Utterly Dejected

I had a routine rigid sigmoidoscopy today which revealed that my Proctitis has healed and the piles are not bleeding. However there was streaks of red blood higher up in the Sigmoid which has prompted the GI to want to do a yet another Flexible Sigmoidoscopy next week. That's two in 6 weeks. He is baffled that the mucosa looks immaculately normal throughout and the stools are normal yet there is streaks of blood. He even thinks the topical Mesalazine may have made the colon more inflamed as can happen.

I'm baffled and frightened too and can't work it out.

Here is my flare up in short.

August: loose stools. Bright Red Blood. Mucus. Increased Pentasa and Metronidszole. No change though.

September: Remission achieved for 3 weeks after taking Asacol suppositories night and day plus Pentasa.

October: Bleeding after Flexible Sigmoidoscope. Then intermittent light bleeding. Normal stools. 2 bowel movements a day. 1g Enema taken plus Pentasa.

November: Light bleeding but bleeding stopped completely after taking Proctoseydal. Normal stools. 3 bowel movements a day. 1g Enema at night plus Pentasa.

So I had bleeding intermittently with Enema. Stopped with the suppositories. Obviously the Enema worked for Proctitis but not for the Sigmoid as did the Suppoditory.

He's putting me through another sigmoidoscopy so I'm very anxious about what he's looking for. He's stopped rectals and has me on Metronidazole for a week.

Post Edited (LondonRed) : 12/1/2015 2:27:09 PM (GMT-7)

Hi..understandable how you're feeling, but all you can do is try it.

It is possible that the mesalamine or something IN the foam enema has made it worse. But...your rectum is fine (and you use mesalamine supps and enema), then it's not the mesalamine. So, I wouldn't make that conclusion.

The supps wouldn't have dealt with the sigmoid area....did he at least take biopsies of the inflamed friable area in the sigmoid?
How big is that patch of inflammation? and where exactly is it in the sigmoid...close to the rectum or close to the descending colon?

What did he say about the fact that your butt is very painful?

q

People's advice would be much welcome:

Thinking rationally; and taking my over anxious hat off – I think it’s better to treat the symptoms rather than do the Sigmoidoscopy. We had a look and did multiple biopsies only 6 weeks ago; and unless there is something else he is looking for then what is the point? Indeed, I think the last Sigmoidoscopy made things worse as I’d stopped bleeding at the time and was deliberating whether to do it or not anyway as forum members will testify.

Quite clearly; the suppositories have worked to clear the lower and upper rectum, and the Enema hasn’t. It would probably be prudent to do Metronidazole, Asacol High Dose, and Continue with 1g suppository at night and 500mg during the day - that covers the whole Colon.

The other reason I am saying to not do the Sigmoidoscopy, is when I go to the USA; the GI there will also probably want to take a look and give his own opinion so that will mean another scope – 3 in 3 months - with a Colonoscopy only last year.

Better to wait until I move and get a 2nd opinion no?

I agree with your decision. Why repeat a sig-scope so soon with no good reason and as you say your new GI will want to do their own look-see. I have stood my ground with GI's who pushed me to have a scope with no good reason and they were fine with that (didn't fire me as a patient ha).

Especially if your recent sig-scope made things worse.
Trust your gut feeling about this.

I just had bright red blood on the tissue and blood in the toilet. Not much but enough. It's the first time in 2 days since I took Metronidazole.

This has a significant pattern.

- it's never the first bowel movement of the day always the latter ones.
- I never have more than 3 BM's a day
- the motions are always normal. Never diarrhoea and there is no mucus or urgency.
- There is significant anal soreness after each bowel movement.

I will now not bleed for another 2 days. It's like something bleeds then stops for 2 days. And maybe we need to look at the whole Colon to find what it is.

We also know that Metronidazole and the Proctoseydal have stopped the bleeding instantly but only for a couple of days in the latter's case but I did start using one every two days which wasn't enough.

I'm very worried. This is new territory. I've always got into remission within 2 months and apart from the bleeding every 2 days and the anxiety I feel totally well and normal. The pattern is the same whether I take Enema or Increased Pentesa or whatever. I bleed every few days with normal bowel movements and no other symptoms.

Normal UC and CD does not behave in this way normally. It's more about bloody Diarhoea, abdominal pain, mucus, and urgency. I have none of those.

I'm totally baffled.

Post Edited (LondonRed) : 12/3/2015 5:12:03 AM (GMT-7)

I think the fact that it bleeds at the end of the day suggests that the anus is bleeding after being irritated and pooling blood after the first 2 BM's. In addition; the soreness and pain after the BM suggests an anal issue - fissure and Hemmie - both of which I think I have too. The issue is whether it is the Colitis too. I had a stool test a few months ago which was normal and the Calprotectin score was 300 but coming down the last time. I too also think most people's bleed pools at night and comes in the morning, but because I never had a BM late afternoon or early evening he anus isn't irritated. Maybe?