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Posted 1/1/2011 9:37 PM (GMT 0)
I just can't seem to completely get rid of blood one way or another.
Even when I string together several 'good' days (ie 3-4 bm's) it invariably crops up again, mostly on the tp. Not an excessive amount but considering I've been pretty much on cortisteroid enemas for almost a year it's p***ing me off.

I've tried Mutaflor and VSL#3 the past year and it seems the powerful probiotics can't even stem this occasional blood.

My main question is, is blood (bright red on the tp) an indication of inflammation or could it mean that there is maybe just one open ulcer/polyp/laceration that might be the culprit? It puzzles me why there can be none for a few days then recur for no apparent reason.

I've been on azathiprine for maintenance for the past 4.5 years also.
Posted 1/1/2011 10:27 PM (GMT 0)

bright red blood means it's coming from a place very low near the anus or rectum.  Most likely culprit is an internal hemmoroid or fissure.  Best to have the doc do a flex sigmoid and take a good look.  Try not to be so upset.  It happens to the best of us.  What about any rectal med besides the corticoid enemas like canasa which are mesalamine based?  It has helped me heal the last part in the rectum.  Good luck with this.

MyUC

Posted 1/1/2011 10:58 PM (GMT 0)
I react badly to all the 5ASA drugs MyUC.

I doubt I have a fissure, I can imagine them to be painful and I don't have painful bm's. (only when I'm in a bad flare-up)

I did have (external) hemmies many many moons ago (pre UC) but my GI never encountered any internal ones at my last flex-sig about a year ago. The only anal anomaly was/is a skin-tag which seems to be quite innocuous. If it was bleeding I would probably have sussed it out by now.

I think your assertion that the problem lies in the lower rectal region may be closer to the mark.

Thanks for the help.
Posted 1/1/2011 11:51 PM (GMT 0)
Hi...maybe the steroid enemas are too high of a dosage possibly causing too much thinning of the mucosal layer causing some of the bleeding?

Since you cannot take the 5ASA meds, and if the enemas are too much, maybe using something like proctocedyl suppositories can help?

OR, maybe try a lower dosage of steroid such as to use proctofoam enemas.

The look-see by your doc is a good idea and that can be done in-office.  Since you do have a sentinal tag, it could be that you have another fissure.  Not all are painful...mine isn't.  The blood on the tp is what I have, and I KNOW it's from a fissure and not anything else.  

q

Posted 1/3/2011 12:39 AM (GMT 0)
Q, I never figured on steroid enemas having an effect on the mucosal lining. Maybe that's one of the reasons why they don't want you on them long term. You just can't win for losing with this UC thingy.

I've got cortifoam but we know it doesn't reach up too far. I've also got some proctofoam left and the problem with it is that the applicator 'nipple' (for want of a better word) is very, shall we say 'short'? I'm wondering if it would contravene any clinical rules if I put proctofoam into a cortifoam applicator (which is a more sensible length)

From what I've heard, even cortifoam only contains a small amount of steroid, much less than the body produces without any assistance.
Posted 1/3/2011 12:56 AM (GMT 0)
where is your UC...throughout or limited?

The enema, whether it's foam or not, will go into the sigmoid. That's high enough I think.

Regarding the short nozzle..are you saying it doesn't go into the rectum?

A small amount of topical steroid will work regardless...maybe less is better?

How were you when using the proctofoam or cortifoam in the past?

Are you using fibre supplements?

Are you using fish oil?


q

Posted 1/3/2011 1:15 AM (GMT 0)
I thought bright red blood on TP could be a hemorrhoid. I hope nothing more serious then that. If so then I bet the days you see the blood are the same days that you happened to sit outside on a cold bench or rock. Shows up more often in winter obviously.
Posted 1/3/2011 1:21 AM (GMT 0)
could be hemmie...

forgot to add Mackster...have you taken a look-see yourself?

q
Posted 1/3/2011 11:44 AM (GMT 0)
Also another suggestion, I found this out when I was on the steroid E's. When you use the enema, sometimes we just insert and squeeze but sometimes the med doesn't come down to the rectal area; it's supposed to but I found that when I squeeze a little out as I insert, the steroid then coats the lower most portion of the rectum and it works more efficiently.
Posted 1/3/2011 11:25 PM (GMT 0)
Babe, I'm pretty sure it ain't a hemmie plus I don't sit around on cold surfaces, I learnt that when I really did have one!

Q. I've never taken the trouble to take a 'look-see' (using mirrors I guess) mainly because I don't have the inclination. I suppose it does make good sense but tbh I wouldn't know what to look for! I'll leave the visuals to my eagle-eyed GI. If it was a hemmie I'm sure I would have had some definitive clues by now, ie bleeding around the anus when *not* having a bm, damp feeling and stains on my underpants etc.

Red34, yeah, I think yourself and Q have mentioned the 'early squeeze' method before. I'll try and remember to do it from now on, thanks.
Btw, does it work for foam as well?

The nozzle on proctofoam is already short enough to concentrate *only* on the anal area and would be pretty much useless for higher into the rectum. As a matter of fact it is marketed more for hemmies anyway. That's why I posed the question earlier if it would be kosher to load procto into a corto applicator which has the longer nozzle (thanks for the correct term Q).

Well, is it? :)
Posted 1/4/2011 6:07 AM (GMT 0)
I guess if you can retrofit one and dispense the correct dosage....

But, the foam would still reach the entire rectum since when it's not in use, it's a small area.

It sounds like a fissure to me....the look-see can be an aha moment to see what you're dealing with, but I get your point.

The just into the anus method should work with the foam...just be aware of how close to the edge you are and how fast you dispense it. I only used the proctofoam once...that was 21 years ago, but I liked that it ws a foam.

Keep us posted on the procto-chango.

q
Posted 1/4/2011 12:47 PM (GMT 0)
FWIW, I have an internal hemmie and I was bleeding off and on a few years ago. I thought I might be going into a flare so the doc did a sig just to check and everything looked good except that I had a small internal hem. The blood was bright red and only on the tp. I didn't have any other issues. But then I eventually did go into a flare and that internal gave me a bunch of grief. And now to this day, I never feel it unless I am having a bad day with D.
Posted 1/4/2011 4:56 PM (GMT 0)
Thanks guys, obviously I'm not going to discount it being an internal hemmie.
It's just that I have a hunch that this blood is UC related, whether from a polyp or a small inflamed stubborn area that is reluctant to heal. It might just take the slightest abrasion to sporadically set it off bleeding.

If my memory serves me correct, the hemmie(s) I suffered with 30+ years ago were caused by a bout of extreme constipation (lasted over a week). I've never had constipation like that since. I realize that during flare-ups there is a lot of downward pressure in the rectum, and that could cause hemmies which may perforate at a later date, and that is why I won't entirely dismiss them, nor will I rule out a fissure for the same reasons.

Q's assertion that constant use of steroid weakening the colon wall just might have some credance, if it's capable of doing that to the colon then it's probably capable of causing an anal fissure.

My next GI visit is March 21, let's hope I don't have to mention it.
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