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Any advantages of suppository vs enema, apart of ease of use?

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Ulcerative Colitis
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Posted 12/18/2019 1:38 PM (GMT 0)
My son was using suppositories for 9 months or so, but then calprotectin got elevated to 300 and his GI switched him back to enemas. Calprotectin seems to be moving in a right direction (150), but mild symptoms (bloody spots on toilet paper) start appearing from time to time.

I wonder if suppositories are better for proctitis? or may be alternation would work better?
Posted 12/18/2019 1:46 PM (GMT 0)
Canasa suppositories are typically 500-mg of mesalamine and treat just the rectum. Enemas are usually 4,000-mg of mesalamine and treat the entire left side of the large intestine (rectum, sigmoid colon, all of the way up to the splenic flexure where the colon turns from left-side to horizontal across your belly).
Posted 12/18/2019 1:53 PM (GMT 0)
Thanks, iPoop. my question really, can Canasa be more effective in treating the rectum?
Posted 12/18/2019 2:04 PM (GMT 0)
Suppositories never did anything to help me personally. The enemas have helped me a lot though.
Posted 12/18/2019 2:43 PM (GMT 0)
Enemas are more effective for my son... fact. but, I have a feeling that he currently has inflammation only in rectum as there is no blood in stool, no reddish water in toilet, just some spots on TP. So, I wonder if supps can be more effective in treating the rectum as i assume enemas may be missing the first inch or so... Difficult for me to make assumption as I am writing about my son.
Posted 12/18/2019 2:45 PM (GMT 0)
I don't have the answer to that question, but I doubt it? Enemas should reach the entire area. I usually have some leak out so it's definitely covering the rectum too.
Posted 12/18/2019 2:46 PM (GMT 0)
He could use a supp in the morning and enema at night and see if that helps.
Posted 12/18/2019 4:25 PM (GMT 0)
I would agree with Sara14, try one at night and the other in the evening. My gasteroenteroligist prescribed me two mesalamine enemas a day, which cleared up blood once (I was taking 4.8 grams orally, and 8.0-grams rectal route; 12.8 grams total daily). It's really hard to overdose on mesalamine but you should always run it by his doctor to verify it as he's a pediatric case. You said 17, so should be about adult weight/size.

I suspect that suppositories are a little better within the rectum, at least in the very end by the sphincter. Nothing but a suspect, can't back it with evidence. Certainly the enemas are a lot more potent, more mesalamine and I'd guess that means a higher dosage to the rectum too. Again, a guess.
Posted 12/18/2019 6:26 PM (GMT 0)
I thought the Canasa was 1000mg. They can be used 3x daily, but one's rx needs to reflect that use for accessibility to product.

Regardless, the enemas are a better bang regarding dosage and do treat the rectum obviously. As mentioned, using the supps during the day and the enemas at night would be best considering his inflammation level
is high.

What are his bm symptoms exactly?

q
Posted 12/18/2019 7:05 PM (GMT 0)
Thank you, guys/gals! All your comments help as I still find it tough to deal with my son's condition. exhausted mentally. I will talk to the GI about supp+enema or 2 enemas (poor boy).

We eat pescatarian, plus almost no processed food, fruits and veggies. Mediterranean diet without any meat overall. So, our normal is 2-3 bms. Last couple of days it is 4 for him. Well formed, mainly 4 by Bristol chart. So, the only symptom is a slight increase in bms and blood on TP. Currently 2 versions - beginning of a flare or some fissure (may be wishful thinking). Will explore both.

By the way... this is probably his first flare after 18 months remission. Is it possible to get back to remission by staying more or less on the same medicines or in. most cases it requires a significant change and/or upping the dose significantly?
Posted 12/18/2019 7:26 PM (GMT 0)
It doesn't necessarily mean he will have to have a significant change or increase in medication. Hopefully he won't.

Take care of yourself, too! He's lucky to have you.
Posted 12/18/2019 7:43 PM (GMT 0)
Flares usually require a temporary increased dosage, and/or temp additional meds to beat. Flares do not go away on their own without intervention the majority of the time.
Posted 12/18/2019 8:08 PM (GMT 0)
Yeah, to clarify what I meant...it doesn't necessarily mean that he will have to switch to a new med or stay at a higher dose once back in remission. There are no clear-cut answers with this disease, which I hate.
Posted 12/18/2019 9:14 PM (GMT 0)

iPoop said...
Flares usually require a temporary increased dosage, and/or temp additional meds to beat. Flares do not go away on their own without intervention the majority of the time.

Have any of your had any experience with budesonide/uceris foam? Can it be effective in stopping the flare?
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