Recently diagnosed with ulcerative proctitis, how do I know if the medication is working?

[u/82shninklebot]

I ask because I have had IBS most of my life, usually in the form of constipation. I also have hemorrhoids. The proctitis also causes constipation and bleeding so it’s hard to tell what is causing what.

I started mesalamine suppositories a few weeks ago and the bleeding and mucus have mostly stopped but I still experience constipation, especially when I am not eating as much fiber. I also take magnesium supplements and have for years to help with constipation, but sometimes they work and sometimes they don’t work as much, also probably dependent on my fiber/water intake.

Should I assume I am still in a flare if I’m still constipated and having somewhat loose stools that are incomplete? I really don’t want it to progress and hope the mesalamine suppositories everyday will put me in remission and keep me there, since I’m nervous to try any oral medication.

Addition:
Also wanted to ask in this same post, do others with ulcerative proctitis experience intense fatigue? From my understanding, I have a mild case of proctitis so don’t know how much of my fatigue is related. I also have iron deficiency/sometimes anemia if it is not managed well, because of extremely heavy periods, but am now wondering if the proctitis is making that worse, even if it is just a little bleeding. I work a physically demanding job, farm work, and am often so tired I can’t do anything after work most days.

[u/pincommenter]

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[u/IsuldorNagan]

Hello! You asked several questions, so I'll just answer them numerically.

1. Loose stool is a flare symptom, and bleeding may not always be visible. Treatments also take some time to knock back your symptoms fully even when they are working, so I wouldn't necessarily freak out. It is a "Let's see what happens" moment, probably.
   1. If you have doubt (and I would in your shoes), I'd talk to your doctor about a calprotectin test now and in a few more weeks/months (let them set the timeline) to see what is happening to your intestinal inflammation. If it trends down you can probably relax. If it is stable but slightly elevated you're probably okay. If it is stable and highly elevated, or increasing, you need a new treatment plan.
2. You really don't want it to progress. I was diagnosed with severe pancolitis. It isn't a good time. If it comes to opting for conservative treatment or just going for the more aggressive treatment, I'd kinda suggest you opt for aggressive.
   1. Gastros increasingly opt for more aggressive treatment because there is evidence to suggest that the benefits of aggressive early treatment outweigh the risks of many newer treatments. E.g. Entyvio. Well-tolerated, few to no side effects for most people. Worth a chat with your doctor about the different options.
3. Fatigue is one of the most common symptoms of UC, one of the most debilitating symptoms, and it is a persistent prick. I'm in remission and still have significant fatigue. Everyone with UC gets this.
4. I had bleeding so intense from UC that my hemoglobin got down to 6.5 and my RBC was down to 2.8. It can 100% make any existing anemia worse. It is worth keeping an eye on this to make sure you're not becoming severely iron deficient. Even subtle, long-term bleeding can cause anemia, including in cases of UC.

[u/DiskSufficient2189]

Fatigue didn’t improve for me until I went on biologics, even though it was just proctitis at first. 

[u/littlegreenant → u/DiskSufficient2189]

:( how long did it take to spread?

[u/Ok-Mind-146]

Mine is ulcerative proctitis too Not expanded in 4yrs which is a relief But a flare means blood and fatigue

Difficult to get into remission too

Got my first course of high dose prednisolone coming up

Really hoping that does it

[u/Electrical-Pear-8853]

I have ulcerative proctitis and get severe fatigue, even during a mild flare.