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Posted 12/8/2014 8:28 PM (GMT 0)
I just got a flex sig, mostly to check up but also because things have been somewhat irregular lately (going more frequently, some mucous, not sure if there was blood)

My GI said that he saw proctosigmoiditis which he believes suggests that the Canasa I've been taking for over a year is not reaching far enough. He told me that he thinks this can be resolved with Rowasa. He also indicated that I should NOT have been taking Canasa every night, and it is something that should have/should be limited to 2-3 times per week. I told him that I often felt worse when I didn't take it and he said it's better to take Librax more often than Canasa nightly.

My issues are this:
- I have never been able to properly administer enemas. I used to have the same problem with suppositories but have obviously gotten over that with the Canasa. I guess I'm wondering if anyone has suggestions as to how to be administer this.

- The doctor had suggested that if the Rowasa didn't work or I wasn't able to properly administer, the next step would be Uceris or Budesonide. He said he'd prefer not to go this route, as my inflammation is mild/moderate and he doesn't think it necessary. I've done Budesonide in conjunction with the Canasa before and it worked well. Should I just go this route, if it makes me more comfortable and is tried and true?

- Am I in for a long haul now? I was hoping to make some life changes (possibly moving cross country) and am not sure if this will negatively impact that or set me back. I honestly have not been feeling very sick but would absolutely prioritize my health if it's necessary to take a step back and wait for a bit before things normalize. Will this Rowasa treatment be something I can do "on the go" or rather, something I won't need for a long time?

Any/all input is much appreciated.

Post Edited (sfc425) : 12/8/2014 4:57:22 PM (GMT-7)

Posted 12/8/2014 8:36 PM (GMT 0)
Are you on any oral mesalamine meds (Lialda, Apriso, Asacol)? If not, I think you should be, especially before going on Uceris.

What problems have you had, specifically, with the enemas? It would be easier to offer advice if we know exactly what your problems are.

I'm confused as to what you mean by if you're in it for the long haul. I've found that my UC is relatively easy to control, and it hasn't stopped me from doing anything. It doesn't sound like your UC is all that hard to control, either. I think your treatment plan just needs to be tweaked a bit.
Posted 12/8/2014 8:47 PM (GMT 0)
I'm taking Asacol HD at the max dose daily, in addition to Librax.

My problem with enemas is the act of administering - I just can't get comfortable sticking the tube up there and squirting something out. I tighten up and can't go through with it. It's more of a mental thing, I think.

I'm asking if I need to set aside a week, a month or whatever to take care of whatever this issue may be. I guess that might be something I need to wait and see about, but I was hoping to make plans for the next month and I wouldn't want to do it without knowing for sure that I'll be feeling better by then. I agree that my UC is not too difficult to control but, for example, if I want to go on vacation/out at night and enjoy myself, have a few drinks and maybe not sleep at home in my own comfort zone will I be OK without administering this prescribed nightly enema?
Posted 12/8/2014 8:56 PM (GMT 0)
That definitely sounds like a mental issue with the enemas, and since you used to have similar problems with Canasa, I encourage you to try again. Just remind yourself how much smaller diameter the enema tip is compared to Canasa!

I've traveled with mesalamine enemas before with no problems - once you get comfortable with it, they're pretty easy to do anywhere.
Posted 12/8/2014 9:00 PM (GMT 0)
So assuming I can get my head around the rowasa, do you think I'll likely clear up this mild flare in a short period of time?

I realize everyone is different, so I guess I'm asking for opinions more than anything
Posted 12/8/2014 9:06 PM (GMT 0)
Yeah, I think there's a good chance. Did he say anything about how your rectum looked? If it looked better than higher up (indicating the Canasa was treating it), I think there's a really good chance the Rowasa will work. And if that doesn't, perhaps a course of steroid enemas, instead of oral steroids, would work.

I am confused, though, why he said one should't use Canasa nightly. Plenty of people on here use rectal meds nightly.
Posted 12/8/2014 9:23 PM (GMT 0)
He did say it seemed confined to the area just beyond where the Canasa can treat, so I think that's what you mean by "looking better than higher up." He also emphasized that it was mild to moderate many times, and said he saw no inflammation higher up.

I think he meant the goal should be to have reduced the need for Canasa once the inflammation had gone down. I was playing it safe and going with the "if it ain't broke" method. I guess he'd have preferred to see how things looked if I hadn't.
Posted 12/8/2014 11:58 PM (GMT 0)
The directions say I need to lay on my side for 30 minutes when I administer this...is that true?
Posted 12/9/2014 12:24 AM (GMT 0)
Tips for using meslamine/rowasa enemas:

When you first start using enemas, use them in the bathroom very close to a toilet as they can come up very quick and unexpected. As you get better at them, and more confident, you can administer them in bed.
Add extra Vaseline (petroleum jelly) to the tip of the enema.
Warm the enema up to body temperature before administering. Put it in a pocket for a while before using, or warm it up under an armpit.
Squeeze all of the air out of the bottle before administering. You do not want to inject any air into your bowel as it will both be uncomfortable and make it likely you will need to urgently evacuate the enema fluid.
Lay an old towel down as any drips of the enema fluid can stain clothing, carpet, etc.
Use one of the positions described in the instructions.
Administer the enema slowly, too quickly and you will be less successful. If you wish, you can do one half the bottle first, wait a few minutes, and then administer the rest.
Stay reclined on your left side for about 20 minutes to allow the enema fluid to be absorbed. Retire for the night.
It takes practice to hold the enema in for 7 hours. Do not get discouraged, and keep trying. Even if you evacuate part of the enema, some will likely remain and heal you. As you heal, it will be easier to retain them for longer lengths of time.
Posted 12/9/2014 12:31 AM (GMT 0)

sfc425 said...
The directions say I need to lay on my side for 30 minutes when I administer this...is that true?

No, not everyone does. I administer mine, wait a few minutes in the bathroom to make sure the enema is settled, then gi to bed and lay on my left side to retire for the night.
Posted 12/9/2014 12:31 AM (GMT 0)
Yeah, see this doesn't sound like something I'm gonna be able to do. I may as well have just taken budesonide and continued on with the Canasa.

And how can it be convenient if I need to set aside an hour to administer this? How does that get easier as I get used to it? How do I stay anywhere overnight but home, alone, if I'm going to have to take this?

If I make one mistake, it sounds like I'm in for a messy disaster and this stuff is expensive. This whole thing sounds like it's not gonna work for me.
Posted 12/9/2014 12:32 AM (GMT 0)
I use mesalamine enema just before going to sleep because who has the time to lay around being immobile any other time. It helps to warm the bottle up to body temperature (not in the microwave lol) put it in your armpit or someplace similar a half hour in advance.

It took me a long time to get used to using an enema but the results are really worth it. I have the feeling that if I had used enemas early in my diagnosis I would not have progressed to left-sided (original diagnosis was first proctitis and then procto-sigmoiditis). But who knows.

When you first start don't feel like you have to dispense the entire enema, work up to that.
Squeeze a little up, relax and breathe (iPod? candles?), do a little more and drift off to sleep.

When you see the results (after maybe a week of use) you will be be convinced.

BTW, I only use them when needed, not every night, maybe once a month. So don't worry you'll have to do this every night the rest of your life. Not necessary once you get things calmed down.

Post Edited (imagardener2) : 12/8/2014 5:35:02 PM (GMT-7)

Posted 12/9/2014 12:33 AM (GMT 0)
I have to "get used" to taking this in order to properly absorb the medication?

I mean, maybe I'll get there but I don't see it :(
Posted 12/9/2014 12:40 AM (GMT 0)
I have to "get used" to taking this in order to properly absorb the medication?

I mean, maybe I'll get there but I don't see it :(
Posted 12/9/2014 1:18 AM (GMT 0)
although there is some absorption, it mostly works topically, and the longer it is held the more effective.

severe cases do need nightly while flaring. many people use 1-2 weekly for maintenance, and some only use when symptoms uptick.

the steroid should be for limited time if used.
Posted 12/9/2014 1:24 AM (GMT 0)

DBwithUC said...
although there is some absorption, it mostly works topically, and the longer it is held the more effective.

pardon my ignorance, but what does this mean? blush
Posted 12/9/2014 2:25 AM (GMT 0)
It means what it says. The mesalamine enema is like a lotion you'd put on your skin. It acts topically, on the surface of the colon. Very little of the active ingredients are absorbed into your blood stream.
Posted 12/9/2014 2:58 AM (GMT 0)
and that's a good thing? I don't understand what this all means as it pertains to my trepidation in taking the med
Posted 12/9/2014 3:09 AM (GMT 0)

sfc425 said...
Yeah, see this doesn't sound like something I'm gonna be able to do. I may as well have just taken budesonide and continued on with the Canasa.

And how can it be convenient if I need to set aside an hour to administer this? How does that get easier as I get used to it? How do I stay anywhere overnight but home, alone, if I'm going to have to take this?

If I make one mistake, it sounds like I'm in for a messy disaster and this stuff is expensive. This whole thing sounds like it's not gonna work for me.

Hee hee hee, first off...deep breath...relax.... This is an enema bottle you need to administer, not a bomb you need to diffuse. If you can deal with the canasa suppositories you can deal with enemas. Suppositories have two hurdles that wnemas don't: inserting your finger in your butt and leakage. Lol. I've never experienced any leakage from an enema (but have from suppositories). My tips for you? Take it slowly. Take a hot shower, then put the enema under your armpit for a bit, lay down on your side on a towel, insert the enema (follow the tips above) then, only squeeze a tiny amount in, I mean, like a table spoonful. That's it, that's all you're expecting if yourself tonight. The next night, same routine, but aim for two tablespoons full,..etc etc. thinking about injecting that entire thing is too scary. A little bit is better than none, eventually you can aim for 1/2 a bottle, or 3/4, but take baby steps. I started this way and gained confidence quickly. No leaks...only couldn't hold it in once or twice-when the flare was too bad, and I didnt poop myself or anything, my guts got gurgley and I just knew this crap wanted out so I went to the can and farted it all out without incident. I've used the enema away from home, camping of all places, but, I've also skipped a night when I was going somewhere and wanted a night off of thinking about butt meds. It's all about balance, don't think of it as all or nothing. Also, I don't need an hour. I put the goo in, stand up right away, wash my hands clean up and go to bed. It adds about 3 minutes to my bedtime routine.

Enemas are worth the trouble, they work.
Posted 12/9/2014 3:20 AM (GMT 0)

toomuchpoopin said...


Hee hee hee, first off...deep breath...relax.... This is an enema bottle you need to administer, not a bomb you need to diffuse. If you can deal with the canasa suppositories you can deal with enemas. Suppositories have two hurdles that wnemas don't: inserting your finger in your butt and leakage. Lol. I've never experienced any leakage from an enema (but have from suppositories). My tips for you? Take it slowly. Take a hot shower, then put the enema under your armpit for a bit, lay down on your side on a towel, insert the enema (follow the tips above) then, only squeeze a tiny amount in, I mean, like a table spoonful. That's it, that's all you're expecting if yourself tonight. The next night, same routine, but aim for two tablespoons full,..etc etc. thinking about injecting that entire thing is too scary. A little bit is better than none, eventually you can aim for 1/2 a bottle, or 3/4, but take baby steps. I started this way and gained confidence quickly. No leaks...only couldn't hold it in once or twice-when the flare was too bad, and I didnt poop myself or anything, my guts got gurgley and I just knew this crap wanted out so I went to the can and farted it all out without incident. I've used the enema away from home, camping of all places, but, I've also skipped a night when I was going somewhere and wanted a night off of thinking about butt meds. It's all about balance, don't think of it as all or nothing. Also, I don't need an hour. I put the goo in, stand up right away, wash my hands clean up and go to bed. It adds about 3 minutes to my bedtime routine.

Enemas are worth the trouble, they work.

Thanks for this thoughtful reply.

Can I ask a few things:
a) How old are you, if you don't mind?
b) Why did finding Asacol HD in your BM lead you to stop taking it? As I understand it, that's fairly normal, no?
Posted 12/9/2014 4:19 AM (GMT 0)
May I ask how you overcame your issues of giving yourself canasa supp?

As far as rowasa, I too was not a fan of the selfie enema. It turns out, it's a great medication that has saved me on many occasion. You've already been given great suggestions for administering it and now my thoughts. Lay on your left side, relax your butt hole as if you are going to poop, don't bear down like you would to poop, just relax your butt hole. I'm guessing the mind over matter for you is the applicator tip not the medicine? Once you are able to overcome the urge to tighten your sphincter, the insertion is essentially pain free unless your rectum is flaring which yours is not. If it's uncomfortable, the angle of the applicator tip needs to be adjusted slightly. Once the applicator tip is in, gently squeeze the bottle and see how you tolerate it. Once you're able to tolerate the entire dose, roll the bottle up like most people do with a tube of toothpaste, to make sure you get all of the medicine. Throw the bottle away, wash your hands and go to bed. The sensation of needing to poop after the enema should go away after a few minutes. If not, go to the bathroom and you'll eventually be able to hold it all night and will have forgotten about it by morning.

I realize this can interfere with one's love life but your colon needs you now. ❤️ I would give it several weeks/1 month before skipping doses. How long does your doc want you to be on rowasa?
Posted 12/9/2014 4:47 AM (GMT 0)
The RX says "twice daily for 1 week then at bedtime for 3 weeks"

I feel like that's an awful lot
Posted 12/9/2014 5:00 AM (GMT 0)
definitely sounds like you need to add a few beers to the mix !
Posted 12/9/2014 5:38 AM (GMT 0)
Just tried it and was amazed at how easy that was. I almost want to apologize for this thread. I had no issue emptying the whole bottle.

Stood right up and ate a granola bar. This won't be an issue at all if this is how it'll go.
Posted 12/9/2014 1:12 PM (GMT 0)
Excellent!
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