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Mesalamine enema making me poop more

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Posted 10/20/2019 9:54 PM (GMT 0)
Hi
I have been feeling better so my doctor said I can stop using enema.
So I did and there was blood in stool the next day. Started enema again for the week.
Got better. Now I’m afraid to just stop so using it so I’ve been using enema on alternate days.
I notice I poop twice on the day I use mesalamine enema. Didn’t happened before.
Does that mean I’m better and my body is just not absorbing it? because I can see white mesalamine on stool.
Also I notice mesalamine enema makes my stool super soft (that’s not new for me)
Does it happened to anyone?
Posted 10/20/2019 10:21 PM (GMT 0)
Hi, I have used these enemas on and off for a year now. Usually when I begin to flare I become constipated or inflamed to the point that I pass bloody mucus only. Then I start using the enemas and lots of the enema will come back out with more bloody mucus at least for a few days before I settle down.
Hope you feel better soon, Sassy
Posted 10/20/2019 11:04 PM (GMT 0)
Putting more in = getting more out.

Yes it's possible you're getting better and don't need to absorb as much. I would continue them or alternate to ever second day or so. I would ask the doctor and see what they suggest.
Posted 10/20/2019 11:08 PM (GMT 0)

Sassysback said...
Hi, I have used these enemas on and off for a year now. Usually when I begin to flare I become constipated or inflamed to the point that I pass bloody mucus only. Then I start using the enemas and lots of the enema will come back out with more bloody mucus at least for a few days before I settle down.
Hope you feel better soon, Sassy



thanks. Yeah I too got severely constipated when I finally noticed and got treated.
Posted 10/20/2019 11:12 PM (GMT 0)

Andrina said...
Putting more in = getting more out.

Yes it's possible you're getting better and don't need to absorb as much. I would continue them or alternate to ever second day or so. I would ask the doctor and see what they suggest.

I have really unhelpful doctor. I doubt he would know anything about things like that. I even have to ask him if I should discontinue enema and reduce meds eventually. If I didn’t ask he would just let me go with full dose for 6 more months
I ask him about weight loss and he just told me to talk to my primary care 🤷🏻‍♀️
Posted 10/21/2019 2:27 PM (GMT 0)
According to medical text books, we all need enemas for flares and in a remission we should be able to stop them. Medical text also says we can reduce the dosage of our mesalamine/Balsalazide dosage to approximately half of flare dosages during remission. That's a broad generalization, but as everyone's disease severity is varying so are what you/I need to sustain a remission. In my case, I've never been able to taper off of the mesalamine enemas even during a remission. Others can. Some might do the enemas at a reduced frequency during a remission, as needed, twice a week, etc. You have to findout what works for you.

If you failed one taper off of the enemas, continue nightly for another month or so and then try again. Go to every other night and do that for multiple weeks, then twice a week, then once a week, then stop. If your symptoms get worse during a taper then go back to nightly.

Yes, while on mesalamine enemas, that first poop of the morning might have more urgency, be a little looser, and might contain white liquid, or the stool might be lighter than coloration than poops later in the day. Why? The enema fluid is never 100% absorbed, so it might make the stool looser, and might discolor the stool. I've even seen white drops in the toilet the next morning, some of the fluid wasn't 100% absorbed, normal for us.
Posted 10/21/2019 3:50 PM (GMT 0)

iPoop said...
According to medical text books, we all need enemas for flares and in a remission we should be able to stop them. Medical text also says we can reduce the dosage of our mesalamine/Balsalazide dosage to approximately half of flare dosages during remission. That's a broad generalization, but as everyone's disease severity is varying so are what you/I need to sustain a remission. In my case, I've never been able to taper off of the mesalamine enemas even during a remission. Others can. Some might do the enemas at a reduced frequency during a remission, as needed, twice a week, etc. You have to findout what works for you.

If you failed one taper off of the enemas, continue nightly for another month or so and then try again. Go to every other night and do that for multiple weeks, then twice a week, then once a week, then stop. If your symptoms get worse during a taper then go back to nightly.

Yes, while on mesalamine enemas, that first poop of the morning might have more urgency, be a little looser, and might contain white liquid, or the stool might be lighter than coloration than poops later in the day. Why? The enema fluid is never 100% absorbed, so it might make the stool looser, and might discolor the stool. I've even seen white drops in the toilet the next morning, some of the fluid wasn't 100% absorbed, normal for us.

Thanks so much for explanation! While I do not mind using enema I’m concerned about kidney damage from taking both oral balsalazide and enema. Do you have blood works done for that or is it a none issue for you?
Posted 10/21/2019 4:29 PM (GMT 0)
Potential effect of mesalamine on kidney is rare, and for topical rectal administration should be negligible unless you have unusual sensitivity.

It is not clear to me why you are seeing more fluid expelled when you feel better. I do not think that healthy tissue absorbs less than inflamed tissue. That idea seems backwards to me. Inflamed tissue should have more difficulty absorbing meds, and shudl impair upwards movement of the liquid.

good luck
Posted 10/21/2019 4:44 PM (GMT 0)

DBwithUC said...
Potential effect of mesalamine on kidney is rare, and for topical rectal administration should be negligible unless you have unusual sensitivity.

It is not clear to me why you are seeing more fluid expelled when you feel better. I do not think that healthy tissue absorbs less than inflamed tissue. That idea seems backwards to me. Inflamed tissue should have more difficulty absorbing meds, and shudl impair upwards movement of the liquid.

good luck


I think you might be right. I’m back to pooping once this morning despite using enema last night. Sneaky flare or I never went into remission in the first place😅
Posted 10/21/2019 4:48 PM (GMT 0)
Hi...how long have you been using the enemas nightly? And when did you taper to every second night?

Ive used bothoral and rectal mesalamine for well over 30 years. I have blood tests for kidney function checked every 6 months.

q
Posted 10/21/2019 4:50 PM (GMT 0)
It is very difficult to overdose on mesalamine in UC dosages. The most I've been prescribed by my doctor was 12.8-grams a day of mesalamine, that's 4.8 grams lialda, and two of the 4.0-gram mesalamine enemas a day.

The kidney warnings are more for new patients, it is a good, and reasonable precaution to do a blood test a few months after starting mesalamine as there are rare odds of kidney or blood abnormalities. If you've been on mesalamine for years with no issues, then your kidney is fine and not a worry.

You'll be fine at current dosages, no worries about your kidneys. Remember mesalamine is a 90% topical and 10% systematic medication. So the majority of that mesalamine is pooped out. The systematic percent does go through the kidneys and we pee it out (making our pee a darker color and staining the toilet bowl).
Posted 10/21/2019 5:15 PM (GMT 0)

iPoop said...
It is very difficult to overdose on mesalamine in UC dosages. The most I've been prescribed by my doctor was 12.8-grams a day of mesalamine, that's 4.8 grams lialda, and two of the 4.0-gram mesalamine enemas a day.

The kidney warnings are more for new patients, it is a good, and reasonable precaution to do a blood test a few months after starting mesalamine as there are rare odds of kidney or blood abnormalities. If you've been on mesalamine for years with no issues, then your kidney is fine and not a worry.

You'll be fine at current dosages, no worries about your kidneys. Remember mesalamine is a 90% topical and 10% systematic medication. So the majority of that mesalamine is pooped out. The systematic percent does go through the kidneys and we pee it out (making our pee a darker color and staining the toilet bowl).


thanks! I’m taking Balsalazide 750mg 9 capsules/ day and enema 4g nightly. I’m new at this and started on August this year. My GI didn’t mention anything at all so I’m wondering if I should be getting tested and he’s being negligent as usual
My pee color doesn’t change into darker so that’s my other worry. Maybe I’m overthinking it who knows
Posted 10/21/2019 6:59 PM (GMT 0)
My doctor never did any blood work either after starting the mesalamines, it's a pretty rare event and many do not test for it. If your general practitioner doctor does blood work in your annual physical then you should be fine.

I can tell you have a bit of anxiety over it all, and, yes, you are definitely over thinking things a bit. The majority of people have no side effects or problems with the mesalamines, they are well tolerated by most. They're the safest meds we have or an UC. Treatment is always balancing risks versus benefits. Anything described as rare, is less than 1% (and often far less than that) of patients experience it. There's small risk in exchange for great chance of a benefit.

The pee color change isn't all of the time for me, just random and it is brown to dark orange. Just figured I'd mention it as it freaks some people out. Not sure if everyone sees it, some do for sure.
Posted 10/21/2019 11:07 PM (GMT 0)
To reinforce what iPoop posted, I've been on 4.8 gms of oral mesalamine for over 20 years, and 4.0 grams of mesalamine enemas, both daily, with no issues...and I get blood tests at least every six months, for another condition. You should not experience any issues, keep vigilant, without overthinking it.

If you really believe your physician is "negligent" Vlight, a change is in order.
Posted 10/23/2019 2:39 PM (GMT 0)
Vlight....i,m not sure how long you have had UC, I have been basically in remission for 20 years taking Mesalamine only, until this year, cause my mind thought I was good and could cut down on meds. It didn't work! So i am using the enemas as so many here have suggested. They seem to help me with inflammation, however I think I am having side effects.

My pee is dark yellow or brown right now and after using 2 days of 4.0 gram enemas I am getting headaches, feel exhausted and my heart seems to be palpating.

Then I experienced pain in the left upper side quadrant. Should I continue using the enemas? The rectal urge and pain has slowed, and the stools are loosely flowing now.
Do you or anyone else get these side effects?
Posted 10/23/2019 3:27 PM (GMT 0)
I would always first defer to your doctor, describe all you've said here and have him/her assess whether you should continue ahead or stop. We're not doctors.

From my understanding the dark coloration of the pee from taking mesalamine is completely harmless. If you use bleach in your toilet water when cleaning, then the coloration is even darker. I get purple rings at the high-water-mark in my toilet bowl and it takes extra abrasive scrubbing to keep that bowl white and stain free.

Are you properly hydrating? Not sure how bad your flare is but we can dehydrate very, very fast with frequent diarrhea during flares. In fact, dehydration alone can explain the dark pee, rapid heart beat, and head aches (all classic dehydration signs).

If you are prone to anxiety, then there could be a bit of that injected as well.
Posted 10/23/2019 5:00 PM (GMT 0)
I've NEVER had dark pee...and the stains also depend on what's in the water I think, and for me, mostly from the enemas.

Sassy....If your urine is that dark, consult your doc asap, for it could be kidney related.

q
Posted 10/23/2019 8:12 PM (GMT 0)

garyi said...
To reinforce what iPoop posted, I've been on 4.8 gms of oral mesalamine for over 20 years, and 4.0 grams of mesalamine enemas, both daily, with no issues...and I get blood tests at least every six months, for another condition. You should not experience any issues, keep vigilant, without overthinking it.

If you really believe your physician is "negligent" Vlight, a change is in order.


I’m currently not too bad in needing to change dr and my insurance only covers for the Dr in the hospital I work at. So it would be like changing Dr in same office. I wonder if it would be awkward. I do overthink but at least I’m self aware lol
Posted 10/23/2019 8:17 PM (GMT 0)

Sassysback said...
Vlight....i,m not sure how long you have had UC, I have been basically in remission for 20 years taking Mesalamine only, until this year, cause my mind thought I was good and could cut down on meds. It didn't work! So i am using the enemas as so many here have suggested. They seem to help me with inflammation, however I think I am having side effects.

My pee is dark yellow or brown right now and after using 2 days of 4.0 gram enemas I am getting headaches, feel exhausted and my heart seems to be palpating.

Then I experienced pain in the left upper side quadrant. Should I continue using the enemas? The rectal urge and pain has slowed, and the stools are loosely flowing now.
Do you or anyone else get these side effects?

I’ve only been diagnosed and getting treated for a few months. When I started taking meds and enema it was like I had flu/very bad DOMS after a workout for 2 weeks at least. I’m fine now though. No more muscle/joint pain.
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