Proctitis and Suppositories vs Enemas

The primary difference between the suppositories in enemas are (1) dosage and (2) distance covered. A suppository will treat the rectum only and is in a 500mg or 1000mg dosage of mesalamine. An enema is in 4,000mg dosage and treats the rectum, sigmoid colon and the whole left side up to the splenic flexure (the bend where the large intestine turns from left-side to horizontal across your belly button). Overall an enema has more potency and also covers greater distance (in case the flare goes further than you expect it to). So generally here we say go the enema route as it has the most bang for the buck. No harm in trying suppositories, mind you, just know their limitations (which may or may not apply to you).

Has this blood been confirmed as inflammation, either through endoscopy or a FCP stool test? Just wondering if you've got hemorrhoids a fissure/abscess, or something else going on that isn't UC-related.

How many bms a day are you having? Any urgency? Are they formed?

If it was me, I'd probably insist on endoscopy before going up a class of UC medications (at least a flexible-sigmoidoscopy). What you're experiencing is pretty mild, and unless there is a big disconnect between symptoms and underlying inflammation levels (which can happen) it is a little harder to jump classes. Mind you, there's times it is appropriate, and you have been struggling for a while trying to resolve this flare so you are mostly in that category. When we're struggling it can make sense to go up classes. I'm always a fan of having some clinical evidence and data points, to know how far and how severe your inflammation currently goes. Having good data makes decisions easier.

Sounds like a good plan. I find "trust but verify" to be a good policy. Just a footnote on FCP, it isn't at all good at catching very mild and limited inflammation, I've had a few result come back normal yet I've been slightly flaring (same accuracy with CRP blood test). CRP and FCP are great for spotting moderate or severe inflammation. Endoscopy is always the 20/20 vision, but a royal pain in the arse for us (given a flex-sig is less of a pain to prep for).

I wrote out a reply on your other thread....i must have forgotten to post it, sheesh.

I dont see the need to go to imuran even in nov unless symptoms increase.

Yes....mix using supps as well as the enemas. Mix the supps mesalamine and steroid. Use the highest dosages. Not all enemas go up the descending...my opinion. Guaranteed, however, to cover the sigmoid and a bit above. Concentrating the medication at the lower rectum by withdrawing the nozzle a bit to that area will do it.

Plus yes on the above regarding a look-see. Your doc should have done that yesterday because it's a simple procedure with no prep.

I have no experience regarding FCP....while it seems to be gaining popularity, it doesnt seem reliable compared to visual. As well....you are in the very, very mild category at this point re ipoop's explanation of its capability.

q

I'd request steroid foam, enemas, or supps instead of budensonide. I'd probably try to get a combo of those to use as needed. Budensonide is great, but sometimes it's not as effective.

We had no way to get cortifoam so was put on the budenoside. I will see if they can change it to another steroid option.
Thanks x

Oh wow....and rightly so to be upset. No stool, just mucus and blood? How many times during the day Bms?

Why on the oral budesonide?

I suggest you call the GI's office and make an asap appointment and request for him to take a look-see. If he sees nothing, then you should have a sig-scope....

Just throwing this out there....how are your periods...are you coming up to a period, or could you be pregnant?

Hugs,
q

Hi....I agree to push for an appointment. Tell the assistant/nurse/receptionist that he didnt take a look as you requested and you need to know what's going on NOW and not waiting till November.

Sound desperate and beg.....🙄

Ovulation can have a part in bowel issues.....how are you today?


Let us know the outcome of the call.

q

Hi lovely people!

My GP rang for me yesterday and asked and they have popped me on waitlist. He didn’t seem to think it was urgent. She also sent a letter outlining my concerns with adding another med without knowing what my UC was doing.

I am on two weeks holiday from work (I teach full time) so also hoping some break from stress and resting will help this flare.

I live in a small country town and my GI is a 7 hour round trip drive which also complicates things for me. I am feeling a lot less upset today at least too. Hard emotionally to be flaring for so long!

Better yesterday with a tiny speck of blood on TP last night after I pooped.

I am hoping he gets me in but have to trust him still as in the end he treats me.

Will keep this updated.

Thanks!
X

Post Edited (Mamatomypeas) : 9/21/2018 5:53:17 PM (GMT-6)

Its great your GP called your GI.....hope it will be sooner than November.

Absolutely stay on the rectals. You say no improvement....not totally true. It's sporadic. The point of importance is to see where that but of blood is coming from.

Enjoy your time off.

q

Thanks guys, no blood so far today. Will be watching my symptoms closely this week or two and if they continue to show blood and tummy aches will be ringing GI and getting in as an emergency! 😉
Rectals are annoying but definitely used to them now. Been so long I forget bedtime without them!

Went another 7 days with perfect poops two times a day. Saw a speck (TINY!) of blood (mucus looking) on tp last night when wiped and am fine again this morning.

Still booked for mid November. My GI letter (he sends one after every appointment) mentioned starting the immunosuppressant if symptoms persist. I am going to refuse unless things get worse (ie. daily bleeding again) or he looks and can prove his case! I feel 100% healthy.

Am travelling to Canada for 5 weeks as of mid December. Wondering if that is another reason he wants to start immunosuppressants before I go to stop the flare? I really don’t feel that I am doing worse than I was. In fact from a few bloody bms a day to one every week or so seems remarkably better.

So I wait and hope I don’t need to plead any case for staying on the current rectals and mesalazine. My budenoside has one more 30 day box to go then stop.

Ahhhh. X

Post Edited (Mamatomypeas) : 9/29/2018 2:49:44 AM (GMT-6)

Hey Quincy!

Do you mean that I may not have inflammation causing The bleeding?

I am going to London Ontario (my whole family lives there now!) with my Aussie hubby and two kids. So excited for family time. Would be nice to have my health sorted or at least the looming flare sorted before then though!

In your opinion, carrying on should work eventually?
I know no one knows for sure. Just wondering why he wants to jump ship!