Why I Love Rectal Medications

The first time I started taking rectal medications I used to go to the pharmacy and fill my whole backpack with boxes of enemas. These were mesalamine enemas and I needed to use them twice a day daily. What this meant was lying in bed with one leg tucked, inserting a long plastic tube into my anus, slowly squeezing the bottle to let the medication out, removing the tube, and then holding incredibly still for at least 15 minutes so that my body wouldn’t expel the foreign liquid.

At first, I was embarrassed by the whole process — from picking up the medication to actually using it. However, I started to see changes in my symptoms much faster once I added the enema to my daily mesalamine pills.

Reaching remission with rectal medications

Within a few months, I was in remission. Over the course of the next few years, I would use mesalamine enemas whenever a flare started coming on. The liquid, like magic, sustained my remission for about 6 years, alongside the mesalamine pills.

Unfortunately, mesalamine is no longer effective for me, so I’ve had to move on to other treatment options. Starting in May 2021 my doctor started to talk about putting me on biologics. In the meantime, though, he wanted me on prednisone to try to subdue my bad flare. To my and my care team’s surprise, the prednisone did very little except give me side effects like moon face and stretch marks. Still, the doctors wanted to keep me on the steroid since the flare was so bad.

Finally, in August 2021, after months of suffering from prednisone side effects, I contacted my doctor and asked if there was any kind of rectal steroid he could give me. I told him that rectal medications had helped in the past.

Budesonide foam for ulcerative colitis

He suggested Uceris, a budesonide foam that is even easier to use than mesalamine enemas. The process takes less than a minute and basically consists of shaking the medication, inserting it, holding it in for 15 seconds, and then moving on with my day or night (to start, my doctor prescribed Uceris twice a day and then just nightly). The foam is easier to retain in my body as well.

While Uceris hasn’t put me in remission, it has allowed me to stop taking the prednisone. When I started the steroid foam, I immediately saw a difference. I have less urgency and my stool is more formed now. There is even less blood in my stool.

On top of that, Uceris doesn’t have the same level of side effects as prednisone since it is more of a topical treatment than a systemic one. What I’m finding is that the topicals – mesalamine or steroid – seem to make a big difference for me, possibly because the medication is directly being applied to the place it needs to go.

So much better than prednisone

The one problem with Uceris is the cost. Even with insurance, it comes out to almost $500 for a month’s supply. I have been able to sign up for a co-pay card that brings the cost down, but the medication still costs around $200 per month.

While that is a big drain financially, it is worth it for me, since the prednisone was also raising my glucose levels and my blood pressure. It was also possibly depleting certain minerals in my body and causing me to lose some bone density. I was starting to worry about long-term effects of the prednisone, so I figured I would take on the cost of the Uceris for a few months.

I’m grateful for the rectal medication option. While it may come with some embarrassment — and even high costs, depending on what type the doctor prescribes and what insurance is being applied — it also can add to the treatment plan and help cull the symptoms that are really detrimental to everyday life.