Lingering Inflammation & Lots of Constipation

Started with a flare a while back. Lots of diarrhea and blood for about a year until I started Entyvio. Entyvio got my inflammation down to inflammation in the last 30cm of my system, so all of my rectum and a little into my colon. My doctor put me on Methotrexate at 25mg weekly. My symptoms are generally 2-4 BMs a day, a toothpaste-like stool, bleeding every once in a while. That has gotten me down to moderate inflammation to 20cm, so pretty much all of the rectum. My doctor added Canasa suppositories nightly. So far, the bleeding has subsided for the past week and my stool is regaining some type of form. Still no where near the form that it was prior to being diagnosed or in remission, but a very positive step. I still have lingering stomach/abdominal pain, BMs roughly the same.

So I've had a lot of positive signs lately, but I have never felt more ill than recently. I wake up a lot of mornings with headaches that persist throughout the day and a lot of nausea. I am guessing that these symptoms have to be either some pretty bad constipation or side effects from any of the 3 medications I'm on. I'm more inclined to believe it is constipation since I have a lot of bathroom trips where my stomach hurts and I feel like I have to go, but cannot go and nothing happens.

I am hoping this is just part of the process as inflammation is reduced, especially in the rectum. Maybe my stool is starting to regain its normal form but the inflammation is around. Given this is my first ever flare, I've never experienced what the process looks like to go from moderate inflammation to remission. Is constipation a big part of the process? What can I do to reduce these symptoms? I currently eat fiber everyday. I am trying to now drink more water, but any other suggestions/tips would be greatly appreciated.

Ditto the above. In all it varies wildly as we heal. It sounds like you are doing pretty well with 2 bms a day that are solidish, without urgency. Constipation is most often rectal-inflammation (20cms or less fits that bill).

I'd ditto that Methotrexate (MTX) might be the cause of the nausea, but also want to note that flares can cause nausea as well. You can skip MTX for a day and see if the nausea ceases. You could always transition to Azathioprine/imuran/6mp if it is bad enough (but those meds can cause nausea too).

Healing is never a linear process, with daily improvements from flare to remission. Rather it is more of a rollercoaster ride with unexpected sharp ups and downs. Expect a lot of wild daily variation until you achieve a remission (a series of good days, a really bad day, and then a good day; normal). It's infuriating and frustrating but just par for the course. You'll have blood randomly appear again, stools suddenly a lot looser, pain, etc etc.

Regarding formation of your stools. Any form of solid is your goal. You are not going to have always normal bms once in a remission. I have the occasional normal bm in a remission, you stand back and think "wow this is a Kodak-moment and should get my camera lol." Often it's just some type of solid and what that is varies wildly. Taking fiber supplements can make them consistently denser, like metamucil.