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What's my next option rectal med wise? Frustrated

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Ulcerative Colitis
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Posted 11/13/2010 2:14 PM (GMT -5)
I have been flaring for over a month now (thanks to Cipro for a UTI). Luckily no D just lots of bright red blood. Been on Rowasa nightly the entire time. Have been doing hydrocort suppositories for 2 1/2 weeks. Should I ask for Cortifoam? I'm already on azathioprine and 9 colazal/day. I DO NOT want to go back on pred.

Was on vacation all week. Had 2 days where I was running back and forth all morning. Lots of blood. Then a couple of days of constipation. So pretty sure, as stools are formed, I'm primarily looking at rectal inflammation and some internal hemmies (I can feel them).

Anyway just getting frustrated. Going to see NP at my GI in next week or so and want to see what you guys thought I should ask for. Thanks for letting me vent!
Posted 11/13/2010 3:21 PM (GMT -5)
Cortifoam, personally, did nothing for me. Maybe because my inflammation was higher then the sigmoid. So I use primarily Colocorts now. But if you feel that it's solely rectal then the foam should be a good choice.
Posted 11/13/2010 3:23 PM (GMT -5)
It seems you are improving....Is the Colazal the only oral 5ASA you've been on?

How were you initially at this flare?

You could ask for the cortifoam to use in the mornings.

when were you on pred last?

Have you added any fibre supplements to your intake? If the stool is a bit softer/fluffier, maybe it won't aggrevate your hemmies.

q
Posted 11/13/2010 3:28 PM (GMT -5)
Hi! Yes Colazal is the only oral 5ASA I am on. Been on it for probably 5 years.

Initially started as D and some blood (right after the round of antibiotics). D went away. But now fighting some constipation, urgency and the blood (that is being stubborn about going away!). Having the blood even if just have gas or passing parts of the Rowasa in the am. Blood has been on stool, in toliet and on paper.

I was last on pred. 3 years ago. Took almost 2 years to get off. Really, really don't want to go down that road again. The NP threw it out last time I was there and told her it was really a last resort option for me.

I have been sporadically using Miralax to attempt to soften things up to give the hemmies a break. I need to look into some other fiber options. I did buy some Metumucil waffers. I need to get those out and try them.

Thanks for the help :)
Posted 11/13/2010 5:48 PM (GMT -5)
I am a big fan of Metamucil for keeping stools soft and yet formed - my stools are much looser when I don't use it! (and the only time I don't use it is for the five days before my annual colonoscopy.)
My son's GI also recommends Benefiber. I guess I just find the predictable, finely ground fiber easier to deal with than fiber from foods.
I used cortifoam some, years ago, when I had some stubborn rectal inflammation...... but otherwise cortenemas are what I use to get out of flares when nothing else will work. Fiber and probiotics are now part of my daily regimen, and the probiotics really help - but sometimes a flare will begin anyway.
You were on the Rowasa when you started bleeding......? I've had that happen a number of times.
Sometimes I've used the Cortenema at night and Rowasa in the morning.... or at least a Canasa in the morning.
Good luck, and keep us posted!
Posted 11/13/2010 8:11 PM (GMT -5)
You could try cortifoam and if that doesn't help, then colocorts might be worth a go. Sometimes you just don't know exactly how high up the inflammation goes, except by try to guess from the symptoms. If you are not having D or soft stools, then it is probably pretty low down. If the stool is completely formed, then the inflammation is probably limited to just the rectum and perhaps a bit of the sigmoid.

For me, the constipation from the proctitis is really damaging because it leads to pushing and a lot of pressure. It causes hemis and really stresses those little muscles in the rectum and creates a lot of pain and cramping down there. The pressure and pushing seems to really aggravate the inflamed and swollen tissue. I use psyllium husk powder which bulks up the stool a bit and keeps it moving.
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