Bleeding with Uceris Enema

Just curious if anyone has heard of more bleeding with a corticosteroid enema (Uceris in this case).

I’m a proponent of the SCD diet, I don’t think it works for everyone but I think it can help a lot and has helped me. The last month due to a wedding, bachelor party, etc I’ve been off the diet. The last week a little more. Honestly still feel mostly fine with just my pentasa (mesalamine) but I’m going on a cruise in a week and wanted to be able to eat whatever I want so I decided to try a Uceris enema.

I have used Uceris 3x before and it’s always helped (more the first time). I had a recent colonoscopy which was shockingly clean except there was moderate inflammation in the last 8cm so my doc started me on the Canasa suppositories. Well Saturday I had some pizza and ice cream and then used the Uceris enema for the first time and the next morning had a ton of blood. Now 3 days later every bowel movement has had a ton of bright red blood. Filling the toilet bowl.

Nothing hurt too badly when I put it in but I’m almost wondering if I perforated tissue or something? Yes I did eat junk the night before but there were plenty of days in the last month I ate way more junk and didn’t have anything like this so I’m thinking it’s either
1.) odd coincidence
2.) perforation
3.) the Uceris enema is itself somehow actually causing bleeding

Sucks because I really want to be able to enjoy this cruise but do not want to take oral Uceris a 4th time. I think the more corticosteroids I take the worse off I’ll be from their side effects so I’d like to avoid anymore oral steroids

No. If you had a perforation of the intestine, you'd have a very high fever, be in septic-shock, and in the Intensive Care Unit of your local hospital. Bowel perforations are life threatening.

It's very possible, and expected that the enema is not 100% absorbed after administration. A drop of blood, much like food dye, in a liquid spreads throughout that liquid. So, one drop of blood suddenly looks like all of the tablespoon of liquid it touched, as then spread throughout.

DBwithUC said...
I think that it is hard to say with high confidence. You have several things going on.

I think perforation is unlikely unless you have lots of pain. But, some small abrasion or scratch could be possible, although that should not make lots of blood.

Any steroid can make tissue a little thinner and weaker. It is possible that you were very close to a friable state, and with a very small nudge from steroid the tissue became more friable - but that is still inconsistent with "tons" of blood.

I have not seen any medical study that otherwise says an anti-inflammatory steroid has a direct mechanism to make tissue bleed. But, it is possible some inert ingredient is making tissue bleed. Some have found that the sulfa in ordinary Rowasa brought more harm than the mesalamine brought benefit. I have no idea what inert ingredients are in your enemas. If available, you could try a suppository which would have different inert ingredients, and since you only need to treat 8cm.

It is also possible that the tissue was a bit friable, and when eating a menu expanded from your SCD, that you changed the texture and firmness of your stool enough that the friable tissue gave off more blood.

If your symptoms (if not underlying inflammation) respond to dietary manipulation, then it does not follow that in the absence of inflammation you can forgo all dietary manipulation. The deal you want is to live your life without regard to your chronic condition. It is a great deal if you can get it. Some do. But for many it is not a reasonable expectation.

good luck

Yea the tissue already being friable and then the steroid somehow damaging the tissue was my concern. So there is evidence corticosteroids can make tissue thinner and weaker?

ewafromwarsaw said...
I don't know if it is in any way related, but I've read that many people on the Polish uc forum are complaining that salofalk foam enemas cause bleeding while they perfectly tolerate the regular ones. Maybe there's something wrong with enemas in the form of foam?

Interesting, do you have a link to that? So there are regular salofalk enemas people are fine with and then the foam version is causing problems?

That’s really interesting you say that- I am currently on oral budesonide and tapering, but when I first started it the results were so great I thought that using the foam at the other end would help. I quickly had blood too (although in tiny amounts) but after a day or two I doubled up on my canasa- that definitely helped me more that the Uceris back there. Hang in there and sorry you are dealing with this!