Asacol in solid stool

I have had UC for two years. For quite some time now I have been taking Asacol (400mg) 2 pills, 4 times per day and VSL#3, 2 pills, 4 times per day. I have been totally normal for several months with no dierrhea and pretty much solid stools almost all of the time and can't remember the last time I saw any blood or any other UC symptoms. I don't ever lose weight, in fact I have to fight not to gain. Unfortunately I have still been having urgency and several BM's per day even though the rest of me has been totally normal. Recently I have been finding 1 Asacol every once in a while in my solid stools. I know it's bad if you have dierrhea and the pills just slip through but mine have been in solidly formed stool and I have never found two at once. I don't know if the pill I have been finding is from my most recent dose or from 2 or 3 doses ago. This seems a little unusual to me and don't really know what to make of it, other than the fact that obviously this one particular pill didn't do anything. It makes me wonder if most of my benefit is coming from the VSL and kind of wonder what would happen if I cut back on the Asacol.  I'm asking for opinions here as I really don't trust the docs to know what they are doing. They just kind of shoot at the side of the barn in the dark and hope they hit something. I kind of treat myself and take the docs along for the ride if I need to.

I agree with Peety. Also if your still having urgency then I would ask for some rectal meds. They really help with that.

I was finding Asacol pills (and I confirmed there was medicine still in them) in my poop and it's part of the reason I switched from Asacol to Apriso. The other was that I wanted to be on one of the one-daily meds. I LOVE only taking Apriso in the morning, rather than taking Asacol three times a day.

Apriso starts dissolving at a lower gut pH than Asacol, and UCers are thought to have lower gut pH than the normal population. So I thought it made sense to switch based on that as well.

I STRONGLY urge you to try the mesalamine enemas. The urgency is very likely due to inflammation low in the colon and rectum. Asacol and other oral meds are not great at treating those areas. Enemas, however, are the gold standard in treating the distal colon and rectum.

I DID have to do them every day to gain remission, as do most people. I was in a very severe flare. However, I tapered to twice weekly and have been using them twice weekly for three years now and I have had no flares in those three years. I generally just have one non-urgent BM each day, in the mornings. I'll occasionally have a second BM in the evening, depending on my diet. Right now, for instance, I'm eating a LOT of fruits and veggies because things are in season and I'm indulging, so I'm having a morning and evening BM fairly often. ;)

Also, I had a c-scope in October that showed absolutley no inflammation. I credit this to using the Apriso and the twice-weekly enemas religiously. I don't miss doses.

For full disclosure, I do want to say that I was off the enemas for 9 weeks following surgery to repair a perianal fistula. The fistula developed from an abscess that was not thought to be related to my UC. I noticed some (very mild, potentially "all in my head") symptoms creeping back in at the end of those nine weeks, so used enemas nightly for about a week, and everything cleared right up.

You're welcome.

I would like to point out that you'll never know if you'll have problems even if you're using an enema every day. And even when I was, it was no big deal. Many research studies show the benefit of using oral + rectal mesalamine compared to oral mesalamine for both induction AND maintenance of remission.

I wonder if you could eat something acidic, to lower the pH of you colon. Something that would help more than irritate. Maybe tomatoes.

I read online" Delayed release dosage forms such as Asacol employ coatings that are engineered to breakdown and release the drug topically at the nominal pH of the lower intestinal tract. Asacol tablets were found to dissolve in an erratic fashion when they are dissolved in buffers below pH 7 which can occur naturally."