does steroid enema lead to dependency on them?

i've had 5 bouts in the past 15 years.  had 4 colonoscopies, but the pathology does not show "ulcerative" colitis.  But there are mild inflammation.  The GI doc thinks it may be "sub-clinical" or "non-specific" colitis.  My next colonoscopy in 2 wks.

this bout started 12/2010.  not as bad as previous bouts, but i'm now a single father, so the demands on me being fully functional, working full time, and taking care of 2 y/o. 

i been on messamine enema since 12/10 once/night.  started oral asacol 1200mg/day 1.5 wks ago.  still have on/off days.

the doc gave me steroid enema to replace the messamine enema.  used it last night, seems to help.  but i'm afraid of dependency on it.   heard so much horror stories about steroid (or are they referring to oral prednisone?).  

should i alternate between the steroid/messamine enema?  or should i just give the colon a good amount of the steroid enema and then taper off? 

Also, the hydrocortisone enemas can lead to thinning of the tissues. So I wonder if part of dependency just comes from ending up with more delicate colon walls where the steroids reach?

Hi I've had uc in excess of 30 yrs and during that time have used hydrocortisone enemas and in more recent years entocort budesonide enemas and have never become dependant on them. If they caused the colon wall to thin I'd have no colon left by now. I have had good results from using steroid retention enemas and certainly for me the benefits have far outweighed any possible downside. Compared to oral steroids the absorption into the blood stream is minimal. I've had pred, azathioprine, pretty much every enema going, salazopyrin, elemental diets...the list goes on. I finally got better on the sc diet.

I have been off and on steroid enemas for the last year...More on than off I'm afraid. I keep trying to get off but keep flaring up. So, i will keep trying to get off of them...

Where in the colon is the mild inflammation...throughout?
Have you for sure been checked for microscopic colitis?

When you say you have off days...how exactly?

I think the doctor should at least have upped your asacol to 1600 mg daily or even 2400 mg.

Are you on foam enemas or liquid steroid?

You'll be fine with them for a while...but maybe a short duration might be just the thing to kick "butt"...if you're able to resume the Rowasa, that would probably be the best thing. Save the steroid enemas for a bit of a boost possibly.

q

I'm one of those people that had developed a dependency on them. I was flaring pretty bad and my GI and I refused to put me on oral pred so we decided on the steroid E's instead. I have used them off and on over the years but during this particular flare I was on them for almost a year. Every time I tried to get off them, my flare came back. Eventually I had to be placed on an immune suppressor. But many people have used them successfully over the years and got off them successfully as well.

Have you ever had a stool test to rule out parasitic causes of the inflammation?

I've been on nightly hycort (steroid) enemas now for just over a year. They keep me from flaring out of control but if I miss just one night, I will flare out of control.

It would seem that although it's much less steroid than oral prednisone, it's got me hooked anyways.

I see my GI on Monday and will ask him if there are any alternatives.

Be careful with steroid enemas laser_doc, do what it says on the box/package ie: nightly for 3-4 weeks then taper. I think my problem is that I didn't stay on it long enough to attain remission before tapering, and got sucker-punched.

Cazzmags, were you ever on nightly steroid enemas continuous for a year or more?

Mackster, No never as long as a year but on occasion for several months at a time. I've almost always used them as an extra assault on the uc when its bad and have often used them whilst on oral steroids as well. With occasional flares that weren't so bad I have found them sufficient to stop me flaring before it escalates to the point where I've had to take the pred. I've even had the joy of 2 a day when the goings got really tough! Obviously being in a situation where you are completely reliant on them every night isn't ideal and your quite right when you say that you really needed a solid remission before tapering them. See what your doctor says on Monday he may be able to offer a good alternative that suits you better. I hope he can help you with it.

Laser_doc, I'm a newbie here too although I've been reading the posts for a good while. I live in the uk and participate in a really good supportive forum here as well. IBD can be very isolating, when I was diagnosed in '79 there was little or no support out there and without a doubt these forums make a huge difference to people struggling with all the contradicting info we get deluged with. If I had a pound (sorry dollar!) for every person who's told me IBD is psychosematic I would be VERY rich!

For me, the steroid enemas were the way I successfully weaned off of oral prednisone.  I'm not sure I would ever have gotten off the oral if not for the enemas.

I am having problems tapering off the steroid enemas. I wouldn't say that they created the dependency, it's just that the inflammation is persistent and the enemas don't get to the root cause.

Obviously it is better if you can get relief with mesalamine enemas since they are quite safe for most people to use long tem. For some reason, they don't work or me anymore.

The only side effect I am getting from the steroid enemas is weight gain. I am up about 20 lbs since I started using them about 6 months ago. Other than that I am not having any mood swings or roid rage or what have you, things I have when I am on oral pred.