rookie (Asacol) questions and Charmin's update

Hi, Charmin. I'm glad you finally got to the specialist. Asacol sometimes causes abdominal pain at first. For most people this will ease after a week or two. If not, you will need to talk to your GI, as there are other drugs to use. For some of us who can't tolerate Asacol, Colazal (Balsalazide) has been very effective. If at any time the pain becomes really sharp, like a knife, you need to get to the emergency room right away. In rare cases, the colon can rupture and this is a life-or-death emergency. But all-over, grinding pain goes with UC flares.

The dosage of Asacol isn't figured based on weight as many drugs are. It really acts more as a topical medication - like a cream you put on your skin - in that it works by direct contact with the walls of the colon. Hence the need for the rectal medication in addition, as it doesn't get all the way to the end in an effective dosage.

You are hoping for remission, which mean no blood, more solid and fewer stools, although some of us never get back to one a day. For the short term, you're looking for any reduction in bleeding and frequency of stools.

We're all different about diet. At this point, I'd start out eating a light diet. No fatty foods, no spices, low on fiber. Keep a food diary and compare this to your UC symptoms as you add new things to your diet. If you consistently see, over five or six times, that every time you eat something you get worse a day or two later, you may want to avoid that. Be aware, though, that you may not be able to tell at this point. In a bad flare, I ate whatever I wanted because I was just as sick whether I drank Ensure or ate enchiladas.

Some people have specific intolerances. Lactose intolerance is more common in those of us with UC, for instance. If you suspect something of this sort, ask your GI to test you.

I don't think I had yet welcomed you to Healing Well, so welcome! I hope you'll find the support and ideas here that will help you get through this.

Hi Charmin

I read that you were drinking apple juice and a bell went off in my head. Years ago I went to a lecture on nutrition for UC given by a doctor and he said to stay away from apple juice and cider. There's something in it that can aggravate symptoms. Just a word of caution! :)

about the hydrocortisone supp.,-- you can read a lot here about other rectal meds and the dosages. You can combine different rectal meds -- using one kind in the morning and another at night. The suppositories should be good for stopping bleeding but if you don't see improvement in a week, I would ask your doctor about adding another kind into the mix. Maybe cortifoam in the morning and the supp at night.

Asacol - I took it all the time on an empty stomach. I agree that you should keep your doctor informed about the stomach pain. If you're certain it's from the Asacol and it doesn't go away soon I would ask to try a different drug.
There are a lots of similar drugs and you might just need to find the one that doesn't make your stomach hurt. (Makes me think of "Don't squeeze the Charmin"!) Seems like an unfair side effect when that's part of the problem in the first place!

Keep us posted. :)

Charmin:  I always suggest taking all meds with food/milk unless it specifically states otherwise.  Taking pills without food can (in some cases) lead to gastritis.  So, just as a precaution, I take all of my meds with food.

Twelve Asacol per day is considered the maximum does and is usually used to treat stubborn flares.  Six Asacol per day is considered a maintenance dose to keep the inflammation at bay and to keep the UC from spreading.

Abdominal pain is a huge symptom of UC.  Your heating pad is probably the best solution.  Tylenol is another option.

As for food, when bleeding I try to stick to a low residue diet - to keep things from scraping my insides.  If it's white, it's probably low residue.  I'd make muffins for breakfast and to snack on throughout the day.  Bagels are a staple in my flaring diet.  Mashed potatoes.  When the bleeding stops, I start expanding my diet back to "normal".  Fruit juices usually have too much sugar for my body during a flare, so if I did crave them, I would water them down.  Sometimes just plain water wouldn't cut it and I needed that flavor.

Ask your doctor about other rectal meds rather than oral steroids.  I've decided that I like meds that treat where the symptoms are rather than swallowing a pill to go through my bloodstream to get to the spot.  (Like Judy said - Asacol is more topical...)  The rectal meds treat inflammation at the source.  The prednisone, while a wonder drug at times, can have some severe side effects.

Now that I've written a book, I'll end this.  Just ask more questions if we've confused you!

 

Hey Charmin,
Don't worry about being in bed. I think that resting up is great help. When I'm flaring, I think I sleep about 10 hours a night! Your body is going through a lot, so take it easy as much as you can.

Maybe others will weigh in on this but I think that if the Asacol is making you really uncomfortable, you should try a different drug rather than just cut the dosage. Colazal is one that is very similar. Your doctor should know which of the other drugs in this class of meds (5ASA drugs) might be a good second choice. It seems that many people start on Asacol and then move on to Colazal if the Asacol doesn't work for them.

Hang in. Remember, you can call your doctor's office on the weekend if you need to speak with whoever is on call. They're used to it, so don't suffer until Monday if you feel you need immediate advice.