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Asacol 1g foam enema

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Ulcerative Colitis
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Posted 8/25/2016 8:16 AM (GMT 0)
As some of you may know from other threads I've been struggling to get a prescription for some rectals for a few weeks now, mainly due to a stubborn Ibd nurse that was saying they won't help me. Yesterday she finally gave in and I was prescribed Asacol 1g foam enemas to be used morning and night.

Last night I used for the first time before bed and was surprised how smoothly it all went, so smoothly in fact that I'm actually wondering if it was faulty. I did it at 10pm went straight to bed and woke up at 6.30am no problems at all. I haven't done one before I left home this morning, I'm on the road now for a few hours and wasn't fully confident. Think I'll experiment with the daytime one at the weekend when I'm not working.

I've noticed on here that most people seem to use 4g liquid enemas and only at night.
Are the liquid 1's better?
Why am I being asked to do it twice a day is that normal procedure with the foam enemas?
Is 1g going to be strong enough to do anything?
Posted 8/25/2016 10:30 AM (GMT 0)
Hi UC555, glad to hear they have prescribed an enema at last. If you don't have much inflammation in the rectum it is much easier to hold on to the enemas. The foam, shoot up higher and are easier to retain in the day than liquid enemas. It is easier to use the Salofalk liquid enema (2g) at night but for me this time it wasn't really shifting inflammation in the sigmoid and if your inflammation is higher up then I think that is why they have given you the foam. There is a 2g foam mesalazine enema which is better than the 1g. I can't recall the brand but you could ask the pharmacist or your GP if the IBD team are unhelpful. I asked for the 4g liquid enema about three weeks ago and the consultant said my hospital didn't have them/he had no experience of prescribing them (very honest!). He told me there was no harm in using 2g twice in 24 hours to get the same dose. This would have been the Salofalk but then they switched me to Predfoam because they said the inflammation was too severe. Twice a day will be to give you 2g in 24 hours.
Posted 8/25/2016 5:35 PM (GMT 0)
Thanks for that Jessa, I've just noticed that it says you can give 2 doses at once which would equal 2g, not sure how it would be to hold in though with it being twice as much foam. 1g seemed easy though so might give it a go tonight.
Posted 8/27/2016 5:55 AM (GMT 0)
Little update on the enemas, I've used them 4 times now and had no problem at all keeping them in, overnight hasn't been a problem and yesterday I used 1 at 07.30am and kept it in all day at work until I got home at 8pm so all good on that front.

I do worry that not very much foam is coming out of the canister though, I squirted 1 dose in the toilet bowl and their was hardly anything there. A very thin line of foam 2 inches long at most, theirs actually more stuck/wasted inside the nozzle which is about 3 inches long. Is this normal?

First thing in the morning for the last 2 days I've had a dark purple/black mucus come out before anything else. Is the enema causing this or have I something else to worry about?

I've also noticed bright red blood on the end of the nozzle a couple of times so I presume this means that some of my inflammation is in my rectum even though the Ibd nurse said it wasn't.
Posted 8/27/2016 7:09 PM (GMT 0)
Great to hear that you have had no problem retaining the enemas. I think when there is still some foam left in the nozzle this is from either not inserting the foam firmly enough on the actual canister or withdrawing the nozzle too quickly.

I'm not too sure about the mucus. I had it in my first flare and then gave up wheat and I haven't had much mucus since. I had read a post on here where other people had had the same result. I think sometimes all the irritation comes out first especially in the morning and hopefully this will stop soon. It sounds like it is from further up the bowel with the colour. Have they told you how extensive the colitis is?

Yes my understanding is also that bright red blood means there is some inflammation in the rectum. You could try not inserting the nozzle as much sometimes so that the foam lands further down. The liquid enemas are best from my experience for inflammation in the rectum. You can withdraw them as you insert them whereas the foam comes out really quickly. I had some bright red blood in my first week of the steroid enema but this became more infrequent in week 2. I still haven't had my histology results but the sigmoidoscopy could only see inflammation in the sigmoid. Have you chased your histology report? That will confirm if there are any issues in the rectum and if so you might want to ask for suppositories in due course to keep inflammation there at bay. If you had bad inflammation there at the moment you would struggle holding on to the enemas so the fact you are not is very promising.
Posted 8/27/2016 7:38 PM (GMT 0)
It says to leave the nozzle inserted for 15 seconds after pressing it, I've been leaving it for at least 30 seconds and the disposable nozzle is definitely fully on the canister. Think it's just how it's designed to be honest, bit rubbish when your wasting more than your using though. Afterwards I'll maybe pull the disposable nozzle off the canister leave it inserted in my rectum and see if my wife will mind blowing the rest out for me?

I've had mucus since the beginning of the flare but never this dark purple colour that's what makes me think it might not even be blood and something to do with the enema. Certainly doesn't look like blood.

The only info I've had has been from the Ibd nurse who doesn't seem to be the best at explaining things. Hopefully find out more when I meet with the gastro for the first time in 9 days. It'll be 6 weeks since my flexi-sig then. She said I had inflammation as far as the flexi-sig could see but not so much at the rectum. That's as much as I know. What does a histology report show?
Posted 8/28/2016 7:50 AM (GMT 0)
More of the dark purple/black mucus this morning which was alarming to see but I've just put "purple,mucus,enema" in the search bar and it seems that it is a normal reaction to the enemas for some people. That's a relief.

The bit about my wife in my last post was a joke by the way, just in case you don't get my English sense of humour. Doubt even I could persuade her to do that.
Posted 8/28/2016 4:41 PM (GMT 0)
Yes normal. Were you told to use the enema twice a day or 2 dosages once a day?
Posted 8/28/2016 8:58 PM (GMT 0)
That's good to hear Quincy, had me a little worried at first. Didn't think something that went in pure white could possibly come out black. Was told to use the enemas twice a day, 1 dose morning and 1 dose evening.
Posted 8/29/2016 5:42 PM (GMT 0)
It's a mix of stool, blood, mucus and the enema. Anything dark or purple....normal if you have blood and using mesalamine enemas of any kind or suppositories.

How often are you having bms or any evacuation of "stuff" per day?

Let's just sum up your nurse as being lazy and stupid.
When will you see your doctor next?
How long is this rx and did you get refills? Because you will need them.
q
Posted 8/29/2016 8:58 PM (GMT 0)
Hi Quincy, I'm currently going 3/5x per day from 1/3x per day, today was 5 times. I think it's actually the enemas making me go slightly more than I have been, 3 of those 5 times today was just a clear liquid, enema maybe?

I'm going to see the gastro for the first time next Monday so hopefully he's better than my pain in the backside Ibd nurse. They gave me a months supply of enemas and I'm about 5 days in. What do you mean by refills? Each canister lasts a week if you use it 2x per day, it comes with 14 disposable nozzles.
Posted 8/29/2016 10:32 PM (GMT 0)
Enemas can make your first bm a little more urgent or looser as not all of the liquid is absorbed. I've passed white and tan liquid that were obviously from the enema before. Clear could be mucus, it can be white as well.

Often enemas are a long-term maintenance treatment and not a once off prescription. The lavel should say how many refills you're allotted before your doctor must write a new prescription. A refill means, you go to the pharmacy and get another package of your prescription. Nobody ever reuses the old packaging.
Posted 8/30/2016 4:42 AM (GMT 0)
You've only been using the enemas for 4 days. Give it at least 2 weeks. If you don't improve in the symptoms, maybe ask for the liquid in a higher dosage that will cover more than just the rectum.

q
Posted 8/31/2016 6:58 PM (GMT 0)
ipoop- Yeah that makes sense, I've definitely noticed that my first bm has been more urgent and very watery since starting the enemas. My prescription was for a 28 day supply of enemas, I presume I just ring my gp and request another repeat prescription when needed the same way I do with the others meds.

Quincy- are the liquid enemas seen as a better option than the foam enemas? I've found using the foam to be surprisingly easy and from want I've read on here the liquid sounds like much more of a chore. I can only presume that they must have a better effect or else everybody would go with easier foam option wouldn't they?
Posted 9/1/2016 12:06 AM (GMT 0)
Hi...not a chore, lol.

The foam mesalamine enemas are NOT available in Canada or US. So, that's not even an option for us to try. I think they'd be great for maintenance and done twice a day for treatment...but still low dosage compared to the 4g liquid ones.

It's good they are working for you...you still have the option to step up dosage should you need.

q
Posted 9/1/2016 12:15 AM (GMT 0)
Liquid enemas tend to go further than foam enemas do. There are some exceptions, I think uceris foam goes just as far as liquid enemas but they're not all created equal. Foams are easier to retain. Both have their potential pros and cons.

Yeah, just ask your doctor for a refill (if it doesn't already say 1/3 refils on the label).
Posted 9/1/2016 5:14 PM (GMT 0)
I've been reading through your threads, I'm also from the UK and have had trouble being prescribed enemas, like with you it was the IBD nurses who told me it wasn't necessary as I have pancolitis. It was only because of this site I pushed for them. My consultant wrote to my GP asking him to prescribe me enemas, although didn't state a name. When the GP checked the computer system Asacol foam enemas were blocked. I'm from the Midlands and I'm not sure if they're just not available in this region. Did you get a hospital prescription? I don't know the name of other mesalamine enema's and my GP isn't very well informed either. Does anyone know the brand names for enamas available here through prescription? I have made a separate post on this, but if anyone could help i'd be really grateful.
Posted 9/2/2016 2:28 AM (GMT 0)
Icanttrustmygut- hi, don't get me started on the NHS IBD nurses, mine has been a nightmare from day 1! Yes I got my prescription from the hospital, after weeks of pestering the nurse for them she finally caved in and said she'd get the gastro to write me a prescription, I had to collect the enemas from the pharmacy up at the hospital later that day. Maybe give her another ring and try that route. Mine were the Asacol foam enemas but I think theirs a liquid version available here to called Salofalk.

Good luck.

Quincy- Ahhh ok, that's strange that their not available in the US and Canada, I would of thought countries so big would have had all options available to them.

Although frequency has gone up and bm's gone looser (annoying) since using the enemas the blood has definitely gone down which I'm going to take as a positive. Was almost non-existent yesterday for the first time.
Posted 9/2/2016 12:11 PM (GMT 0)
My IBD nurse isn't too bad most the time, the biggest problem is getting through to them, it's usually on voicemail!! I have a prescription now for suppositories, even though I wanted enemas. The IBD nurse told me I could get both but my GP would only prescribe one of them, and wanted me to try the suppositories first. With help from the local pharmacy I found out it's Pentasa 1g liquid enemas which are supplied here. It's like a game of cat and mouse!!

I was reading from your other post you had to wait 6 months for your colonoscopy, I had to do the same, they wanted the inflammation to subside, because it was dangerous the first time.
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