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Scope cause flare?

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Ulcerative Colitis
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Posted 10/27/2016 11:41 AM (GMT 0)
Hi everyone, I was diagnosed with UC about 4 months back during my first flare which consisted of 15/20 trips a day, pain,blood and d.
I was put on 4.8mg Mesalazine and told to start a pred taper from 40mg. This helped a lot but when I got down to 25mg the symptoms came back so I was told to go back to 40mg for a few weeks and then try tapering off again. I also added foam enemas around this time which seemed to really get the bleeding under control.

Last week I finally got down to 5mg of pred a day and things were looking good, only going 1-2x a day, no blood, pain or d. However on saturday and Sunday I noticed a tiny bit of blood on the tissue when wiping which panicked me a little, no other symptoms though. On Monday i had my first colonoscopy and the doc said that my inflammation looked much better and had gone from moderate/severe to mild which was good news.

Since then things have really gone backwards! That same night the blood,D,pain and urgency were all back with a vengeance and I've been going 6/7x a day since!

I rang my ibd nurse and she said that this is normal after a scope and things should settle down in a few days, she also said the blood was probably coming from the biopsies since my inflammation didn't look bad anymore.

Does this sound right to you guys?
Posted 10/27/2016 12:07 PM (GMT 0)
It took a good week for me to get back to normal after my last scope. I had bleeding and increased frequency for a few days. If you aren't taking any, look into a probiotic to help restore your gut flora.
Posted 10/27/2016 12:10 PM (GMT 0)
Yes, scopes are invasive and I'd expect your symptoms to be worse for at least 3-4 days. It should settle down.
Posted 10/27/2016 12:17 PM (GMT 0)
yes, things should return to what they were before the scope in short order -

did you have a sig scope at DX time, not a c-scope ?
Posted 10/27/2016 12:17 PM (GMT 0)
Thanks guys, that gives me a little hope that im not right back at square 1 again. Could the biopsies cause this much bleeding though? Every time I go the whole paper is covered in bright red blood/mucus. Very worrying.

I should of stopped taking the pred on the same day as the scope but I decided to keep taking the 5mg until things hopefully calm down.
Posted 10/27/2016 12:23 PM (GMT 0)
Hi Soynomore, yes that's correct. Wouldn't of noticed any difference after that though because I was already in a fully blown flare.
Posted 10/27/2016 2:01 PM (GMT 0)
you might consider (trust me, my mind is functioning perfectly turn) UPPING the pred a bit, just to help settle things - sounds like maybe your drop to 5 pre scope could be contributing -

are you using any butt meds - if not, please add them to your arse anal !
Posted 10/27/2016 2:18 PM (GMT 0)
That did cross my mind actually soynomore, when I mentioned it to my ibd nurse she said to give it a few more days first. I probably had the scope at the worst possible time with me just dropping down to 5mg per day, looking back now I wish I'd postponed it for a month or 2.

In regards to the "arse anal" I've got the Asacol foam enemas.
Posted 10/27/2016 2:29 PM (GMT 0)
"Could the biopsies cause this much bleeding though? Every time I go the whole paper is covered in bright red blood/mucus. Very worrying."

Yes, biopsies can cause what looks like a lot of blood. Even a small drop of blood can skim the toilet water or turn tp red, so we tend to over estimate the amount of blood that's actually there based on its appearance. They take a number of biopsies, so you have quite a few little pin pricks on your large intestine, each can bleed a little for a series of days after your scope. What you describe is typical, I'll often have bms that are very red with obvious blood on tp and water surface for several days after a scope.

Hang tight, it'll get better, and I can assure you the blood looks a lot worse than it actually is. Certainly, seeing any blood is unsettling, but it's okay in this case.
Posted 10/27/2016 2:44 PM (GMT 0)
There is still mild inflammation, which means the tissue is a bit friable - or likely to bleed when touched. So to be correct, you are still flaring until the inflammation is gone. Sometimes when symptoms go up and down people speak of multiple flares, but it is really one flare simmering and then boiling. The scope has causes an uptick in the symptoms.

I don't get extra heavy symptoms or bleeding after scoping, but many do.

good luck
Posted 10/29/2016 12:18 PM (GMT 0)
Thanks for the all the replies guys, I'm really starting to think this is more than just a blip though. Things are getting worse each day, today is day 6 and I'm having my worst day since this whole uc nightmare began a few months back. Maybe I was just lucky first time round with the pain side of things but I only really had it for a minute or 2 whilst having a bm and once it passed the pain went away. Today I woke up in pain at 5am and I've had it since, it gets a lot worse when having a bm but is still there in between bm's. I've been 9x today already with blood every time.

This time last week I thought I had 2 more days left and I'd finally be off the prednisone, today I'm considering whether I should start taking 40mg again!
Posted 10/29/2016 2:25 PM (GMT 0)
Sorry to hear that things haven't settled down by day 6. I'd call your gastroenterologist office. C diff is possible as is a worsening flare. Usually there's an on call doctor even after hours or on weekends and I'd differ to him/her on raising your prednisone dose.
Posted 11/1/2016 7:20 PM (GMT 0)
I've upped my pred back to 25mg, only day 2 but things are still getting worse. The pain is becoming unbearable for the first few hours of the day and I'm feeling very weak/sick/dizzy for the rest of the day. Seems nothing like my first flare though which is making me think whether I could of maybe got c-diff whilst in hospital like iPoop said. Docs don't want to do any tests though until I've been on the pred a few days longer.
Posted 11/1/2016 8:04 PM (GMT 0)
sounds like you need to call your GI ASAP some exacerbation of symptoms is normal after a scope, however you are describing what sounds like a little bit more than a flare. In fact, if your GI doesnt get back to you within the next few hours I would head to their emergency department.

Severe or unbearable pain is considered an emergency, is it cramping or tenesmus type pain? is it worse before, during, and or after BM? is it accompanied by nausea?

have you been eating/drinking at all? you might have gotten dehydrated from all the BMs. if you have no appetite, sucking on ice chips might help you get some fluids.
you may also have lost some electrolytes with all of your BMs,

do you know how to take your own pulse? try taking your radial (and brachial and compare the two if you can) I would assume that it would be a bit high at this point.

Scopes have been known to trigger worsening of a flare that does not resolve within a few days, might be prep, might be the stuff they use to clean the scope, might even be a tiny perforation, could be one of the biopsies caused a tiny tear.

the fact that upping the pred elevation did nothing may or may not be concerning (you were on it for some time so can get less receptive to it)

you should have a stool test and check labs for anemia, dehydration, WBC activity, inflammatory markers...

also, this is a general tip if you ever are going to an ED if you know specific expert in your area that you wanted a second opinion with, you can always head over to their ED. generally going to an academic medical center that has a special division for the reason you are going in (and does their own research!!) is best because they are in the know with the latest research


good luck! update how you are doing
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