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Straight to steroids or try pred foam?

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Ulcerative Colitis
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Posted 12/17/2016 10:51 AM (GMT 0)
I have been flaring quite badly for a couple of weeks. Have had about a year of remission on 2.4g of oral mesalamine and 2 applications of a mesalamine foam enema per week.
My flare this time seems different in some aspects. Mainly that I feel quite rubbish most of the time. Zero interest in food. Lost loads of weight. I also have the urgency to pass blood, liquid stool loads of times a day.
As soon as I started flaring I increased the oral and enema to the max but symptoms getting worse not better.
I went and saw the ibd doc yesterday and they actually wanted to admitt me to hospital as I had high pulse rate, high temp and multiple loo trips.
I resisted this as I have 2 young kids and close to xmas etc.
They gave me a prescription for a pred enema and a course of pred tablets if i felt the enema didn't work.
Unfortunately for the last 3 or 4 nights I have been unable to hold the foam enema in for more than a 4 or 5 hours. I have been waking up in the early hours and rushing to the toilet.
So, it's xmas soon. Will be hoping to spend lots of time at family houses, with the kids etc. I feel like crap, I need to get better quick. Do I try the pred emema or do I just go straight for the pred??
Posted 12/17/2016 12:11 PM (GMT 0)
have you used oral pred before ?

if it were me in the same situation, i would use both -

4 - 5 hrs is plenty of time for the enemas - keep using them -
Posted 12/17/2016 12:40 PM (GMT 0)
Yes on my prev flare last year I had oral pred, no emema. This willl be my first time using a pred enema.
With prev flares whilst symptoms were horrid, I generally felt okay. This time I feel physically rubbish
Posted 12/17/2016 12:47 PM (GMT 0)
Go straight for the pred. The enema won't touch the systemic symptoms of fevers and feeling like utter crap. Hopefully you are a fast responder and it will kick in within a day or two.

If pred doesn't work and your symptoms don't get any better, then I would accept the doctor's offer of hospitalisation once Christmas is over. It sounds like your UC has taken a severe turn, and you will need stronger meds than mesalamine to deal with that.
Posted 12/17/2016 1:59 PM (GMT 0)
what dosage of pred were you given to start with ?
Posted 12/17/2016 2:30 PM (GMT 0)
40mg of oral pred for 7 days then a long taper down (3months)
Posted 12/17/2016 2:32 PM (GMT 0)
Just picked up the prescription..
Seriously these pred retention enemas... I am actually supposed to hold this in for any length of time???? It's 100ml of liquid!!!!
Surely that's too hard to hold in?
Posted 12/17/2016 3:13 PM (GMT 0)
You've gotten lots of good advice already.

Steroids are quickly absorbed by the body on contact, think asthma inhalers which use the same active ingredient. I'd still try to retain them for as long as you can but don't believe 7 hour retention is needed for steroids.

I'd use both the enema and prednisone. Make sure to get a stool test for pathogenic causes to your worsen symptoms (could be an infection or overgrowth like c diff).
Posted 12/17/2016 5:35 PM (GMT 0)
Okay thanks for the advice and thoughts guys. I did wonder about infection as my uc symtoms are not as bad as prev flairs but I feel worse than ever. Funny old thing is uc. Not in a ha ha way tho!!!!
I will give both a go as I need to get better for xmas. I am due back to the docs just after xmas and if no improvement they will admit me
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