The topic is about dealing with ongoing diversion colitis after having a sub-total colectomy. This condition is causing colitis-like pain and rectal bleeding for the person who shared their experience. They are currently managing symptoms with nightly prednisolone foam enemas, but these cause nausea and discomfort. Missing a dose leads to a significant flare-up. They are hopeful that an upcoming pouch surgery will help resolve these issues. Here are some pieces of advice and insights shared by others:

1. Mesalamine/5-ASA therapy:
- Canasa (mesalamine) suppositories, which are non-steroidal and contain the same active ingredient as oral Asacol, might help reduce pain without the side effects of steroids.
- The cost is noted to be around $675 for a one-month supply, but it could be worthwhile if covered by insurance.

2. Re-evaluate if symptoms persist or worsen:
- In one case, diversion colitis was found to involve the entire colon, which was packed with mucus and blocked scoping.
- Seeking another colorectal surgeon's opinion led to a proctocolectomy, which resolved the diversion colitis symptoms, leaving only typical ostomy issues like blockage risk, IBS-type symptoms, and dehydration.

3. Practical recommendations:
- If enemas provide limited relief or cause severe side effects, discuss the possibility of using mesalamine suppositories or other medications with your gastroenterologist.
- Consider requesting further imaging or scopes to check for extensive mucus build-up.
- Do not hesitate to seek a second surgical opinion if your current medical team downplays ongoing bleeding and pain.