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Hydrocortisone steroid enemas/suppositories

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Posted 2/17/2021 12:19 AM (GMT 0)
I have seen some people here saying that long term use of steroid rectals will thin the wall of the colon/rectum. Can anyone share a link on that? I have tried searching and can't find anything with that info.

Mesalamine enemas don't work for me so I use the steroid enemas if I think a flare is starting then after a few weeks I wean off and stop. A few years ago I was in a really bad flare and was on them daily for about 6 months or so. Doc never expressed any concern about using then that long, but I am not 100% confident in his knowledge. I use the suppositories for 2 or 3 days when a hemmie acts up. That happens a couple times a year

Thanks!
Posted 2/17/2021 1:11 AM (GMT 0)
have you tried the steroid enemas and the mesalamine in some sort of combo therapy ? maybe use the m enemas after you stop the steroid - or alternate -

honestly don't think anyone knows what the long term use effect would be -

i dunno ?/?!!

TT
Posted 2/17/2021 2:22 AM (GMT 0)
Basically, a UCer with continuing problems should not self-medicate. You need an experienced IBD gastroenterologist who will partner with you to find the best regimen and/or alternatives. In general, retention enemas are best for treating sigmoid colon, rectum, and anal canal. If anal canal is the only inflamed area, then suppositories should suffice to treat that. If the suppository is 1-5% steroid, you should not be endangering the canal wall with infrequent use. However, if you use a steroid retention enema for more than 3 months continuously, then you have to be concerned about systemic side effects. There should be a medication sheet accompanying Rx enemas that tells you when and what to watch for in terms of prolonged steroid use.** Luckily I haven't needed to use them since 1990s, but the medical consensus on their side effects then was based on a 50% systemic effect of the standard oral steroid (i.e., Prednisone) by 6 months of continuous use. [** Info gleaned from drug trials] Be sure that your rectal inflammation is not caused by internal hemmies, rather than a start to flaring. Internal hemmies can be treated with 1% steroid foam + Lidocaine or Pramoxine combo. Also, some Lidocaine & Pramoxine remedies are now sold OTC as hemmie meds. / Old Hat (40 yrs with left-sided UC; in remission taking Colazal)
Posted 2/17/2021 6:39 AM (GMT 0)
Anal canal isnt affected by UC, but can be with CD.

For treating hemmies, meds such as Old Hat mentioned (ointments and suppositories) can be helpful...also compounded meds into a product called Rectal rockets might just do the trick if all else isn't.

q
Posted 2/17/2021 10:14 AM (GMT 0)
Regarding what you said about anal canal is not affected Quincy. When my GI is saying I have 4cm inflammation is that not the anal canal which is the same as the rectum?

Its 4cm from what point?
Posted 2/17/2021 12:14 PM (GMT 0)
My doc is fully aware of my enema usage. He even gives me 90 day mail order prescriptions. In the past 3 years I have received 2 shipments of the enemas. Still have 2 months left of the last shipment. Other than that bad flare a few years ago I generally don't use them for more than a few weeks at a time and I let him know when I use them. In Dec I developed diarrhea with no increase in frequency, urgency or blood. Contacted doc and did a stool test -- no pathogens. In Jan I tried some enemas and things started to improve so guessing it was a minimal flare. Diarrhea is gone now and I am starting to wean off of them.

I have tried alternating mesalamine with the the steroid enemas and that just prolongs things. For some reason the mesalamine enemas just don't do anything anymore.

Will check out those OTC & rectal rockets hemi treatments

I really just wanted to read something that tells of the dangers of long term use of steroid enemas rather than just believing strangers on the internet (no offense) since my doc has never been concerned. I can find lots of info about oral systemic steroids. Not much about enemas and nothing that said there was a danger of thinning the colon.
Posted 2/17/2021 5:47 PM (GMT 0)
1 Wish...Any measurement of UC/UP involvement is from the very end of rectum and above.




Anal canal is about 3 - 5 cms.
At that junction (bottom of rectum/and in anal canal) can be internal hemmies and/or external hemmies at the bottom of the anus.

Depending on where yours are, rectal meds will help...but the nozzle of enemas can definitely scratch them. I have one that gets nicked lightly by the enema nozzle... lubrication (i use proctocedyl on the tip) and positioning the nozzle away from it can help.
I also eat foods that create a very soft stool.

If yours are within the anal canal, you can withdraw the nozzle into that area while squeezing the medication and cover some of the anus.

q
Posted 2/18/2021 1:34 AM (GMT 0)
CCinPA, try looking for the steroid enemas' info sheet. If it didn't come inside your package, see if the bottle label lists a Website and if so, look for information on use of steroid med there. I don't recall my past Rx info sheets specifically mentioning thinning of the colon wall as a possible side effect, but the literature that came with my med always stressed that oral steroids brought on many side effects much quicker than steroid enemas do. *** RE the possibility that mesalamine enemas can stop helping, you're right-- that can happen. It happened to me after 14 yrs of successful use, and not only did they stop helping-- they also started causing pain right after application. My gastroenterologist assured me that it was just another obstacle that UC can throw at patients unexpectedly. / Old Hat
Posted 2/18/2021 2:02 PM (GMT 0)
Hi CC it was me, sorry not wanting to freak you out. Long term use can cause the muscles of the rectum/anus to atrophy, also known as steroid myopathy.
Regarding thinning I was thinking of topical steroids which are known to thin the skin, here is a list of other known side effects
https://www.news24.com/amp/health24/medical/skin/health-tips/The-dangers-of-long-term-and-continuous-use-of-topical-steroids-20140530 Not sure how many are transferable to topical application inside the colon.
And as pointed out above there is always a percentage absorbed systemically, which means the same risks as oral steroids over long timescales
Posted 2/20/2021 6:36 PM (GMT 0)
CC those are exactly my questions. In the past I have asked if any forum members have personal experience with steroid rectal side effects. I have also looked for studies or case histories that directly link tissue thinning to these topical products. My doctor does not object to hydrocortisone enemas or Uceris foam.

I do believe these side effects are probable and act accordingly. It's just common sense and posts have mentioned that some doctors don't prescribe rectal steroids. I have them on hand and try to limit use as if for a "rescue" medication. The morning after a really bad day I can count on some relief. I consider it a victory to avoid oral Prednisone. Is there an argument for using Prednisone as a first choice when the usual first-tier treatments are not effective?

I should mention that I have been on Entyvio for over a year with a good response (not remission) for the first 7 months with increased symptoms after that.
Posted 2/23/2021 6:13 PM (GMT 0)
I read the little paper with the enemas and it said that side effects "may" be similar to oral steroids but there wasn't anything definitive. Side effects listed were the same as oral. The little paper also said they weren't sure how much of the steroid that is absorbed by the colon becomes systemic. I get the impression that they really haven't done studies just on the enemas and are just theorizing how the enemas work based on oral steroids

I will discuss with my doc the next time I see him, but I feel ok with the way I use the enemas. I've never had any side effects with the enemas like I did with oral pred.

naturalcurl -- sorry to hear that Entyvio is losing its effectiveness. If things aren't improving after being on the 4 week interval for a while, maybe think about something else before you get too bad? I hung in with Entyvio longer than I should have and ended up in a flare from hell for almost a year until Remicade gave me my life back. Things aren't as good as when Entyvio was working for me (compete remission), but UC isn't interfering with my life now and doc says I may now have IBS (we'll know when I get scoped sometime this year).
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