# Mesalamine / Canasa / Asacol for IBS-C



## twonK (Oct 30, 2006)

Hi,

has anyone been prescribed this for IBS-C? All the research and posts I see are for people with IBS-D. Inflammation occurs in IBS-C also (apparently) and so I'm wondering why it's not been prescribed for it.

My guess is that the manufacturer had to pick a subgroup for their trials and they picked IBS-D - possibly because it's more common/lucrative than the other IBS subtypes.

Pete


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## Kathleen M. (Nov 16, 1999)

Probably because the IBD's are much much more likely to cause diarrhea than constipation. There may be a sense that if someone's diarrhea is more severe than usual IBS diarrhea (which is common in people with IBD to have more episodes of diarrhea per day than people with IBS) there is some off chance they could have some mild IBD or microscopic colitis that just isn't showing up in medical tests. So a trial to see if these calm it down may be worth it.

It is fairly rare they use these with no increase in the inflammatory markers as they generally do have more side effects than other anti-diarrheal medications. They often don't use them in microscopic colitis which is much closer to the IBD's than IBS is.


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## twonK (Oct 30, 2006)

So are you effectively saying that it sometimes appears to work on IBS-D only where IBD has been misdiagnosed as IBS-D?


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## Kathleen M. (Nov 16, 1999)

Well I don't know if it works in IBS-D just because it works on IBS-D that isn't anything but run-of-the-mill IBS-D.

It is more of a nothing at all has worked, we have no idea what is going on, we can't find evidence of something "more" than IBS going on, but we are going to throw some spaghetti on the wall and see if it sticks and the symptoms are bad enough to be worth the risk of throwing that particular brand of spaghetti on the wall.

My thought is they would be more likely to toss that brand of risky spaghetti on the wall when there might be some chance that something more than IBS is going on even if there isn't hard evidence. Some mild cases of IBD are hard to catch as you gotta happen to do the biopsy in the small part of the effected intestine at the moment it happens to be flared up enough to do something you can see. And if there is some very mild IBD going on this may be working on the right mechanism to do some good. The types of immune cell changes you see in IBS are not classic inflammation that we know drugs that suppress the immune system reverse. I'm not sure if we have much data about what drugs might effect the kinds of cellular changes you see in IBSers.

I'm not sure there are any studies, but let me go look. Generally it is hard to get them to throw no evidence at all spaghetti at the wall but it may depend on exactly how miserable you are, how obnoxiously you insist on some treatment, or how exasperated the doctor is that they are willing to go against the evidence based best practices guidelines.

Links aren't working but three small studies (like 20 people) 1 showed no benefit, one showed a change in bacteria and some benefit for some people's symptoms. 1 showed people thought they felt better (increased well being) but no change in their symptoms.

So not a lot of evidence of this is something wildly effective that doctors just are too mean to prescribe.


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## twonK (Oct 30, 2006)

oh I didn't think it was that doc's were too mean (fiscally or otherwise) to prescribe, I was just curious at the focus on IBS-D.

Thank you for the info.

I saw my GI doc last night and completely forgot to mention Canasa







... So the approach adopted for the foreseeable is


get an anorectal exam (I think) to check my ability to push and so on.
try Linzess. I didn't give it a proper try the first time due to (possibly unlinked) GI pain. If that doesn't help...
increase Gabapentin from 900mg to 1800mg. If that doesn't help...
try Rifaximin. Again.
acupuncture. Ugh.

He also prescribed Bentyl as-needed for sharp cramping pain.

I guess if none of this helps I'll suggest Canasa.


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## annie7 (Aug 16, 2002)

Twonk--looks like you have a good plan for things to try. i always like to have a plan







. it gives me hope.

one thing about gabapentin though--if your problems are constipation, gabapentin can make that worse. it's one of the side effects. i tried to take it--just 300 mg-- but it stopped my colon stone dead cold. so no more gaba or any of the related meds like lyrica, neutontin for me. of course we're all so different in how our bodies react to different meds. hopefully it won't give you problems. take care...


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## twonK (Oct 30, 2006)

Hi Annie,

yes it's a shame that Lyrica&Neurontin have that SE. However since I am also on Abilify, Provigil, Bupropion and Lexapro, the chances of me having a spontaneous BM are pretty much zero anyway, gah. Meds, meds and mo' meds...

Pete


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## annie7 (Aug 16, 2002)

Pete--oh yes--meds meds--i hear you....

and it is a shame about the side effects. i have overactive nerves due to fibro and i really wanted to be able to take gabapentin or lyrica to help with all that..


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## Nojokeibs (Apr 14, 2014)

Other ways to get things moving... exercise really works for me. Even a short walk. But I have been using a rebounder (mini trampoline I just bounce/walk on while watching tv) for I don't know, 10 years or more. I wouldn't be without my rebounder. I had to buy a new one recently... the price went up from $20 last time to $45... reaaaal expensive, eh?


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## twonK (Oct 30, 2006)

>> Other ways to get things moving... exercise really works for me

Wow you're lucky. I play 2 hours of soccer with no effect. Gah.


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