What are the discharge instructions for a patient with colitis?

Discharge Instructions for Colitis

For patients with colitis, the most effective discharge plan includes oral mesalamine 2-4g daily combined with topical mesalamine 1g daily in a formulation appropriate for disease extent, with continued monitoring for symptom recurrence and medication adherence. 1, 2

Medication Instructions

Primary Treatment

• Oral mesalamine (5-ASA):
  • Take 2-4g once daily with food
  • Swallow tablets whole; do not split or crush
  • Continue taking even when feeling better
  • For maintenance: 2.4g (two 1.2g tablets) daily 1, 3

Topical Treatment (Based on Disease Extent)

• For proctitis (rectal inflammation only):
  • Mesalamine suppositories 1g daily 1, 2
• For proctosigmoiditis or left-sided colitis:
  • Mesalamine enemas 1g daily 1, 2

Follow-Up Care

Monitoring

• Schedule follow-up appointment in 2-4 weeks
• Contact healthcare provider if symptoms worsen before next appointment
• Laboratory tests needed at follow-up:
  • Complete blood count
  • Kidney function tests
  • Liver function tests 2

Warning Signs (Call Your Doctor Immediately)

• Severe abdominal pain
• High fever (>38°C/100.4°F)
• Increased bloody diarrhea
• Inability to keep medications down
• Signs of dehydration (dizziness, decreased urination)
• New or worsening joint pain 1, 2

Lifestyle Modifications

Diet

• Drink adequate fluids (at least 8-10 glasses of water daily)
• Avoid foods that worsen symptoms (keep food diary to identify triggers)
• Consider small, frequent meals rather than large meals
• Limit caffeine, alcohol, and spicy foods during flares

Activity

• Resume normal activities gradually as tolerated
• Moderate exercise is beneficial when symptoms are controlled
• Rest appropriately during symptom flares

Disease Management

Medication Adherence

• Take medications as prescribed even when feeling well
• Medication adherence is more important than higher dosing for preventing flares 4
• Do not stop medications without consulting your doctor

Symptom Tracking

• Keep a symptom diary noting:
  • Number of bowel movements
  • Presence of blood in stool
  • Abdominal pain (scale 1-10)
  • Factors that seem to trigger symptoms

Special Considerations

For Microscopic Colitis

• If diagnosed with microscopic colitis, budesonide is the preferred treatment over mesalamine 1
• Standard dosage: 9mg daily for induction of remission
• Maintenance dosage: 6mg daily for those with symptom recurrence 1

For Severe Disease

• If previously hospitalized for severe colitis, be vigilant for early signs of relapse
• Follow any additional instructions for thromboprophylaxis if prescribed 1
• Continue any prescribed immunomodulators (azathioprine or mercaptopurine) without interruption 2

Preventive Care

Vaccination

• Stay current with vaccinations, especially if on immunosuppressive therapy
• Annual influenza vaccination recommended
• Pneumococcal vaccination may be recommended

Cancer Surveillance

• Follow recommended schedule for colonoscopy surveillance
• Typically begins 8 years after diagnosis 2

Additional Resources

• Patient support groups: Crohn's and Colitis Foundation
• Educational materials about inflammatory bowel disease
• Medication assistance programs if needed for prescription costs

Remember that consistent medication use is crucial for maintaining remission, even when you feel well. Most relapses occur due to medication non-adherence rather than medication failure.