Newly diagnosed, constipated, have some questions to ask

Hello everyone!

Let me say for a start that I have spent the last couple of days reading about UC across the internet and this community here has been one of the best resources, especially for first-hand information for combating the disease. Thank you all for that!

Now let me tell you my story:
I am a 31 year old male, diagnosed with UC a week ago.
Exactly 2 years ago I stopped smoking and started a somewhat healthy lifestyle with a high-protein/slow-carb diet and doing bodyweight excersises 3-4 times per week. I ate mostly fish, chicken breast, eggs, diary, oatmeal and steamed vegetables. Almost no junk food at all, no soda, low sugar, high fibre. Up until 3 months ago I could say that I was at the peak of my health.

The very first symptoms which could be related to UC appeared about a year ago when I experienced a month full of 2-3 bathroom trips per day with a lot of mucus and gas. I blamed this on cardboxed low-fat milk, which I eliminated from my diet and everything went back to normal. Since then I went on to consume diary only in the form of cottage cheese and yogurt.

Some 3 months ago I started experiencing similar symptoms and noticed some blood on the toilet paper, but blamed it on hemorrhoids and hoped to fix it by increasing my fiber intake. After that I went to Thailand for two weeks and upon my return the symptoms got worse: bloated stomach, cramps and very urgent and explosive bathroom visits with a lot of mucus leaving faulty smell. I went to see a general practitioner who suspected I caught some bacteria in Thailand and prescribed some antibiotic/antiseptic plus some liquid probiotic. Those helped somewhat and returned my stools back to normal with the only problem being the mucus in the morning.
After I finished with the prescribed meds, the following 2 weeks I had mucus-only bathroom trips every morning with constipations lasting for 3-4 days.

This is when I finally realized this might be something serious and a week ago went to see a gastroenterologist. I agreed on the recommended colonoscopy right away (without any anestesia or sedatives) because all I wanted was to rule out the possibility of colon cancer. The doctor gave me a preliminary diagnosis of UC (Rectosygmoiditis ulcerosa) and the results from the biopsy confirmed it.
As the doctor perscribed, yesterday I started taking Mesalazamine, Flagyl, Prednisolone and some probiotics.

Overall my symptoms are very, very mild. I don't have any pain whatsoever, rarely some bloating and gas. The only problem I can tell is the mucus in the mornings. Now the weirdest part is that I haven't had any diarrhea either and I have been constipated and haven't had a single real BM since the prep for the colonoscopy 8 days ago. I eat regularly, 3 meals a day + 2-3 snacks, almost the same I was eating before (which is mostly oatmeal, eggs, fish, chicken), except that I reduced the fiber from wholegrains and stopped eating salads and raw fruit/veg. Yet after 7 days without a BM, I don't feel too full or bloated and I have problems grasping where does all that food go.

The doctor is also confused about this and said the constipation is not something he expected and is a bit contradictory to the diagnosis.
I tried increasing the soluble fiber intake, added some grounded flaxseed, fish-oil capsules but nothing helped so far. Today I am starting with some psyllium powder and flaxseed oil and increasing the consumption of well cooked vegetables.

• Is constipation something normal for a case like mine? Do you have any recommendations on how to get my BMs back to normal without additionally irritating the colon?
  
  
• If I maintain the same diet, can I expect the symptoms to stay as mild as they are, or will it get worse in time regardless?
  
  
• Also, based on the description of my symptoms, would you say this is a correct diagnosis or should I go and ask for another opinion?
  
  
• Is there something I should be aware of in regards to the medicine I was prescribed? I plan to cut alcohol completely while on Flagyl. Anything else which I need to avoid?
  
  
• Any other general piece of advice in regard to my situation would be more than welcome.
  

Thanks!

Your primary method of treating this disease should be rectal, not oral. Get your mesalamine in an enema, not a pill, and this will improve things most quickly. Rectal inflammation is not treatable with oral mesalamine.

The constipation could be from the rectal inflammation alone. Insoluble fiber is a good choice, too, glad to see you started that. The colonscopy prep can be quite harsh on your gastrointestinal tract and it may take a while to recover your normal routine.

I found that with proctitis diarrhea wasn't really an issue. The mucous and rectal pressure, plus gas, were my most troublesome concerns, like you. Get rectal mesalamine to treat your proctitis and you will marvel at the results.

Did they do a stools test for C. diff? thats the first thing you want to rule out.

As Kazbern said, you need rectal mesalamine (and Hydrocortisone IMO). How much oral Prednisone are you on? Make sure to taper VERY slowly. It will help since its your first time but in future, you may want to keep hydrocortisone enema handy (so that you avoid oral Pred and the side effects of that).
If you are married or in relationship, make sure to tell your partner, you may act moody (side effect of Prednisone, everyone is different.)

Your constipation, my last flare started with severe constipation. Never before in my life, I had constipation. I added laxatives, big mistake. It worsened my situation. You may want to do it gently, using stool softner in the beginning. If that doesn't work, add 50mg-100mg of Mg-Citrate 3X a day. Do it slowly but steadily. Avoid fiber for a while. Your intestinal mucosa is inflamed at this moment. Scrubbing against inflamed mucosa with fiber is not really good (it could/will worsen the situation).
Look into probiotics. Some popular brands are discussed on the board.

Your diet seems OK. I never had any success with diet change but others have seen some benefits.

Your diagnosis seems correct. If you have too much of an issue with urgency, get a Rx of Bentyl 20mg. Start with 10mg an hour before going out or rectal meds administration. If you do not see effect (no more urgency, lasts for about 6 hours), increase the dose to 20mg. You can take 3X a day. Until you get Bentyl Rx, get Imodium, but do not use it as Bentyl substitute for longer term.

No more alcohol. Some of the medications may put a decent strain on liver. In such case, you do not want to tax liver. And even otherwise, after diagnosis, I could never digest even a pint, weird hiccups and stuff, so stopped alcohol completely. Not worth the trouble. Does become an issue when you go out but you need to prepare for this crap.

Take meds religiously. Maintain a diary, for food, symptoms etc. If there is any trigger, you should know. Some foods may give you troubles and you want to watch out. Diary helps to figure this out.
Most likely, you will hate sticking a bottle up your rear end, I hate it too but thats the place where your problem is and majority of the medications you will need are more 'topical' than systemic (like mesalamine), so sticking a bottle up your rear end will get you quicker effect. Learn the technique.
Do NOT go with what doctors say. They are usually eager to put you on biologicals but do not go that route until you exhaust all other options.
Keep some medications handy, so if flare starts out of nowhere, you have emergency plan ready until you see the doc. I ALWAYS stocked up Prednisone (oral) but now I learned that maintaining hydrocortisone enema is a better option, although expensive one with my craptastic insurance. I ALWAYS have 3 month extra supply of Bentyl and 2 month extra supply of other medications.
Finally, make a habit of checking the 'wipe' and down in the 'oval office'. Your poop will tell you if you are in good condition or needs extra attention.

Good Luck.