Blood clots, ulcerative colitis and cholostomy in friend with MS.

[tootietoo]

I am writing for a friend who has MS and had a cholostomy a year ago.  She has recently been diagnosed with ulcerative colitis and is being treated for that.  For the past 6 months she has been passing huge blood clots from her rectum.  Her colorectal surgeon says this is normal.  She thinks it is not. With the colitis she has horrible stomach cramps before passing these clots. She will be seeing her dr. again next week even though she has talked to him on a couple of occasions about this problem. Has anyone experienced this before and I know she is dealing with a lot having MS, the cholostomy and the colitis too.  Any and all comments will be appreciated.  ***@**** is my e-mail address if anyone can help.  Thanks so much.

[kimbacat]

just want to make sure we're talking about the same thing.  she has a colostomy where her colon (at some point) is diverted to her abdominal wall and she uses an appliance with a pouch to collect stool?  it sounds like she still has her rectum, but does she have some of her colon still attached to her rectum?  I'm going to take a stab here and say that her colostomy is a bypass colostomy, where they left in the rectum and a portion of the colon below the stoma.  if she ONLY has inflammation and ulceration in her bowel BELOW the stoma, then she might be experiencing what is called "diversion colitis" and it is sometimes confused with ulcerative colitis.  your bowel needs the continual flow of digestive juices in order to remain healthy.  it's pretty common for people with diverting or bypass ostomies to get colitis in the section of bowel that is bypassed.  bleeding is very common with any type of colitis.  since the part of her colon connected to her rectum isn't currently functioning regularly because it is being bypassed, the blood (and mucus which is normal) can sit around in the colon for a while and has time to form clots.  pain and cramping are also common with any type of colitis.  

if she doesn't have a lot of colon attached to her rectum, she can treat the inflammation in her rectum and the attached portion of colon with topical meds like steroids and mesalamine.  both of those come in suppository and enema formulations and the steroids come in a foam formulation too.  they work well to calm the inflammation.  the definitive cure for diversion colitis is either reconnection or removal of the portion below the stoma.  but, the only definitive cure for ulcerative colitis is removal of the entire colon.  the main difference between the 2 is that a reconnection of the bowel will cure diversion colitis, but it won't cure ulcerative colitis.  

if she has a lot of colon attached to her rectum BELOW the stoma or if she has ulcerative colitis ABOVE the stoma, then she'll need to be taking oral medications for that.  enemas or suppositories thru a colostomy don't reach very far or stay in very long and therefore don't work very well.  and enemas or suppositories thru the rectum will only reach a short way beyond the rectum.    

either way, treating the inflammation will help stop the bleeding (and the formation of clots).  people with ulcerative colitis can bleed very heavily and can become seriously anemic if it persists.  the first drug to try is mesalamine.  oral steroids can be used for a VERY short period to help calm the inflammation.  but steroids should not be used as a maintenance medication.  clinical studies have shown that steroids aren't that good at maintaining remission anyway.  the recommended dose of mesalamine is 4 grams per day and has trade names like Pentasa, Asacol, Rowasa, depending on the formulation.  Proctafoam or Cortifoam are some of trade names for the foams.  there are other medications that she can try.

Ulcerative colitis and Crohn's disease are types of IBD (inflammatory bowel disease).  there is a US organization call the Crohn's and Colitis foundation of America or CCFA.  they have a website at www.ccfa.org.  there are similar organizations throughout Europe that have thier own sites.  there is lots of good info on UC and treatments on all of those sites.  another good site for info is ibd.patientcommunity.com  there are also some really good ostomy sites out there.  the United Ostomy Association has a web site at www.uoa.org  

I have Crohn's disease that has resulted in me having a permanent ileostomy.  I've had my rectum, colon and a pretty good sized chunk of small bowel removed due to severe Crohn's.

I hope this has helped

[lambt]

A related discussion, diversion colitis+treatment was started.