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Rectal Meds and Steroids

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Ulcerative Colitis
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Posted 8/27/2015 12:43 PM (GMT 0)
I am having 2-4 BM's a day, largely formed stools and the blood is slowly going away - but coming back from time to time. What I seem to have is this constant need to "go" because I am unable to pass wind. If I passed wind then I'd not need to go if you get what I mean.

I then get a bit of mucus come out and along with some stool. Were it not for the mucus, I don't think I'd have got the urgency or the increased stools.

I reckon like a few years ago I have Proctitis in addition to my normal right sided flare up; and I have never taken Steroids.

Can someone recommend:

1. A good rectal medication for Proctitis
2. A good starter Steroid that isn't so harmfull

I am seeing the GI tomorrow, and I want to be armed with the right information and not just trust him. He tried to put me on Steroids last time but I got better with just Pentasa.

Any help much appreciated.
Posted 8/27/2015 1:19 PM (GMT 0)
I was in the same boat, pentasa sachets were clearing it up gradually but still getting the odd bit of blood\mucus, and like you said breaking wind was like playing russian roullette. I don't know what pentasa you're on but the doc prescribed me pentasa 1mg suppostries along with the granule sachets and it was back to normal after 2 days, apart from the hemhorroids(prep h clearing that up now).

As for steroids i was given Entocort, worked wonders the 1st time(2 years ago) but made little or no difference this time around.

Post Edited (ChrisHUC) : 8/27/2015 7:22:33 AM (GMT-6)

Posted 8/27/2015 1:31 PM (GMT 0)
Are you on Pentasa now and how much? You should be on 4 grams per day while having problems, 2 grams per day when in remission. If that wasn't good enough to keep you in remission then you should just take 4 grams per day all the time. Steroids aren't such a bad thing short term. They are prescribed for many different things and can be extremely effective. The problem with UC is that if your mtnc meds aren't good enough your symptoms will return when tapering to the lower doses or off and that's where everyone makes the mistake of just increasing the steroids back up again, causing you to be on them longer term and the side effects get worse. If your mtnc meds work properly you can just take the steroids for about a month or even less, pulling you out of a bad spot. They do have a more topical steroid, Uceris, that is not as systemic but it is probably a 50/50 shot of working when prednisone is probably about 90% successful. Entocort often doesn't work well for UC. For rectal meds you can either take mesalamines or topical steroids.
Posted 8/27/2015 3:24 PM (GMT 0)
Thanks for the advice guys.

I'm on 4.5g Pentasa TABLETS now on a flare and normally on 2g on Maintenance.

I have Chrohns Coltis. Mild right side along with Proctitis. It's probably the same now with bright red bleeding and mucus.

I guess I should try Rectal meds.

Interested to hear what Pentasa Sachets do?
Posted 8/27/2015 3:34 PM (GMT 0)
Canasa and Uceris
Posted 8/27/2015 3:53 PM (GMT 0)
I'd try alternating a liquid mesalazine enema with a suppository. Brand name depends on which country you are in. I don't think the brand is as important for the rectals as it is for the oral tabs because the oral tabs do actually vary in that they release at different parts of the colon (Pentasa the highest, Lialda the lowest).
Posted 8/27/2015 4:03 PM (GMT 0)
I would start out by doing rectals and if it works to put you back into remission I would always stay at 4.5 grams of Pentasa. Don't lower the dose at remission. The goal is to never flare again if possible because future flares often get harder and harder to treat so 2 grams Pentasa daily wasn't good enough to keep you in remisison. Might also help to continue rectals at some level while in remission, even just once per week.
Posted 8/27/2015 5:23 PM (GMT 0)
I think 3 grams of Pentasa (2 tabs 3 times a day) plus a rectal meds at weekends would be a good remission dose! But God willing I need to get into remission first.
Posted 8/27/2015 7:11 PM (GMT 0)
Use the rectal meds nightly until all clears. Then taper to every second night for a few weeks..then to twice a week for maintenance.

Where are you living at this point?

q
Posted 8/27/2015 7:14 PM (GMT 0)
There's no reason to stay at the highest dosage of Pentasa if not flaring...but 2000mg is too low methinks for maintenance.

The dosages should be tapered slowly over a period of time....not dropped from highest dosage to maintenance.

q
Posted 8/27/2015 8:18 PM (GMT 0)
In London now. Moving to Seattle soon.
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