Use of suppositories and enemas in proctitis and proctosigmoiditis
Ulcerative colitis is a disease of the large bowel (colon) and back passage
(rectum), in which the lining of the bowel becomes inflamed (red and swollen).
When only the rectum is affected and the rest of the large intestine is normal this is
known as “proctitis”. When the colitis goes a little further above the rectum and
around a bend into the sigmoid it is called “proctosigmoiditis” or “distal” colitis.
Topical therapy acts locally on contact with the affected part of the colon to reduce
thisinflammation. Suppositories are most effective for proctitis and enemas for distal
colitis.Topical therapy is most often either a mesalazine or steroid preparation.When
taking this medicine you should follow the instructions given by your doctor.
One suppository or enema should be used each night for four weeks (or at least 2
weeks after the rectal bleeding has stopped). After this, treatment depends on how
your colon has responded to the medicine. For example, some patients with
frequently relapsing symptoms can keep on top of the inflammation quite
satisfacorily by taking a suppository or enema two or three times a week.
Sometimes combination therapy can be helpful – alternating the use of a steroid and
a mesalazine topical preparation or using a supposity in the morning and an enema
at night. Some patients find that foam enemas are easier to retain than liquid enema.
Experiment for yourself and see what is best for you.
1) Steroid Enemas
Most modern steroid enemas are foam based - as the likelihood of someone with
colitis being able to retain a water based enema is quite low. These act topically
applying the steroid directly to the colon - with only small amounts being absorbed
into the bloodstream. This makes side-effects less likely. The downside is that they
can only reach the descending colon and rectum - so for those with extensive colitis
oral steroids may be needed.
Colifoam Enemas
Colifoam enemas are a low volume foam enema - applied by filling an applicator and
then inserting this into the rectum. The foam only really reaches the rectum so best
suited to the treatment of proctitis. Being a low volume enema it is significantly easier
to retain than predfoam.
Predfoam Enemas
Predfoam enemas are a much higher volume foam enema - inserted directly into the
rectum via a disposable tube. The larger volume reaches higher into the colon -
making it well suited to the treatment of left sided colitis (descending colon). The
main drawback is that the higher volume makes the enema harder to retain.
Instructions on how to use Predsol Retention Enema (steroid)
Some people prefer a warm enema. If you do, put the bottle in warm water for a few
minutes before use.
1. Hold the bottle upwards and remove cap.
2. Attach nozzle.
3. Place hand in the protective plastic cover.
4. Grease the nozzle with petroleum jelly.
5. Lie in bed on the left side with knees drawn up (semi-proneposition). Gently insert
about half the length of the nozzle into the rectum (back passage). Squeeze the
bottle until all the liquid goes into your back passage, taking a minute or so to do it.
Slowly remove the nozzle from your back passage making sure that no liquid goes
back into the bottle.
6. Invert the plastic cover around the bottle and discard the whole unit without getting
up from the semi-prone position.
7. Roll over and lie face down for 3 to 5 minutes. Then go to sleep in any comfortable
position.
2) Mesalazine Enemas
Mesalazine (aminosalicylate or 5-ASA) enemas are used to get the mesalazine
directly in contact with both the rectum and descending colon. Asacol foam enemas
are capable of reaching nearly the whole of the descending colon. So long as these
enemas can be retained for a reasonable time before you pass them they are
extremely effective. They are particularly useful in the case of diarrhoea - where oral
mesalazine can become less effective. It should be delivered to the back passage
(rectum) as described below.
1. Mix contents by shaking the can vigorously for about five seconds.
2. Before using the enema for the first time, remove the safety tag from under the
dome.
3. Push the plastic applicator firmly on to the spout of the can and align the notch
beneath the dome with the spout.
4. Hold the can in the palm of one hand with the dome pointing downwards. This
product must only be dispensed when the can is upsidedown, with the dome nearest
the ground (if the can is not upside down, the foam will not come out properly).
5. You may find that the easiest way to use the enema is to raise one foot on to a
firm surface, such as a stool or chair, and insert the applicator into the rectum as far
as is comfortable. You can apply a lubricating jelly to the tip of the applicator for
comfort if you wish.
6. To administer a dose, fully push the dome down once and release it. The foam will
not come out of the can until you release the dome. To administer a second dose,
press and release the dome again. Wait for 15 seconds before withdrawing the
applicator. Note the can will only work properly when held with the dome pointing
down.
Pentasa suppositories
This medicine should be inserted into the rectum (back passage) only.
There is no special time of day to insert this medicine. It is intended to remain in
place for as long as possible. It is therefore usually best to insert a suppository
before going to sleep. Usually your doctor will prescribe one suppository daily for two
to four weeks for the treatment of an attack of ulcerative proctitis, or for longer to
help prevent another attack.You should go to the toilet to empty your bowels and
bladder (if necessary) before inserting the suppository.
1. Tear along the perforation to remove one suppository blister from a blister strip
2. Put a protector on the finger with which you will insert the suppository
3. Remove the suppository from the blister before insertion. This is done by pushing the
suppository through the printed foil
4. Insertion may be made easier if you moisten the suppository with water first
5. Insert the suppository gently and fully into the back passage. It may help to lie down
on one side and raise the other knee
6. Remain still for a few minutes after insertion to help keep the suppository in place. If it
comes out within 10 minutes, a new one should be inserted
7. Dispose of the empty blister and used finger protector safely and wash your hands.
Dr Max Pitcher, May 2010