Common Ulcerative Colitis Questions Answered - Part II
See Part I of this series for more Q&A from Dr. Eisner
The arthritis in my knee has been acting up lately. A rheumatologist recommended I take Advil, but I am afraid it will aggravate my Ulcerative Colitis. Should I use it?
While Advil is an anti-inflammatory agent, its effect on the colon can exacerbate inflammatory bowel disease such as Ulcerative Colitis. By inhibiting prostaglandins which have a protective effect on the lining of the colon, Advil and other non-steroidal anti-inflammatory agents should be avoiding in patients with inflammatory bowel disease.
I have Ulcerative Colitis and go for a yearly colonoscopy. I am hesitant to proceed this year, as I have heard from my internist that I may need to take a different prep then I had in the past, and that the anesthesia may be different as well. Has something changed?
While there have been some changes in the performance of colonoscopy, with your history of Ulcerative Colitis you need to see your gastroenterologist and discuss them, as it is still very important that you undergo your colonoscopy. While you most likely had previously undergone a Fleet phosphosoda prep in the past, it is possible that your doctor will recommend using a polyethylene glycol prep such as Halflytely or MoviPrep. Most gastroenterologists were using a fleet prep, since the volume was smaller and better tolerated. Patients with diabetes, congestive heart failure and kidney disease were considered unsafe for fleet phosphosoda and were given the polyethylene glycol prep. It was felt that fleet phosphosoda in these patients could cause kidney failure. More recently, a group of patients who did not have diabetes, congestive heart failure or kidney disease underwent colonoscopy with a fleet phosphosoda prep and developed kidney failure requiring dialysis. It was felt that the cause of kidney failure was from the deposition of phosphate crystals in the tubules of the kidney. The risk is much more common in elderly patients and those that were prone to dehydration, or taking medications that decreased the flow of blood to the kidneys, such as diuretics, ACE inhibitors and non-steroidal anti-inflammatory agents. You should check with the gastroenterologist and decide what the safest prep is for you.
As to the anesthesia, insurance companies have recently been trying to eliminate payment to anesthesiologists during colonoscopy. Until about seven years ago, gastroenterologists would use conscious sedation during colonoscopy with Demerol and Versed. Some patients, especially younger females were waking up in the middle of the procedure with this form of sedation known as conscious sedation. Anesthesiologists were asked to assist in sedation of these patients with the drug Diprivan. Over the past seven years or so, close to 95% of colonoscopies were done with Diprivan administered by anesthesiologists. Of late, insurance companies have been talking of refusing to reimburse anesthesiologists for colonoscopy. A few have began to implement the policy. Many hospitals and surgery centers have policies stating that Diprivan can only be administered by anesthesiologists. This has led to some patients receiving Demerol and Versed again, or having the patients pay out of pocket for Diprivan anesthesia administered by an anesthesiologist. Again, you should discuss both of these issues with your gastroenterologist.
How can I tell if rectal bleeding I am experiencing is a result of my Ulcerative Colitis, hemorrhoids or something more serious such as colon cancer?
While history can be helpful in determining the cause of your bleeding, frequently, it will be necessary to undergo either a colonoscopy or at the least a flexible sigmoidoscopy to determine the source. With Ulcerative Colitis, you should be undergoing surveillance colonoscopy more frequently than the general population, depending on the extent of and duration of the disease. If you are experiencing diarrhea, abdominal pain and/or fever, you most likely have a flare of your Ulcerative Colitis. If the blood is only on the toilet tissue when you wipe, it is most likely hemorrhoids. If you have had a fairly recent colonoscopy, flexible sigmoidoscopy can be an easy test to exam the lower part of the colon to see if bleeding is from active colitis or hemorrhoids. You should check with your gastroenterologist to see what the best test is for you at this time.
Click here to see Part I of Common Ulcerative Colitis Questions Answered