Are Salofalk enemas working for me?

Hi all,
I’ve been dealing with a nasty flare for the past year or so and am currently in a regimen of Cortifoam (the hydrocortisone foam) in the morning and Salofalk (5-ASA/mesalamine) 4g enemas at night. I haven’t had problems retaining either and have been using them as directed for about two weeks. For context, I started these treatments after a colonoscopy around Christmas that revealed moderate-severe inflammation for 25cm (rectum and lower sigmoid colon). Over the past week, I haven’t had any reductions in blood, mucous, number of BMs, or urgency. However, I have noticed my stools have been formed (which was not the case before starting).

With all of this in mind, do signs point to working or not? My doctor didn’t give me much detail on how to tell, but did say it would take 3-4 weeks. What does everyone else think? My fear is that, if they’re not working, I’m wasting time where I could be getting onto something more effective (aka the dreaded prednisone).

Having formed stools sounds like a move in the right direction. I'd give it more time and see if the blood, urgency etc clear up. Make sure it is consistently more formed, and not a one day variation due to something you ate.

Healing is a weird thing. All we want to know is things are getting better, but it is never a linear improvement from flare to healed. Rather it is very inconsistent bm-to-bm, better then worse, formed but still bloody. Lots of contradictory things pop up. Unfortunately that is normal for healing.

Best you can do is take the long-view on week-to-week: Are you better this week than last? If the answer is yes, then you're heading in the right direction.

iPoop said...
Healing is a weird thing. All we want to know is things are getting better, but it is never a linear improvement from flare to healed.[\quote]

Thanks for that advice! I've been repeating "healing isn't linear" to myself, but definitely trying to balance it with realism about whether things are actually getting better week-to-week.

[quote=quincy] It would be good for you to continue the treatment as you're doing now at least for a few more weeks. You may need a few months. I would, however, suggest you get on lower dosage mesalamine oral as well.[\quote]

Things seem not to have improved moving into week 4 of the treatment. Still have urgency, stools back to being very loose, lots of mucous, maybe a bit less blood? I've tried oral mesalamine before with no effect, and I'm wondering if prednisone may be a good option to add in to help the enemas along? I've taken it once before at 40mg and HATED it, but I do remember it working pretty quickly (the problem was at that time the gastro gave me no maintenance therapy, and luckily I don't see that person anymore). Any thoughts? Could pred help the Salofalk along? Or am I just clutching at straws thinking maybe the Salofalk could still work?

So the colonoscopy showed moderate-severe inflammation and for me this is the most intense flare I’ve experienced since diagnosis (I was always mild before).

Current symptoms are 3-5 BMs/day, always urgent (can’t hold them but no incontinence and never at night, which I’m very thankful about), passing green (sorry for the graphic) mucus a lot, and some small traces of blood in the stool. Previously I had blood on TP or in the bowl but that has reduced a bit. It’s really the urgency and the cramping that are getting to me the most. That and the fear that all of the above might get worse unexpectedly.