rectal or oral medicine

Hi...welcome to the forum.

Are the rectal meds mesalamine or steroid?

You're better to be using retention enemas than just suppositories. Using both or steroid and mesalamine is helpful. You're still flaring...discomfort with rectal meds is a usual for some of us.

How long were you on the rectal meds exactly?

How have your symptoms changed since diagnosis?

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You can call your doctor and ask for steroid enemas and to increase the oral mesalamine back to 4800mg. It really shouldn't have been decreased until you were in remission...but it's something that can be experimented with.
Are you on the 400mg dosage asacol?

Are you still on the cortiment?

Regarding diarrhea...is it all water or loose soft stool? Is it mostly in morning or throughout the day?

How are you eating...some foods can loosen stool as well.

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Some here have had side effects to the supps and enemas and simply cannot use mesalamine.

I think that if you had firm stool in the morning and diarrhea during the day...it's not the supps. But how are bms at this point exactly compared to when on the supps?

Have you had stool tests done recently to see if something else is going on?

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I wouldn't wait...when did you last use the suppositories? I would try them again for at least a week and document your symptoms.
Where was the pain exactly? And when exactly?

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I would ask ask for steroid rectal meds and see how you do on them. I suggest foam enemas which seem ro be easier for people to retain.

Do you not have a GI?

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You aren't getting worse, so that's a good thing. What you don't want is to not treat the rectum.
Raising the bar for acceptance as it's OK is NOT the best place to go.

Either try the mesalamine enemas again this week to confirm your reaction or ask the doc for steroid foam enemas to deal with rectal healing.

As an aside, I seemed to do worse before things improved when I started the enemas. I was going up to 10 times daily at that point, but it had improved when I started oral asacol from 20 when diagnosed.

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I'm encouraging you go reconsider rectal meds..oral mesalamine won't be enough treat the rectum.
There are topical steroids oral and rectal.

Keep us updated as to how you're doing.

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Depends....but for many it's helped tremendously.
I've only used steroid foam enemas once at in 1989, but that was given by another doctor while mine wasn't available...he wanted to out me on prednisone and I refused, so he OK'd the enemas. I was in a bad flare, and it definitely helped. I was only on it for 2 weeks , then back on Salofalk once my dr was back.

If I was in a flare and Salofalk didn't seem enough, I would request steroid foam (easy to retain for day use) and use Salofalk at night.

Both end approach...UC starts in the rectum...you have options.

Here is my perspective...if you can get things controlled controlled on the lowest tier meds...stay there. That would include mesalamine oral and rectal (and steroid topicals if needed).
The thing is that it takes commitment and eventual understanding of symptoms comes as how to use them effectively.

My 32 years of use has paid off to show normal c-scopes biopsies...and I didnt realise mesalsmine use had the ability to heal to that level.

My flares are extremely minimal, and to the point where some would say it's not a flare, but i have no patience to wait it out to get worse to prove it to someone else. I know my body and symptoms. I have no desire to go backwards.

In saying that...all hell could break loose based on life or illness events. I'm doing the best I can and hope it continues.

You do what is best for you. Some cannot take mesalamine and dont want the commitment. Some do well on immunomodulators, others do well on biologics and ilk. Some are on biologics and still use mesalamine...and on and on. Some don't do well on any and decide to have surgery.

Put out a question and ask those who are on the high tier meds what you need to know.

In the meantime...use the suppositories. I would suggest after bms in the day and at bedtime.. start with one and ask the doc to rx 2x daily if needed.

Keep me updated.

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Let me know how it goes with the suppositories.
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Good on the supps.

Regarding remission...it's a maintenance state for most of us, and a slippery slope regarding recognising symptoms that arent quite obvious to tell us things are awry. It took me about 3ish years to start recognising those symptoms and eventually how to use my meds more efficiently. Mind you, I've been at this a long while. Certainly worth it to me.

My suggestion...while impatiently waiting for actual remission, recognise ALL the symptoms while you are healing (because they will change). I do urge you to try the enemas again since you have sigmoid involvement.

You will see how you do at this point, and always have the option to increase to enemas if your symptoms are not as they should be. You have many options regarding use, and hopefully your GI will be willing to go along with the trials of scheduling and dosaging.

Don't have high expectations...just understand what the meds do and that mesalamine is not an immediate thing. It does its magic through continued use, so give it a fair try.

If you cannot use it or it's not enough...there are always topical rectal steroids to use.

Keep me updated 😊
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Not from the coating. It is just stool that is still watery and soft enough to colour the water.
Do you still have the enemas available?

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