Rectal treatments for ulcerative proctitis: suppositories, enemas and foam

A medicine used through the bottom can be part of treating ulcerative proctitis. The inflammation is in the rectum, so a rectal treatment delivers medicine to the affected area. Understanding what is in the medicine and how it is supplied can make a new prescription less confusing.

The medicine and its form are different things

Mesalazine is a prescription medicine that reduces inflammation. It belongs to the aminosalicylate group, sometimes called 5-ASAs; it is not a steroid. Suppository, enema and foam describe delivery forms, rather than the active drug. Check the medicine name on your own pack: a rectal product is not necessarily mesalazine.

The NHS mesalazine guide explains that its rectal forms are prescribed for the lower gut.

For a first episode or flare of mild-to-moderate ulcerative proctitis, NICE recommends a topical aminosalicylate as first-line treatment. “Topical” here means medicine applied locally. This recommendation does not cover every severity or every cause of rectal symptoms.

What differs between suppositories, liquid and foam?

• Suppositories are small, solid preparations that dissolve at body temperature in the rectum.
• Liquid enemas deliver medicine through an applicator and can reach further into the colon.
• Foam enemas also use an applicator. Some people may find foam easier to retain than liquid.

The extent of inflammation and how you manage the treatment both matter. Crohn’s & Colitis UK’s 5-ASA guide explains the formulations. NICE’s proctitis evidence review did not establish a difference in effectiveness between enemas and suppositories; that does not make either a universal best choice.

Ask for instructions for your exact product

Follow your prescription and the leaflet supplied with the medicine. Instructions differ between products, so advice for one enema or foam should not be transferred to another. Ask your pharmacist or inflammatory bowel disease (IBD) nurse to explain the technique if a step is unclear. The NHS guidance on using mesalazine separates the different forms.

A useful way to prepare is to mark the step in the leaflet that is causing trouble. For example, distinguish uncertainty about the applicator from difficulty keeping the medicine in. That gives the person helping you a specific question to answer.

Understand the ongoing plan

Mesalazine may be prescribed long term to help control inflammation and prevent symptoms returning. Feeling better is not an instruction to stop it. Some plans combine oral and rectal treatment; additions or alternatives, including a time-limited steroid course, are decisions for your clinician.

Mesalazine usually involves blood, liver and kidney checks before treatment and continuing monitoring. Ask which checks you need and who will arrange them.

If treatment is painful, difficult to use or not helping, tell your IBD team rather than quietly struggling or changing it yourself. You could bring these questions to your next IBD appointment:

• Can we go through the part I find difficult?
• What should I do if symptoms persist or I suspect a side effect?
• When should we review this prescription?

For severe or rapidly concerning symptoms, use the help routes in our flare-up guide rather than waiting for a routine review.