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Tapering off an enema?

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Ulcerative Colitis
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Posted 11/28/2009 6:30 AM (GMT 0)
I am currently on a hydrocortisone enema and heading into the final week of my 1 month course. I know that with oral 'roids you are supposed to taper, but I am not sure if that applies to enemas as well. I know the absorption is less, but presumably some kind of tapering would be needed.

My GI did this prescription by phone and I forgot to ask her at our last office visit. I have a call in but have not yet heard back so I thought I'd throw it out to the group. I will be sure to seek my GI's advice but I wanted to poll the forum anyway.

I don't know if it matters, but the enema has not been particularly effective and I am still in a full flare.
Posted 11/28/2009 7:41 AM (GMT 0)
Basically, you haven't improved at all?

When the doc calls, it would be best to say you're still in a flare and bleeding.

Have your bms improved regarding frequency and consistency of stool?

Are you bleeding with every bm?

Is your UC throughout or limited?

You might ask if you could increase the asacol or switch to another 5ASA med such as Pentas, Lialda or Apriso or Colazal...

quincy
Posted 11/28/2009 7:58 AM (GMT 0)
Q - I have lower/distal left-sided colitis...my bleeding/inflammation seems all right at the bottom of the pipeline, so I have formed stool, don't have much of a diarrhea problem, etc.

I'd say the steriod has caused a small improvement. Basically it seems to calm down by bowel overnight and allow me to have 1-2 decent BMs in the a.m. However, for the rest of the day I am still having problems with urgency, bleeding/mucous and some cramps. Looking at the big picture, I'd say I am better than I was right before the 'roids, but you would never mistake this for good, let alone in remission (I have previously enjoyed fairly long periods of remission so this is not typical).

Unless something really changes shortly, I am definitely going to advocate a different set of drugs. I have been considering asking about Colazal or some other alternative to Asacol, which seems useless. I want to exhaust all the lesser remedies before going the remicade/humira route.

Anyway, since my GI and I both want to keep the 'roids course short, I need to think about stopping this enema (replaced with Rowasa most likely) and so I am trying to figure out whether a taper is needed.
Posted 11/28/2009 8:52 AM (GMT 0)
Hi..I don't think it would be necessary to taper if you were to start on the Rowasa nightly.

The other option would be to use the rowasa at night and the steroid in the morning.

I see you used the Rowasa in the past....why did you discontinue to use it? How long were you on it nightly and did you taper to a maintenance?

q
Posted 11/28/2009 8:36 PM (GMT 0)
Q - I had a flare about a year ago. At that time they started me on Rowasa and then Canasa. Those seemed to really help with the bleeding and I eventually was kicked back into remission. I kept up with the Cansa on an every-other-night basis since.

When this flare hit (about Sept), I stepped up the Rowasa/Canasa and it did not seem to have any effect whatsoever. That caused my GI to prescribe the hydrocortisone as a temporary symptom-controller, but as I say it has had limited success.

Regardless of what my GI says, I plan to carry on with Rowasa/Canasa after the steroid course is finished. I (like you) am a bit fan of topical treatment and that only makes sense
Posted 11/28/2009 9:39 PM (GMT 0)
so you were on the Asacol as well during the past year?

Left-sided UC to me has part of or all of the descending colon involved...is that the case with you at your original diagnosis?
That doesn't necessarily mean, however, that all your flares will present as such since they can hopefully be controlled to not move higher with the topical meds and the asacol keeping things above quieter.

ARe you on liquid steroid enemas or foam? Your doc could change the liquid to a foam, lower % steroid and you go back on the Rowasa/Canasa. Using the steroid intermittently would be better than depending on it if 5ASA meds work well for you.

My take on it anyway.

It's a frustrating process...I recently had a bout with external hemmies and fissures progressing to a very mild flare...different than in the past and frustrating. But, interestingly, every time I take fish oil, urgency seems to get worse, and possibly the extra slipperiness in the stools is a contributing factor. Stopped the fish oil, urgency has improved. I did go back on nightly enemas and did use proctocedyl hemmie suppositories during the day. I'm back to normal, on every second night Salofalk enemas and topical external proctocedyl or hydrocortisone cream is keeping things controlled.

I'm seeing the light that as I'm getting older, so is the "wear and tear" on my butt...I have to be realistic and deal with stuff immediately because it can only get worse.

Sheesh, totally sucks!

q
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