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Question about mesalamine enema use

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Ulcerative Colitis
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Posted 2/4/2015 4:47 PM (GMT 0)
hi.

I have a question that might not have an answer, but I figured can't hurt to ask. I had been controlling my UC for the last 10 years with the SCD diet only (no drugs). Then suddenly for the last few months I've been in a flare the diet couldn't get me out of. So I started using mesalmine enemas for the first time. They appeared to be working, as my frequency to go was reduced a lot, to the point of constipation for a couple of days. I still don't get normal formed bowel movements, but at least the bleeding was stopped.

They say the mesalamine enema is ideal right after bowels are empty so it can be optimally absorbed. This was definitely possible the first few times I used the enema since I still had the flare pushing things out constantly. But after being on the enema for about 4 days I'm no longer emptying the bowels regularly because I simply can't go. So my question is if the poop is piling up in my bowel, will the enema be rendered ineffective since it won't get absorbed by the rectal lining as well.

p.s. I did try stopping the enemas for a few days, and some of the symptoms of the flare did return (like severe stomach cramps and occasional urgency), so clearly I need to stay on the enemas, maybe not everyday, but at least every other day for a while.

Thanks.
Posted 2/4/2015 4:56 PM (GMT 0)
Constipation can be anywhere in the digestive tract. So, no issues taking your enema, it goes from the rectum to the sigmoid colon. I'm willing to bet your issue is much higher up, so no worries.

Try any Metamucil or other fiber to get things moving? Constipation is a slow transit time in the GI tract. Fiber may move things along, good luck,
Posted 2/4/2015 5:47 PM (GMT 0)
I do my business in the mornings and my enemas at night. I have improved a lot since November so i have to say they work without emptying your bowels first before using.

Good luck!
Posted 2/4/2015 6:03 PM (GMT 0)

iPoop said...
Constipation can be anywhere in the digestive tract. So, no issues taking your enema, it goes from the rectum to the sigmoid colon. I'm willing to bet your issue is much higher up, so no worries.

Try any Metamucil or other fiber to get things moving? Constipation is a slow transit time in the GI tract. Fiber may move things along, good luck,

Hi, you mean higher up as in sigmoid colon or even higher than that? And why do you think so? I was originally diagnosed with ulcerative proctitis, although I imagine that could have changed now.

As for fiber, I have thought about it, but I'm a bit afraid to since it's actually not allowed on SCD. I'm still doing SCD with mesalamine now. It's not easy, but I figured it worked for me so long that better to stick with it. On top of that, I don't really mind constipation to be honest, other than how it might affect mesalamine absorption.

Post Edited (brucen36) : 2/4/2015 11:06:15 AM (GMT-7)

Posted 2/4/2015 6:42 PM (GMT 0)
Constipation will not affect the absorption. In fact, the constipation is also a symptom of a flare. Keep doing the enemas nightly.

Can you take a probiotic? I would add that especially if you do not want to do the fiber.
Posted 2/4/2015 6:55 PM (GMT 0)
Yeah, I can try a probiotic, but I hear VSL3 is not SCD compliant. I'll look for another. Or I guess I can start eating homemade yogurt again.
Posted 2/6/2015 6:19 PM (GMT 0)
Hi, I have another question about the enema. I usually administer the enema lying on my left side. Then after I'm finished, if I continue to sleep on the left side then no problems. However, if I switch over to sleeping on the right side I start getting painful cramps and the feeling that I need to go. So I quickly change back to the left again and the feeling slowly begins to subside. Any idea what's going on here?
Posted 2/6/2015 7:51 PM (GMT 0)
Also has anyone noticed that movements smell a lot worse while on the enemas?
Posted 2/6/2015 9:06 PM (GMT 0)
If you look at a diagram of your colon, you can see that it goes up your left side from your rectum, so when you lie on your left side, the meds can move further up your rectum and into the colon. If you turn on to your right side, gravity keeps them in your rectum, putting pressure on you to release them. that's why you're supposed to stay on your left side for minimum 30 minutes, to let the meds spread up. I find that my enemas work better the longer I stay on my left side, so as often as possible I turn over onto my left, if early during the night i've happened to roll over onto my right side.
Posted 2/7/2015 6:38 PM (GMT 0)
The gut is more quet usually while laying on the left side, and inserting rectal enemas have the liquid flow easier into the sigmoid. Anything put into the rectum during when it's inflamed or spasming can trigger the need for expulsion. Laying quietly with the flow in one direction helps.

With the colon and rectum reacting so much, it should hopefully hold the med in long enough to startnthe healing. Half an hour is a good start for the med to start working.

When flaring, I can get very nauseated upon insertion of the enemas because of the spasming. I'm quite a moaning and whimpering spectacle for a few minutes, lol.

q
Posted 2/7/2015 6:49 PM (GMT 0)
Regarding the constipation.....it's a part of healing as the inflammation decreases and regresses. Continue to use the enemas until this stops.

You could start adding fibre supplements to your meals. I use metamucil capsules and started with one per day for a few and increased slowly.

you could also increase vitamin c, add salad (field greens) in small amount, coffee possibly...things to increase digestive peristalsis..etc.

I want to note that constipation is also a smptom of a flare after being asymptomatic.

q
Posted 2/8/2015 2:18 AM (GMT 0)
Thanks for the input. Regarding the metamucil, I was thinking of adding something like it or maybe psyllium seed/husk powder, but my worry is that it will cause me to relapse because I'm one of those that responded very well to SCD. It kept me off drugs for almost 10 years, and now it kinda reached its limits that I had to start using mesalamine enemas. I think I'll give the salad a go, since it is SCD compliant. Thanks again.
Posted 2/8/2015 2:19 AM (GMT 0)
p.s. iceberg lettuce has an insignificant amount of fibre doesn't it? Perhaps you meant other kinds of salad greens?
Posted 2/8/2015 7:46 PM (GMT 0)
Iceberg lettuce contains nothing of value...I eat it at restaurants or other places, but never at home.

The reason I suggested field greens is that they're not as rough, good nutrients and can be chewed well. Baby greens would be good in that category.

I don't use powder psyllium because of inconvenience...don't drink anything I'd be interested in mixing it in. Capsules allow an easier time to monitor, I carry them with me when I eat out.

Salad....eat it after your meal instead of before..or with it...small amount and increase as you feel better. I do find cucumbers stays in my stomach longer, but I do have reflux, I still eat them (baby cukes, no skin).

If you're picking a box container or bag...make sure it's completely dry with no condensation. That way it'll stay longer.

We eat romaine lettuce, some coleslaw and mixed greens all mixed together for salad at home. When I'm flaring, I'll cut it back a bit depending on how I'm feeling. Lots to chew, and I usually have lots of nausea. Depends.

It's not an all or nothing...there are many options and variations in foods. Try not to confuse all fibre in one lump...they all offer something of value to how your digestive tract can function. I certainly don't eat all types of fibre, some give me major cramps and discomfort. Oats are one of the worst offenders....and I love it!

Don't freak out if you see salad in the toilet...it's normal since we don't "digest" to break everything down.

Start middle of the road and go from there. Sometimes a salad doesn't work because of the dressing...choose what you like in a smaller amount that isn't too fatty or rich.

q
Posted 2/9/2015 4:39 PM (GMT 0)
Hi, sorry for all the questions, but I have some new observations which kinda don't make sense.

The first time I took the enema, I was able to hold it in all night. It almost immediately stopped the bleeding and urgency to go, but did not result in formed stool. I was able to do the same each day for the next 7 enemas. However, now on the 8th attempt and after, all of a sudden I'm no longer able to keep it in all night. After putting it in I almost immediately have to release it. I've been holding it in for a couple hours by squeezing the sphincter, which I think still should be ok to absorb some of the medicine. But eventually I have to evacuate during the night. The results are still the same, no huge urgency, no blood, but still no formed stools yet either. So what's going on? Why would my ability to retain the enema have gotten worse? If anything I would have thought it would have gotten better.
Posted 2/10/2015 2:35 AM (GMT 0)
I'd be careful with taking Metamucil and stuff. Check with your doc!
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