Ulcerative Colitis flare in third trimester

[MangoM]

I'm currently 35 weeks pregnant and my ulcerative colitis has slowly been flaring over the last few months and is progressively getting worse.

Doctor keeps pushing me to consider infliximab (not likely while I'm pregnant as there isn't much time left now) and has been very hesitant the last few years to prescribe prednisolone. I personally can't see any way out in short term without prednisolone but am worried about the impact on the baby and whether it's too risky for the baby at this stage.

Had anyone been in a similar situation? What happened?

I've got an appointment this week so will discuss it with them then but want to prepare myself for what they might say!

I don't have any advice, but as someone with UC wishing you lots of luck and hope the next few weeks pass quickly and you can get it back under control again too. Must be miserable right now.

Would steroid enemas be an answer?

Another sufferer here.

I found steroid suppositories worked really well. Not sure about use in pregnancy but it’s a low dose and don’t they give you steroids if they think you will go into early Labour to develop the lungs? So can’t be damaging surely?

You might find when baby is here things improve anyway. I felt my babies (twins) were pushing on my bowel at the end and everything seemed inflamed. I was induced at 37 weeks because of it. They refused to make an appearance for another 4 days though!!

good luck, let us know how you get on. Go back to basics, white bread, rice, pasta, well cooked root veg, lots of protein ( I always find chicken improves things), no milk is a biggy for me, had soya milk for years now. And lots and lots of lying down resting and no stress!!!

xx

Thanks for your replies.
I hadn't considered steroid enemas. I guess that might be an option.

I'd have to say no if they suggested suppositories though as I've never been able to get the hang of doing them properly.

@Workinghardeveryday I did wonder they would want to induce me early. The thought of being induced at 37 weeks feels so soon. Did you struggle if you went into labour already feeling pretty worn down? This flare had zapped all my energy, the thought of going into labour in this state is making me feel quite anxious.

I think unfortunately it is the stress and lack of rest that's making this worse unfortunately. Work has been really full on the last month or so and with a toddler at home there's been very little chance to rest during this pregnancy.

You know with uc rest is really important. Think about yourself and if you can make it happen. Family, friends, dp really need to help if possible.

I know you will be thinking dp will have paternity leave soon, but you really need the rest now!

Start mat leave now, get help with toddler, nursery or family and rest.

I know what you mean about the worry of labour when you feel so weak. Rest before will help so much. I was weak but I ended up having section, but then again it was a twin birth x

If you're (understandably) reluctant to take meds, it might be worth discussing how to manage the symptoms that are most debilitating.

So, enemas will help tackle the disease locally and might help then with any bleeding, diarrhoea, cramping (been a long time since I used them).

If you're struggling to keep hydrated, then anything that helps bulk you up and reduce the number of bowel movements will be useful. Rehydration salts (if permitted during pregnancy? I would assume so?) And like a pp said, go back to basics with diet. For me, that also includes upping my salt intake (my inner crisp monster loves this), and lots of potato and egg. Sports isotonic drinks at the very least?

Blood tests to check full nutrition levels - especially things like iron, b12, vit d, magnesium etc

If food is hard on your digestion rn and nutrition is an issue, then you could also discuss with your consultant whether ensure or complan drinks are worth a go.

When are you due to start maternity leave? If you're as unwell as you sound, I would think you need to take it early or at least be signed off sick for a few weeks. It's worth doing everything you can to rest and buoy up your strength before baby arrives.

It's been years since I needed treatment for a severe flare and there are new treatments now, so maybe they can treat you safely with prescription strength prebiotics as well? I don't know the effect of biologics on either your body or your baby, but I'd certainly be asking the consultant about every possible treatment route in the hope that they can be a safely used during pregnancy.

*I meant probiotics but yes to Prebiotics too!

What meds are you currently on? Presume if your consultant is pushing Infliximab then you have already tried mesalazine?

Predfoam and a course of Clipper (lower strength steroid) sorted out my most recent flare. Then I take mesalazine (Pentasa) to keep me in remission. I haven't had a flare while pg so can't comment on that, if you're not already on it then the Crohns and Colitis UK Facebook forum is really useful for finding people who have had a similar experience.

I also flared late in my second trimester. I was put on prednisolone about 19 years ago. My baby came slightly early (FYI I mistook contractions for UC cramping) so I was glad as I assume it helped her lungs develop. Best of luck!

Thanks everyone. Sorry taken a while to update. My long term meds are 6MP (very low dose) and Pentasa.

I've spoken to a few work colleagues since posting on here and they've assured me not to worry about work too much (but until now, there wasn't a huge amount they could do to take work from me early as our team was/is already short staffed and currently recruiting for my line manager - not good timing!) I finish work tomorrow so I can put all that behind me now.

I had a consultant appointment last week and they've put me on a two month course of budesonide tablets which feels like it's already doing something. The stomach aches I'm getting since starting on them are horrible though! Has anyone else had experience of budesonide?

DH has been great at looking after me, so don't think there's anything more we can do on that side. Toddler goes to nursery full time as we don't have family nearby that can help with regular childcare and DH has been doing all the nursery runs and taking him out of the house as much as possible at weekends to let me rest and pretty much taking on all the toddler related tasks at home to make sure I'm not wasting the little energy I have. I feel a little guilty at how much he does but I'm so grateful as it's exactly what I need right now.

Cant offer much advice but just to say whilst I'm not pregnant, I take ifliximab and it's great! Works a treat and I was in a flare for years.
For odd occasions when I need a quick treat I take mesalazine suppositories in the morning and prednisone suppositories in the afternoon. I find the combinations works almost immediately.
Good luck!

I had steroid enemas (foam) which were really easy to take & seemed to help.

Fellow Crohn's disease sufferer here!

I'm sorry that you're not feeling well during your pregnancy, I gave birth to dd 9 months ago and I flared badly postpartum... however the only thing besides strong meds that seems to help me is liquid diet and peppermint tea.

I'm hoping you're feeling better soon, not long left.