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Mesalamine Enema Questions

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Ulcerative Colitis
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Posted 4/14/2019 5:18 PM (GMT 0)
How long did it take most of you to see improvement in symptoms after starting mesalamine enemas? I have been taking Apriso for 8 months to cover the upper part of my colon and Canasa for the lower, but I started to feel discomfort and ulcerations again on the lower part of my colon and the blood and urgency has returned.

I've been using them nightly for 3 weeks. The feeling of discomfort and ulcerations has gone away thankfully, but the blood and urgency is still there. It only took 2.5 weeks for the canasa to work to stop the blood and urgency a year ago. I guess I was just hoping this would work around the same. I'm just especially worried because I don't want to have to move up to the next level of treatment my gastro is recommending (Imuran) because I am trying to conceive.

Thanks for any help all!
Posted 4/14/2019 5:28 PM (GMT 0)
It took around 2 months on Pentasa 4g/100ml enemas nightly for me to feel normal again. I started out with some bloody mucus with every BM (1-2 times a days, usually once), symptoms got worse (also because it was my first time using enemas, I had trouble holding them in at first), then eventually better. I've been on the enemas since December and still on them now, but at a lower dose.
Which dosage are you on?
Posted 4/14/2019 5:32 PM (GMT 0)
I am taking generic mesalamine 4gm/60ml made by Perrigo. It's the only type my insurance will cover. I have no problem holding them in and can last anywhere from 8-12 hours. I just want them to start working!
Posted 4/14/2019 5:43 PM (GMT 0)
Sounds like they are working. I would say 2 months for sure nightly...then see how yyou're doing.

You should taper to a maintenance of 2x weekly...but that's a process we can help you with when you think you're ready .
q
Posted 4/14/2019 6:36 PM (GMT 0)
I'd say 2-4 weeks for an initial sign of improvement, and you can continue healing over subsequent months. Healing is a very slow process, even though you/I want to be fully healed as of yesterday.

For faster results;

1.) You can certainly take an enema at night and canasa in the morning.

2.) You can ask about two enemas daily.

3.) You can ask about steroid enemas, rectal foams, or suppositories. Same as above, you can use alternate between steroids in evening and mesalamines at morning times.

It all depends how bad your symptoms are and how long you're willing to wait for a recovery. Some discussion points to have with your doctor to see if they make sense given your current symptoms. It's always good to have a variety of options to choose from.
Posted 4/14/2019 6:46 PM (GMT 0)
This article suggests imuran/6mp would be ok during pregnancy:
https://mothertobaby.org/fact-sheets/azathioprine-6mp/
Being in an uncontrolled flare during pregnancy is more risky.
Hope you find some relief soon in any case. (also I was wondering, what do you mean by having a feeling of ulcerations?)
Posted 4/14/2019 6:54 PM (GMT 0)
In the end, keeping mom's UC well managed throughout her pregnancy produces the best outcome for her child, regardless of whether that's mesalamines, azathioprine, or remicade/humira. Whereas faring uncontrollably and avoiding necessary meds can result in pre-term births with complications or miscarriages. We have some good info on UC and pregnancy within our sticky resources thread at the top of this forum which discuss risks/benefits and a lot of misconceptions that persist. Good things to read and bring up with your gasteroenterologist and obstetrician when considering pregnancy.

Over the years here, we've had many moms have many happy and healthy children while on all of the various combinations of meds available, without problems.
Posted 4/14/2019 7:01 PM (GMT 0)

poopydoop said...
This article suggests imuran/6mp would be ok during pregnancy:
https://mothertobaby.org/fact-sheets/azathioprine-6mp/
Being in an uncontrolled flare during pregnancy is more risky.
Hope you find some relief soon in any case. (also I was wondering, what do you mean by having a feeling of ulcerations?)

By feeling of ulcerations I mean I could feel as stool passes over some of my ulcers. It wasn't painful, just something I had a sensation of. It then got worse where I was feeling a sort of ulcerated pain constantly, even when something wasn't passing over it.
Posted 4/14/2019 7:17 PM (GMT 0)
It's degrees of inflammation and spasming that causes the pain...we don't actually feel ulcerations specifically...not all of us have inflammation to that point but the pain is horrendous during bms.

When was your last scope?
q
Posted 4/14/2019 9:26 PM (GMT 0)
I had a sigmoidoscopy in September. I was then put on a pred taper and Apriso. Finally the Apriso kicked in and I was golden for a few months. Then blood came back and I started to use Canasa daily but it wasn't helping. My doc and I both assumed the inflammation was higher than the Canasa could reach hence beginning the enemas 3 weeks ago.
Posted 4/14/2019 9:51 PM (GMT 0)
You may want to try hydrocortisone enemas at night, just enough to get the bleeding and under control, then revert back to mesalamine enemas.
Posted 4/15/2019 2:31 PM (GMT 0)
If I'm flaring, I add another mesalamine enema during the day. I have gotten out of a few flares that way without having to use Pred.
I agree that you should give it at least a few months to see how things go.
Posted 4/15/2019 2:39 PM (GMT 0)
What exactly are your symptoms?
q
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