Stopping Ensuing Flare Before it Gets Worse

Hey guys,

Asacol worked for my UC for awhile, when that stopped we tried hydrocortisone suppositories, didn't help. Tried hydrocortisone enema, maybe helped a little bit but not much. Was about to jump onto 6-MP but tried a meselamine enema, Rowasa, and surprisingly that did the trick.

That was about 1.5 years ago. Tried weening off the enema a few times and it didn't work, if I went off for more than 3-7 days the problems returned so for maintenance I've been using it once every 3 days. Well now my colitis is starting to get to the point of where it was before my really bad flare 1.5 years ago. More cramps, more random upset stomachs, and now, disturbingly, a small amount of blood on the toilet paper. Still very tolerable but I'm concerned because 1. this is how the last bad flare began and 2. the next step is the biological drugs like 6-MP with way more side effects than I hope to deal with.

I started the Rowasa every night again last sunday, can't say it's really seemed to help though....if anything doing it nightly almost seemed to make me have more of an upset stomach and feel weird / gurgly if that makes sense, maybe just from physically having the enema put in my body.

Any suggestions? My diet is very healthy and has pretty much been the same foods for 6 years (I'm into bodybuilding so in general my health is a priority so exercise and diet are consistent). I don't drink alcohol. Stress levels are pretty normal.

Thanks

UCandMe said...
Maybe you could stick with the Rowasa for a little longer and try canasa during the day.

I never noticed anything from Canasa unfortunately, but I will continue with the Rowasa daily and am upping my asacol dose from 800mg 4x/day to 800mg 6x/day. I know I have to give it time but as of now it seems to be creeping up towards flaring. Not sure what else could be done though.

Try vsl probiotics. Add two packets a day instread of one

Are there any diet changes you could make? Maybe low residue?

Haven't been overly successful in stopping this :(

Noticing a little more blood on the toilet paper, significantly more cramping/upset stomach, etc

Been taking probiotics daily and Rowasa nightly along with six 800mg Asacol HD pills per day (2 pills 3x/day).

I have dicyclomine 10mg pills for the cramping but they unfortunately have never helped me in the past.

David1991, if you cannot tame this flareup through the use of your current uc medications then it is time to try something stronger. Your choices:

• Steroids: Steroids can help you conquer a flareup and they are available in both oral (prednisone) and enema form (hydrocortisone enema like Hateuc suggested). You can only use steroid enemas short term but with them you might be able to exit your flareup and continue with the meds you used before it occurred. If not, then you move up the medication ladder and consider one of the following.
  
• Immunosuppressants: Immunosuppressants (Imuran, 6mp, aza) will take at least a couple months in order to buildup to therapeutic levels in your body but have helped many exit flares and are also used as a maintenance medication.
  
• Biologics: Biologics (remicade, humira, etc) are also available to help you exit a flareup and also as a maintenance medication. They can act pretty quickly with a noticeable difference after several dosages.

The diets don't work for everyone, myself included, just keep that in mind. I didn't find any help with VSL either (made no difference when taken daily, alternating days, etc). Once my stockpile runs out then I am done with VSL.

iPoop said...
David1991, if you cannot tame this flareup through the use of your current uc medications then it is time to try something stronger. Your choices:

• Steroids: Steroids can help you conquer a flareup and they are available in both oral (prednisone) and enema form (hydrocortisone enema like Hateuc suggested). You can only use steroid enemas short term but with them you might be able to exit your flareup and continue with the meds you used before it occurred. If not, then you move up the medication ladder and consider one of the following.
  
• Immunosuppressants: Immunosuppressants (Imuran, 6mp, aza) will take at least a couple months in order to buildup to therapeutic levels in your body but have helped many exit flares and are also used as a maintenance medication.
  
• Biologics: Biologics (remicade, humira, etc) are also available to help you exit a flareup and also as a maintenance medication. They can act pretty quickly with a noticeable difference after several dosages.

The diets don't work for everyone, myself included, just keep that in mind. I didn't find any help with VSL either (made no difference when taken daily, alternating days, etc). Once my stockpile runs out then I am done with VSL.

Yea, once I finish the VSLs I have I won't be getting more. As for the diet, I keep it clean for my own bodybuilding purposes so that would be the case anyway. Although lately I've had to eat less vegetables and other high fiber food unfortunately.

Won't take prednisone orally, don't want to deal with the systemic effects of that at all. I have taken the hydrocortisone enema in the past....it was somewhat helpful but not enough because I was still considering 6-MP. I then started the Rowasa which helped a lot but now it seems that is less effective so I doubt hydrocortisone enema will help much this time either although I suppose it doesn't hurt. Why can the hydrocortisone enema only be used for short periods? Not much gets in systemically I thought.

I'm worried about the last 2 options you mentioned. They have a lot of serious potential side effects :(

quincy said...
How often during the day are you going?

What's the consistency of the stool?

Blood when wiping? is it around the stool as well?

OK, just to clarify..you're on Rowasa nightly and the Canasa during the day?

Plus you're still taking the Asacol HD daily? What schedule for the Asacol?

q

Only going 1-3 times per day right now so nothing crazy. Blood on the toilet paper but none in the stool currently. In the past it has been much much more but started like this previously as well. Consistency is not formed much at all but not usually completely diarrhea either.

No canasa for me for 2 years or so....it didn't help much so it's just the Rowasa nightly along with two 800mg Asacol HD pills three times per day so 6 pills per day.

i just started uceris. it sees to be making a dent in my 5 year flare......can you ask your dr about trying it?