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Ulcerative Colitis
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Posted 6/5/2013 9:01 PM (GMT 0)
Hi everyone,

I was diagnosed with proctitis in Feb. 2013. The GI put me on Canasa. I was not improving enough so he added Apriso to my meds approx. 5 weeks ago. I am still taking both. I have noticed improvement since being on Apriso, but I can still tell I am flaring. I currently have approx. 3 bm's per day on a good day, still have gas and mucus, and occasional bleeding. Three weeks ago I bleed bright red for 4 days (not always sure if it is UC related or maybe a hemmie of fissure). Today though has been a bad day. I woke up with stomach tenderness and had what I think is dark blood, approx. 5 bm"s and exhausted more than usual and no appetite  :(  I go back to the doctor next week and I am wondering if any of you recommend a medication adjustment or addition or any other suggestions so that I can go into my appointment prepared. Do you think I just need to give things more time?

A little extra history..... This current flare has been since Aug 2012, I know I have had prior flares before diagnosis. I was always told before it was IBS. I do notice each flare has been worse.

Posted 6/5/2013 9:09 PM (GMT 0)
I think you could try a few things. Perhaps a higher dose oral medication like Lialda or Colazal would help. Also, you could try a mesalamine enema instead of Canasa. Enemas are higher dose. If that didn't work, you could try a steriod enema or suppository. Before going that route, I'd definitely try adding Rowasa. I do Rowasa before bed and Canasa in the morning when I am having mild symptoms. You could try using Canasa twice a day, that could be helpful and you already have the Canasa.
Posted 6/5/2013 9:10 PM (GMT 0)
One thing I forgot to mention is that fissures are very painful. I get them and they are truly evil. If you weren't experiencing a lot of pain, it's probably not a fissure. Hemmies can be painless and bleed quite a bit...
Posted 6/5/2013 9:18 PM (GMT 0)
With darker blood I bet you are out of the proctitis world and getting into proctosigmoiditis or colitis. An enema would definitely treat better than Canasa at that point. That would be my next move.
Posted 6/5/2013 10:55 PM (GMT 0)
Notsosicklygirl .... I think I was having trouble with a fissure at the beginning of march. I would have pain during a bm and it really lingered for like an hour and then was just plain old uncomfortable. Could what I see be from it healing?

Plout.... This may sound like a dumb question but how would you describe the appearance of darker blood? I usually see mine mixed with mucus and I looks either black or sometimes maybe purplish. There are other times I see it streaked along my bm. Does that sound like a UC related symptom?

Thank you for medicine suggestions. Another question is can I get too much mesalamine? Can my body build up a toxic level? I thought I was on the max dose for each?
Posted 6/6/2013 3:23 AM (GMT 0)
Apriso is lower dose than most mesalamine I think. Lialda is 1200mg tablets and 4800mg is the max recommended dosage orally each day. I have seen members take a bit more. As far as rectals go, I was using 4800mg Lialda + 4g Rowasa + 1 canasa, and I was fine. Speak to your GI first but I don't think you're on the maximum dose. What you describe could have been a fissure. From what I've experienced, they usually don't bleed unless they hurt. When they are healing, often they will open again and wreak havok, tons of blood and pain that can last long after a BM. It's really awful, I wouldn't wish it on anyone. Darker blood is always worrisome but I could very well be UC. If you see blackish blood, it's good to get a colonoscopy to check for anything that may be going on higher up in the GI tract. Since you say purplish, I think it's probably from Canasa. Canasa is notorious for causing purplish residue everywhere.
Posted 6/6/2013 3:27 AM (GMT 0)
Oooohhhh yeah, blackish purple is Canasa! It isn't even blood, plain old mucus can turn blackish purple in the presence of Canasa. It's so creepy, I wish doctors would warn people! Gross story alert: the first time I used Canasa I retained it for something insane like 18 hours. When it finally came time to 'evacuate' the leftover glycerin etc, some of it had actually re-solidified into a kind of bullet shape, and INSIDE was a core of blackish purple goo. I was so horrified that that had come out of me and I had no idea what it was!

Anyway blood from higher up in your colon could look dark reddish or brown, and if you had a bleeding ulcer in the stomach for example that could come out looking shiny and black, but purple-black is almost definitely from Canasa. If you aren't seeing red blood then I would wonder if you're having any bleeding from UC right now at all...
Posted 6/6/2013 4:01 AM (GMT 0)
Just adding my support to folks recommending enemas. Not only do mesalamine enemas usually contain more medication (dosage-wise), they also can reach higher up in your colon, in case you have more than just proctitis.
Posted 6/6/2013 11:33 AM (GMT 0)
Thank you for the responses. If the purplish is coming from Canasa would I notice it everyday because I don't that's what lead me to think it was bleeding?
Posted 6/6/2013 5:07 PM (GMT 0)
Just in case my doc wants me to do enemas in the future in place of canasa I am wondering if someone can tell me if the enemas are more expensive than canasa?
Posted 6/6/2013 6:12 PM (GMT 0)
Enemas are much cheaper than Canasa. At least the generic medal amine enemas are, the name brand might be around the same price as Canasa.
Posted 6/6/2013 7:17 PM (GMT 0)
It is blood mixed in with the mucus/stool and the Canasa. Otherwise, it would be brownish, not purple.

Since you're still having blood streaked along stool, it's obvious you're flaring and still bleeding.
Sometimes blood can pool in the area and mix with stool and cause more of a darker maroon colour...doesn't mean it's higher up.

I agree you should be on the Rowasa enemas (or generic mesalamine). More dosage, better coverage.
you can use the suppositories during the day for support and continual medication in the lower part of the rectum.

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