UC & IBS?

I had a colonoscopy a few months ago and my GI noted mild inflammation in my rectum and a few inches in my colon. He gave me a second medication to go with my Entyvio and told me to take it until my next appointment which was today.

Fast forward, the bleeding has gotten way under control, often going days at a time without any bleeding, urgency is more mild than before, but it is still there. Other symptoms which I was confused by was stomach/abdominal pain and not feeling like I'm emptying my bowels when I'd go (going 3-5x a day, usually all before 1pm). So clearly my symptoms were pretty mild compared to a few months ago.

My GI said he thinks I might have IBS along with my UC. He prescribed me Dicyclomine and told me to take it for 2 weeks. He also scheduled a scope for end of November to see if any inflammation was still there. That would tell us whether the medication didnt get rid of the inflammation or if it is IBS and I am in UC remission (which would be great).

I guess I have mixed feelings on this IBS/UC. On one hand, this second medication getting me in remission would be huge, especially since I've spent nearly 2 years fighting to get it in remission. On the other hand, I dont know much about IBS and this would be another chronic illness for me to handle longer term with my UC. It seems to me, a big problem is recognizing the difference between UC symptoms and IBS symptoms. I'm not sure how you'd know if you are flaring versus having IBS symptoms.

Anyone have experience with this combo? I put a message on the IBS board, but figured at least some people here would have it.

IBS is very common for people who have IBD - estimates are that anywhere from 1/3 to 1/2 or even 2/3 people with IBD have some amount of IBS on top of it.

But it sounds to me like you might still have some residual inflammation, ie, your IBD isn't competely in remission. It's only when IBD is completely in remission but a person still has problems can the doctors say for sure that it's IBS causing the problems.

I appreciate the responses everyone. I tend to agree with you guys that there is likely some lingering inflammation. I guess I was just confused by my remaining symptoms. When my GI told me after my last colonoscopy that inflammation was at the end of my colon and in my rectum, I figured the symptoms I'd still have would be: bleeding, pain when going, some mild urgency. I didn't think the # of BMs would still be 3-5 and I wasn't expecting a lot of stomach/abdominal pain. However, with my BMs still unchanged since I started the new medication & stomach pain still continuing, I thought my GI thinking there might be some IBS at work. I guess the symptoms I still have didn't make much sense to me given where the inflammation is. Unless the part of the colon/rectum with inflammation doesnt matter and symptoms aren't necessarily tied to where the inflammation is?

iPoop, the other med is Methotrexate, 25mg/week. I had told my GI doctor back in June that I was looking to avoid rectal meds. However, in recent weeks I am starting to think a rectal med is the best solution. I dont want to come off Entyvio and I dont think the Methotrexate has made a huge impact. I have had this flare for almost 2 years and I feel like im close to remission. I am giving this IBS med a chance for 2 weeks like my doctor said to. If they dont work, I am thinking about trying some rectal meds until my scope on 11/30. That should give me a couple of weeks to see if the inflammation was reduced with the rectal meds.

I'd give the rectal-route a shot sooner rather than later. The rectum always has our most severe inflammation, and can dictate: number of bms a day, urgency, etc. As it is the rectum that is the exit point, when it's unhappy and inflamed it will fit and give us no-end of troubles. Yes the rectum can bleed but it can have a lot of other symptoms. And being confused is quite normal with an UC, it is what it does to us (throws us random curve-balls, the unexpected, and baffles us just when we think we have it figured out). There's never easy A+B=C, more often than not a lot more difficult

The stomach pains, that's something else maybe: gerd, IBS, food-intolerance etc. Or I suppose the stomach pains could be trapped gas or stool, which can cause mild pains and aching.

Yeah not sure on the MTX, it might be doing nothing or it might be an assist. I'd just recommend throwing everything at the inflammation, get symptom-free and then whittle away what is truly necessary. I'd not kick any legs out from underneath the stool you're precariously balanced on until you know you're safely within a sustained remission.