Can I dilute enema with water?

Hi Folks,

Hope you guys are doing well. Just want to know has anybody ever got the crazy idea of diluting enema with water. I was on 60ml enema earlier which is a generic version of rowasa which worked well to clear off my inflammation from rectum and sigmoid. But it did not clearup the inflammation in proximal part of descending colon. My GI thought the reason could be that the generic rowasa could not able to reach that part. I know you guys may say that 60ml enema proved to reach upto splenic flexture but it is not at least in my case. My GI then prescribed 100ml pentasa and bingo it worked well and cleared off residual inflammation. Now my GI want me to continue on it but pentasa enema pretty expensive in my country almost triple the price of generic rowasa.So now i've got this crazy idea of diluting 60ml enema to 100ml by adding some water and want to know has anybody ever tried it and will it make medicine ineffective?

This is a bad idea with tap water. Maybe with sterile saline.

It may have been that you needed more time for complete healing and volume of enema didn't matter. That being said, if you feel like you need more volume just use one and a half of the generic.

quincy said...
I wouldnt....stick to the pentasa. There is no reason at all that a 60ml enema wont deal with the sigmoid and a bit beyond. And your oral mesalamine would deal with the lower descending colon as well.

How do you know you had residual inflammation there?

What dosage pentasa?

q

Hi Quincy, I am using 1gm pentasa. Last scope showed inflammation in desending colon despite being on enema for 4 months. I assume high volume and low concentration of pentasa makes it distribute uniformly where as generic rowasa not able to spread uniformly. It might not be the case with reputed brands of rowasa but i always have the doubt that the perticular brand which i am using is having this issue and unfortunately we dont have any other alternate brands of enemas in my country.

My understanding of how UC heals isn't your pattern.....especially since you are on oral mesalamine. 60g will spread into the sigmoid and a but beyond. You might have a twisty sigmoid?
I do agree with upping your oral mesalamine at least one increment (what are you taking?)

The budesonide....uceris? Its targeted for colon and should also have dealt with that patch. Did the doc biopsy it?

q

Post Edited (quincy) : 6/18/2019 11:39:16 AM (GMT-6)

quincy said...

The budesonide....uceris? Its targeted for colon and should also have dealt with that patch. Did the doc biopsy it?
q

Yes Quincy i was biopsied and they didn't find anything abnormal. I was having symptoms like bleeding and diarrhea when i was scoped 5 months ago. Then doc switched me to pentasa enema and it kicked in within one month and my all symptoms gone. Though i did not have scope now, my doctor assured me that residual inflammation is gone since i do not have any symptoms. My question is how pentasa able to clear inflammation in proximal part of descending colon near to transverse colon where as generic rowasa could not? Hence the theory that it is unable to reach that part. I know increasing orals should treat that part but i can't tolerate more than 2.4 gm based on my previous experience. So either i should stick to pentasa or i should switch to rowasa hence the idea of diluting it to make it equal in quantity. I like the idea of using 2 enemas at once but it only caused me to bleed more last time when i tried.

quincy said...
What if you switched to another 5ASA oral such as Pentasa?
q

I was on generic lialda earlier and switched to asacol but neither of them treating left colon on 2.4 gm. I have already asked my doctor whether i should switch to pentasa but he said if delayed release formulations was not able to treat left colon, it is unlikely that pentasa would treat as it releases medication high up compared to them.
The only option appears to me is that i should have another scope to confirm remission and then switch to rowasa and observe if symptoms are coming back. What do you say?