Flare or maybe proctitis?

I have been flaring since about the middle of Dec (which for me is very abnormal). Usually I can stop a flare early on with prednisone and be back in remission within 30 days. The flare has been quite mild in comparison to other flares I have experienced in the past. 2-3 skinny formed movements per day with less urgency than normal. I have though been experiencing a much higher amount of mucus & blood which is a bit concerning along with the fact that 40mg of prednisone doesn't seem to touch it. Was tested negative for Cdiff and now my GI thinks it could be proctitis. I have never experienced proctitis to my knowledge so I guess I'm just curious if any that have could maybe give me your 2 cents. My UC has been fairly predictable for the past 10 years so this curve ball has me a bit lost. Really hoping its something I can figure out and manage.

I am mesalamine intolerant and my Dr BEGGED me to try enemas for a couple days to see if we could slow things down. It's been 10 years since I have taken a 5-asa and I promise you it'll be another 10 or more before he can talk me into trying them again! Now not only am I dealing with the mild flare but I'm in a mesalamine induced major flare after only 2 enemas. Hopefully I'll get it out of my system quickly and get back to the mild flare lol. Sorry had to vent for a sec....

Thanks for any help or advice! You guys are great here even if it's only to read that we're not alone on these bad days. I'll be the first to admit I forget all about this forum while in remission but come crawling back when flares pop up and always find great reading and advice

I'd get a second round of stool tests for possible infectious causes, infectious-proctitis, c diff, etc. As the stool tests for c diff is prone to false negatives. C diff would be suspicious, as 40mgs of pred won't touch it, and c diff only responds to antibiotics.

If you have mesalamine-induced allergies/intolerances then it should clear within 48-hours or so of discontinuation.

Have biologics been discussed (humira/remicade)?

If you've been flaring since december then you need to change something to get out of it. 40mgs of pred isn't touching it.
-Asking for another stool test makes sense
-Asking about 60mgs of pred is a question to ask
-Asking about adding humira/remicade makes sense.
-Asking about a more novel approach like tacrolimus suppositories is another possibility (some research hospitals use it but not wide spread everywhere).

All good conversation points to have. Let us know how the appointment goes!

Yeah, still flaring, but improving. Flares heal in a pattern.....downward, leaving you with more noted symptoms that you haven't noted in the past and elude many of us as early flaring symptoms. I disagree about mesalamine induced flare....you are still flaring, so keep that focus.

Since mesalamine isn't on your list, I suggest steroid enemas....either liquid or foam. Start them asap....then discuss your other options with the doc regarding staying off prednisone and into the next classification such as biologics and ilk.

q

Hi there
Just wondering how you know the mesalamine enemas aren't for you? I only ask because I took Mezavant orally for 2 weeks and was highlight intolerant to it. Changed to Asacol with no issues.
I've always taken pentasa (mesalamine) enemas though (2 or 3x a week as a maintenance dose and daily when originally diagnosed/flaring). I feel pretty yuck the day after an enema though, and can't really take any "symptoms" seriously after having had one. I usually get some diarrhoea, cramping, mucus etc the day after, and then nothing on the days without enemas.
Is this sort of what you had experienced or was it much worse than this?
Thanks for sharing
x

Most are able to take mesalamines orally or rectally without side effects. Those who experience side effects usually have an intolerance to the mesalamine itself, or in the case of the enemas an intolerance to the sulfite preservative within. Regardless of what the intolerance is to, the reaction is the same. The package insert includes a paper that says something along this lines "might produce a dramatic worsening of your UC symptoms" and that's what the intolerance to either results in.

For example, without taking the mesalamine you poop 2-3 times day, solid, without urgency. After taking mesalamine, you poop 6-8 times a day, with great urgency, and pass mostly diarrhea. So, we're talking a very, very dramatic increase in symptoms, and not just a little bit more mucus/etc.

It's perfectly normal for the enemas might make your first bm of the day a little looser, and a bit more urgent as the liquid is never 100% absorbed. It's not dramatic though, just a little worse than your normal.