Bleeding, Canasa, Et Al

In remission for roughly 12 years, I began to experience some occasional rectal bleeding about 18 months ago and saw a colo-rectal surgeon, thinking the problem was hemorrhoids. There were no other symptoms, no diarrhea, no cramping, and my stools were well formed. The surgeon disagreed with my suspicions, thinking the bleeding was more the consequence of my ulcerative colitis and referred me to my gastroenterologist who then did a colonoscopy. The colonoscopy showed active ulcerative colitis and a sample of a large pseudo-polyp was taken for biopsy. No change was ordered in my medication, at the time 3 400mg Asacol twice daily. For the next 15 months I continued to experience occasional bleeding but nothing that concerned me particularly. Then, about three months ago, the bleeding became more insistent. Mind you as before there was no cramping or diarrhea, just the bleeding. My gastroenterologist upped the Asacol dosage to 3 400mg Asacol three times daily but with no important effect on the problem. Then, early in December after one particularly concerning bleeding episode, he added 1 1000mg Canasa suppository daily to the treatment regimen. While initially there was some improvement, after about 10 days things reverted back to the old pattern with episodes of bleeding for a few days then none for a few days, then bleeding again, etc. I reported these results to the gastroenterologist right after the first of the year and he moved up the Canasa to 2 1000mg suppositories daily. Since the normal dose of Canasa is 1 suppository daily, I felt a little uncomfortable about this change. I began to suspect that UC wasn't the problem after all and that I needed to have another colonoscopy
but I went along with the recommended treatment anyway hoping that I'd see the bleeding stop. But it hasn't. The same episodic pattern of bleeding continues unchanged and I've begun to feel a little distal bowel discomfort when passing stool. So after this overly long introduction here are my questions: (1) How likely is the problem to be something other than UC, and (2) could the distal bowel discomfort when passing stool be a consequence of the extra Canasa suppository? What say? I'd appreciate any comments.

I can't tell you how likely it is that you have something other than UC going on although it seems unlikely since you were just scoped. But I can tell you that bleeding has been my chief complaint. I will bleed same as you for a few days, then I'm clear for a few days. My poops are also fairly normal and I have no cramping, etc. Sometime I'll get mucous or urgency but not always. These symptoms are from my UC, which is distal. My guess is that your distal discomfort isn't from the extra Canasa but it's likely from an inflamed rectum. I'd recommend Rowasa enemas instead of two Canasas. I've had good luck with the mesalamine retention enemas helping my bleeding. They work better than the supps.

Mr. Natural:

Thanks for your reply.

Luv2Jump:

Thanks for the reply, your assessment and your recommendation.

notsosicklygirl:

Thanks for your reply.

You ask: "Did the GI say where the colitis was active?"

Yes, his assessment is that the bleeding is rectal.

You also inquire:"Is the blood bright red? On the tp or in the bowl? It sounds typical or mild rectal inflammation."

Yes it is bright red and its intensity has varied. Most of the time its confined to the tissue and there are suggestions of it - hard to define - in the water. Less frequently, there's some water staining in addition to the tissue paper. And on a few occasions, usually accompanied by significant flatulence, it's been bright red with some clots and mucus, and it stains the water and sprays the sides of the bowl. These latter are the episodes that concern me most. There have been two or three of them since December.

Its dawning on me that many years ago, when I was first diagnosed after a couple of weeks of bloody diarrhea and hospitalized, that the disease had been active even though I experienced no blood or diarrhea at the time. I had frequent urgency in those days, sometimes far too urgent if you understand what I'm getting at. I've been thinking that one only has active disease if there's cramping and diarrhea. Not so it would seem.