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Rectal Meds

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Ulcerative Colitis
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Posted 1/14/2013 5:35 AM (GMT 0)
I'm calling my Doc tomorrow to try and schedule an appointment to talk to her about rectal meds. My last bad Doctor told me that they would be of no use to me since I have pancolitis, and rectal meds are used to treat the descending colon - which after thinking about really makes absolutely no sense what so ever.

After my long ordeal with prednisone - 40 to 10mg taper, I've been on 10mg prednisone almost a month without problem, and started 6mp once I reached the 10mg taper. I've been on 6mp for a little over a month. Now, symptoms are returning, but they seem to be (at least I suspect) limited to my rectum at the moment. Tailbone discomfort, sensitive anus, very red blood in the toilet with formed bm, no diarrhea, no blood on formed stool (sorry for the graphic description). I am going to ask for rectal meds, or at least discuss them with her.

I guess my question is, why would she not have already prescribed them? I've never told her of these types of symptoms before, because when I have seen her I've been in full on flare mode. I just can't help but wonder why it is they haven't been prescribed to me, or even discussed.
Posted 1/14/2013 6:09 AM (GMT 0)
There are studies that show that rectals help pancolitis. Many of the worst symptoms come for the left side even with pancolitis. They've been a tremendous help for me and I was diagnosed with Pancolitis in 2003.
Posted 1/14/2013 7:50 AM (GMT 0)
It seems most doctors just think we don't want them. Even my GI said that. She told me that I was the first person to say I actually liked them. I don't like having to do them but I do LOVE the fact that they help keep me well. Good luck.
Posted 1/14/2013 8:08 AM (GMT 0)
rectal meds don't deal with the descending colon.
I'm trying to encourage specifics here with what they do.

Rectal meds some in two forms...enemas and suppositories.
Enemas come in two forms...liquid and foam and in mesalamine and steroid.
Suppositories come on mesalamine and steroid...and are in varied shapes from what I read on here.

Enemas deal with the rectum and sigmoid (except proctofoam I believe which is limited to the rectum based on the dosage released). I would think that some go past that, especially the Pentasa which is 100mg liquid compared to the 60mg of other mesalamines.

Suppositories deal with the rectum only and are limited in their dosage of 500mg or 1000mg.
The mesalamine enemas range from 1000mg, 2000mg or 4000mg.

I don't think any of us like doing them, but what they do can be a huge positive...as well, it's something we can have control over at the first sign of a flare. Much better than running to the GI in desperation.

q
Posted 1/14/2013 3:01 PM (GMT 0)
tommy tutone
Are you sure that the blood is not from hemorrhoids?
I mistakenly thought that I was bleeding due to UC when it was hemorrhoids. My GI finally did a flex sig and verified the source.

I agree with quincy that enemas can be very effective.
Posted 1/14/2013 3:07 PM (GMT 0)
the doc is right that they can't treat the whole colon, and oral meds are needed - BUT the condition of the rectum and sigmoid is strongly connected to urgency and accidents. Adding rectal meds to get rid of urgency seems very worthwhile.
Posted 1/14/2013 3:36 PM (GMT 0)
"I just can't help but wonder why it is they haven't been prescribed to me, or even discussed."

good question - and the only one that can answer is her - so make sure to ask -

every time i read one of these posts, i love my doc even more -
Posted 1/14/2013 3:44 PM (GMT 0)
I also don't understand why more docs don't Rx them. The GI I was seeing dind't give me an Rx until I was in for my first follow-up post diagnosis (about a week later). He said he didn't give me an Rx because he didn't think I'd be able to retain it at all because I was pooping so often. But he agreed it was well worth trying them and gave me some tips on how to have a better shot at retaining them. And once I was in remission, he agreed it was really wise to keep using them twice weekly.

The GI I saw when I first moved to NY kept telling me it'd be OK to go off of them. And when I called the office to let him know I was pregnant and to see if he wanted me to come in for an appointment, the message I got back was, "No, you don't need to come in, but you can quit using the enemas if you want." Um, why would I want to do ANYTHING to rock the boat when I pregnant? So that attitude, but mostly the incredibly incompetent office staff, caused me to find another GI.

This guy thinks it's awesome I'm so committed to using the enemas and said I should just keep on keepin' on, basically. And he was totally OK with writing me an Rx for Canasa to use after the baby arrives, in case I can't retain the enemas due to being up a lot at night.

At any rate, tommy, I highly encourage you to strongly request them. You really have nothing to lose.
Posted 1/14/2013 4:04 PM (GMT 0)
I asked my GI about rectal meds and his initial response was the same as you got. Since I had pancolitis, he didn't feel it would do any good. But then I got a second opinion from a Dr at Harvard Med School. All people with UC have it in the rectum. Some have it just there, some have it up to the sigmoid, some have it further up the left side, and others have it all the way up to the ileum. But all of us have it in the rectum. If you take oral mesalamine (Asacol, Lialda, Pentasa), it has to work its way down along the colon. By the time it gets to the rectum there's not a lot left to be theraputic. Taking rectal meds helps treat the area that the oral meds have difficulty getting to. I started taking Canasa and it helped to eliminate tenesmus and high urgency. I switched to mesalamine enemas and they helped even more. I try and take an enema nightly. If I miss it or can't retain it for at least 2 hrs, I will use a Canasa in the morning. My GI now supports rectal meds after seeing my second opinion and seeing the results.
Posted 1/14/2013 6:08 PM (GMT 0)

ItsAlwaysSomething said...
tommy tutone
Are you sure that the blood is not from hemorrhoids?
I mistakenly thought that I was bleeding due to UC when it was hemorrhoids. My GI finally did a flex sig and verified the source.

I agree with quincy that enemas can be very effective.

I know that I have an internal hemorrhoid, but I can't say for sure what the cause of my problem is. I've often suspected it might be the source of the bleeding, but this is usually how my flares start. So, I don't know. I hope it is.
Posted 1/14/2013 6:29 PM (GMT 0)
After you get used to it, doing an enema at bedtime is not a bother at all. Put it in and go to sleep. Of course if you have a lot of inflammation in the rectum, retaining it is another matter, but for maintenance once you are healed up, it's a breeze.

The other thing is flares start in the rectum and move up. If you can keep the left side healthy, I think it can prolong your remission even if you were diagnosed with pancolitis.
Posted 1/14/2013 6:47 PM (GMT 0)
Even if you have a pancolitis like I do, there is ALWAYS inflammation in the rectum and the left side so suppositories and enemas are def. worthwhile. Canana suppositories are easy to use once you get use to them. I def would ask about them!
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