RECTAL MEDICINES FOR IBD

This is not a topic you ever thought you'd want to know about, right? But Crohn's disease and ulcerative colitis (UC) can cause sores and problems in the rectum and lower colon. In some adults, UC can just be in the rectum or the area just above it, called the sigmoid colon (because of the S-shaped curve). And sores or disease there can be particularly bothersome.

The diarrhea and bleeding that comes from those sores often don't respond to pills and routine oral medicines. Sometimes, they need direct applications—what we would call topical medicines. They have to be inserted into the rectum:

• Suppositories are bullet-shaped medicines, that melt and coat the tissues at the very bottom of the intestine (the lower rectum) and the valve to the outside (the anus). [show anatomy] 
• Creams, foams and ointments can be painted on the anal area outside or inserted into the rectum inside with a nozzle. These too can coat the lower area. 
• Enemas are usually larger amounts that can be pushed up higher using a squeeze bottle or a tube that drains into the large tissue a bit higher up. Still they usually only work in the lower part of the large intestine. 

You may be familiar with these, when they are used to get rid of constipation. But the type we are talking about here are the ones that are used to deliver medicines to the rectum and lower colon (another name for the large intestine).

The medicines these rectal treatments usually deliver are:

• Steroids 
  • Hydrocortisone and budesonide
  • Suppositories, creams, foam, enema
• Mesalamine  
  • Suppository and enema
• Antibiotics, rarely 
  • Enemas can be made (usually by a compound pharmacy) 
  • Topical cream or ointment

Because most patients don't like to use these, they are usually limited to short periods for daily use and then gradually reduced.