Asacol passing through whole

In the last few months, I feel like I've developed intolerance to topical mesalamines, having difficulty retaining enemas, having a lot more "accidents" which stopped once I went off the topicals during a bout of severe antibiotic induced diarrhoea. Well last few days on two occasions I've spied full asacol tablets (and not just the shell) in my stool. First time was just once, and then tonight both. (I take two twice a day). Any clue what this means?

I think the dissolution of the capsules' enteric coating is affected by the acidity (or pH) of your intestinal track and the transit time. so if you suddenly see whole pills in your stool:

Maybe you just never noticed them before
Maybe you GI track has become more acidic
Maybe they are passing through faster

I use a nail file to thin the coating a bit so the tablets will break open. Trial and error to see what works.

It's okay to see an occasional whole Asacol pill within your stool. If you are seeing that regularly, however, then it's a problem as the medication is not reaching it's target area. Asacol is a delayed-release medication whose chemical coating is PH-sensitive, and begins dissolving at certain PH-levels. The pill must reach specific PH-levels within your digestive tract and the coating must be given sufficient time to dissolve. If you are pooping whole pills then it could mean your PH is different than expected or that your mouth-to-anus-transit-time is too fast. When we flare, our transit time can go from a normal ~24 hours to 4 hours or less, and that may not allow the pill coating enough time to dissolve and deliver it's medication to the target area. Essentially, when we flare our large intestinal surface is quite irritated, and our bodies want to purge whatever is on the surface and causing that irritation, so it's full-speed-ahead to purge everything form our systems. As we heal, things slow down to more normal speeds.

What to do? There are many other equivalent medications to asacol, try switching to Pentasa, Mezavant, Apriso, Lialda, Delzicol, or even a different manufacturer of asacol might help. As they all have unique chemical formulations in their delayed-release coatings that will produce slightly different results.

Thanks for all the input! I go back for a follow up next week so I'll be sure to mention it. It's odd because this med is not new, I've been on it a few years. My current flare is about a year long now, but in the last few weeks thanks to cipro (as I've previously posted about) it became the worst ever that my US has been. My GI put me back on cortifoam (am) and betnesol enemas (pm) and it was at that time I started noticing them in my stool. Maybe there was just so much crap before I never noticed, haha. Wondering if my crappy dietary choices have made me more acidic therefore not breaking it down. Sadly at this point it doesn't seem to matter what I eat, healthy or not, in constant agony. Yet my GI will not put me on anything besides either mesalamines or topical steroids. Very frustrating.

Oh that's good to know. I never know what meds are in Canada vs the states so hopefully that's an option.

It was effective until it wasn't. When I first switched I got out of my flare within a week. Then while doing a whole 30 I got a mini flare which was easily treated with steroid enemas in a matter of a few weeks. This is my third flare and I've done strict paleo with no results. I don't know what the difference is. And my GIs constant refrain is that bc my disease is rectum only he doesn't want to over treat. But it also sounds like he thinks he needs to go straight to pred as the next treatment which seems like he's skipping a few options in between... Going to ask him about LDN (is it effective for proctitis?) or immunomodulators.