe their pregnancy/breast feeding safe though. Slow working medications too (at least 6-8 weeks to see a result).
Posted 5/19/2016 10:25 PM (GMT 0)
You might still be a little bit in denial. Admittedly you've had a lot going on with the pregnancy and hormones, so it's hard to assess what's causing what. As flares during pregnancy or post partum do occur. None of us are doctors. We've mentioned some things you can discuss with your doctor. If you're unsure of your path then it's fine to get a second opinion from a second gastroenterologist.
Posted 8/7/2016 10:36 AM (GMT 0)
Hi GMSAF,
How are you getting on? Have you managed to get the flare under control? Like you I am experiencing a massive flare postpartum. It started about 6wks after my lo was born. I'm not fully responding to steroids so will be starting biologics shortly as I'm out of options.
I'm on 6MP and Pentasa. I've had to (reluctantly) wean my lo as I was losing weight and getting weaker by the day.
Just wanted you to know that you're not alone and it's really scary having a flare and dealing with a new baby. Sending cyber hugs your way X
Posted 8/9/2016 1:07 PM (GMT 0)
I am now 12 months postpartum. I started flaring more than two months ago. This is by far the worst flare up I've ever had. Ive never had this much pain before. I've had UC since 2002! But I've always had minor although annoying, mild flares that I could always treat with the salofalk enemas. I would go a year or more without a flare, or they'd come and go. No major problems after my first child 5 years ago.

I don't know why this flare was got so bad. Left it too long I guess as well as being shuffled from dr to dr etc. Finally got to see a GI and was put on prednisone 40mg. Started to feel better almost immediately. Started 10mg taper and immediately symptoms came back. Had to get t3 for pain, was also on oral salofalk and ended up in hospital. ER visit, catscan, Was put up to 60 mg prednisone and have been doing well and tapering slower this time.

Dr wants me on 50mg of Imuran to start. Because the salofalk isn't doing anything. After extensive research and discussion with my family, I am not going to take it at this time. Bloodwork every two weeks for a year, raising two small children with a compromised immune system among other things and side affects and risks, I'm just not sold on it. I've had one bad flare in all this time. Who knows if it will happen again? Maybe with some changes in my diet, lifestyle, sleep , I can feel better. Nobody has discussed any of this with me. I had no idea that ibuprofen and naproxen was killing my gut. So many questions.

Nobody can tell you what do. This is just my thoughts for now. I'm actually going for my colonoscopy this morning... Ugh. Once I have more information I'll decide what is next.
Posted 8/9/2016 1:14 PM (GMT 0)
Hi Prairielilymom,
So sorry to hear of your bad flare!! Just fyi, you may want to start a new topic and introduce yourself since this thread is somewhat old. Hopefully you will be able to hold with the lower level meds once things calm down. Just throwing it out there...what about trying steroid enemas while you are tapering the pred?
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