VISIT 1 First visit to gastroenterologist

19-year-old female who was diagnosed with left-sided ulcerative colitis for 2 years has been taking 5-ASA 2g daily for the past 1 year and was feeling well until 3 months ago.

3 months ago the patient was under considerable stress as her parents were undergoing a divorce. Since then she has been having 5 bloody bowel movements each day. She is having abdominal cramps which improves with each bowel movement.
The doctor orders blood work and stool samples to understand the severity of the inflammation and to make sure the cause of diarrhea is not an infection.

The blood work does not showing concerning findings and there is no sign of infection.

The doctor prescribes 5-ASA 4g enemas for 4 weeks (this strategy has worked before).

VISIT 2 2 weeks later: the Patient schedules an urgent Gastroenterology follow up visit

Despite trying each night the patient is not able to keep in the enema for more than a few minutes.

The patients symptoms have not changed.
The doctor suggests stopping the 5-ASA enemas and in its place she prescribes a steroid foam. She explains this type of rectal enema is much easier to retain.

The patient uses the steroid foam for 4 weeks each night before bed.
The patient tolerates the foam.

The patient is feeling much better. Her bowel routine has returned to normal, and she is no longer seeing blood.

To reduce the risk of another flare the doctor and patient agree to increase the oral 5-ASA dose to 4g as they are aware research studies have indicated that indeed some patients need higher doses of 5-ASA to keep their bowel healed.