Constipation/Ileus after Flare Treatment

I recently had a mild diarrhea/mucus/blood flare treated with steroid enemas and suppositories. The symptoms resolved for the most part.

I then began oral sulfasalazine for a maintenance effect. I developed an allergic reaction and stopped the drug. Started on one day of 60 mg prednisone to both treat the skin hives and to try to prevent a rebound UC flare.

The allergic reaction subsided. I dropped the prednisone to 40 mg, then to 35, and 30 mg over the next several days.

While the urgency and diarrhea is all gone, I have had increasing constipation/bloating/abdominal distension after eating. I have since gotten started on 5-ASA enema and oral Apriso. The constipation and ileus (lazy colon) has remained.

Has anyone else had this transition from diarrhea/mucus flare to constipation and ileus rapidly after starting high dose prednisone or tapering from it?

I realize that the sulfa drug allergy (and abruptly stopping it) probably re-initiated inflammation in the bowel. However, with the number of medications I am now on and with little resolution in the constipation, I am now most concerned about a functional ileus brought by either the shifts in medication or, worse, underlying scarring/bowel thickening that is causing a partial blockage.

I am frightened by the prospect of a "lead pipe" colon at this point (from several years of relatively untreated disease). However, I also did not have much active disease during this time either.

Do you think this constipation and ileus resolves itself with continued treatment or could it be something more chronic/irreversible in nature, such as loss of colonic haustra (normal folding), that may cause a more permanent lazy bowel?

I'm seeing a GI this week, but the collective experiences of those who have experienced this type of colonic slow down either during treatment changes or in general would be helpful to gain perspective. Have you ever developed a lead pipe colon on imaging or scarring/thickening that eventually resolved with continued treatment? I'm hoping this is a short- vs. a long-term event. Thanks so much.

I know both the concept of "lazy colon" and "ileus" well. I never referred to them as the same thing. It could be either in this case.

One may derive a paralytic ileus from either long standing inflammatory damage or rapid prednisone withdrawal. Lazy colon can result from any number of things, including colonic inertia (not "intertia") and weakening of neural feeding to the gut (also possibly from long-standing disease).

Constipation from rectal inflammation is unlikely here given both the enema and suppository treatment and rapid resolution of urgency, diarrhea, and bleeding. That's what makes this an unusual case and I was seeking others who may have experienced this (particularly those who had otherwise not monitored their condition over time and may be surprised by the finding of more advanced disease that is relatively quiet clinically).

Anyway, yes, I'm going to press for the barium enema. I'll keep my fingers crossed for positive news.