I am diagnosed with ulcerative proctitis and suppositories do not work for me. Why?

Question

Hello doctor,

I am 26 years old. I was diagnosed with proctitis stage of ulcerative colitis in January. Doctor prescribed Mesalamine suppositories and I was healed. It again started in May. Doctor prescribed me three Mesalamine suppositories a day but the bleeding still continues. Any advice on medicine or diet will be highly appreciated.

Answer 1

Hello,

Welcome to icliniq.com.

I can imagine how upset you are about your disease. Thankfully it is limited to the rectum and not extensive to involve the left side of the colon. I am sure that your previous gastroenterologist had done biopsy of the rest of colon to exclude microscopic activity in other segments of the colon. So if suppository is not working I suggest you to use Mesalamine enema. You can use 2 grams enema once a day preferably in morning after passing the first stool. Not thrice a day. The once a day dose work fine. Actually suppositories may not reach up to the extend of disease, hence in such situation enema which are rather liquid preparation would work fine. Plus you should add Hydrocortisone enema 100 mg once daily at night time.

You can use Hydrocortisone enema for two weeks and Mesalamine enema regularly. The picture you uploaded (attachment removed to protect patient identity) suggestive of blood with lots of mucus. I also want to recommend to test stool for C difficle antigen, and blood IHA (indirect haemagglutination) titers for E.histolytica, if any of those infections are found would require antibiotic therapy in addition to the above therapy.

You can follow up with me and update me about five days of use of the above regimen, I hope you would be fine by then. I would tell you the long term management of your disease and when exactly you require a repeat colonoscopy.

I hope this helps.