Pepto-Bismol is definitely a medication. I’d suggest spacing it well away from the Metamucil. I do take my probiotic and Metamucil close together, and they seem to work fine for me. Metamucil works best for me when taken just before a meal (breakfast and dinner, in my case).

I agree, my doc suggested Metamucil and Questran (powder, script though) before pep to. If I have butt burn, I’ll take a tiny bit of pepto. What about bulking up with diff foods- potato’s, fiber/veggies etc? 

I was advised to take metamucil like dessert and if using imodium to treat as an appetizer. They had me stir the Metamucil in a little bit of applesauce - it helps.

Thanks for all the responses. I tried the Metamucil with Pepto bismal and pro biotics and it didn't agree with me; so I've stuck to Pepto 3 to 4 times a day with  Align Probiotic, which is doing fine for now.I have an appointment in Sept, haven't seen a gastro in years, hopefully he can prescribe something  that helps slow down things, and cuts my bowel movements in half . Anyways again thanks for the responses.

I'm interested in knowing if the Pepto Bismol was suggested for butt burn or for bowel slowing? If it is for burning, does it work? thanks

Jason Song posted:

Thanks for all the responses. I tried the Metamucil with Pepto bismal and pro biotics and it didn't agree with me; so I've stuck to Pepto 3 to 4 times a day with  Align Probiotic, 

Do you realize that Pepto Bismol is a toxic bactericidal that has heavy metals in it that are inhospitable to most microbes?  It is killing off all the probiotics you are putting in your body.  So whatever money you spent on Align you may as well flush down the toilet.  See wiki for bismuth subsalicyate in next post.

The only thing working for you is the PB. You might as well take antibiotics with probiotics, they are being completely neutralized by the toxins in the PB.

You really need to know and understand what you are putting in you body.  All of these drugs have a mechanism of action and if you don't know what it is you should not be using it. This is not like eating different candies on Halloween after trick or treating.

https://en.wikipedia.org/wiki/Bismuth_subsalicylate

While it’s true that antibiotics (or bactericides, like Pepto-Bismol) can reduce the efficacy of bacterial probiotics, it’s neverless quite a useful combination for some of us, myself included. It works best if the probiotic is spaced as far away in time as possible from the antibiotic (or bactericide), and it may require a higher dose of probiotic. I need a very high dose of VSL #3 DS, and the need for that might well be due to the Cipro and Flagyl I also take. So, for example, I take VSL with breakfast and dinner, but I take my antibiotics at bedtime.

Most people who take Pepto-Bismol get no side effects other than black stool. Taking it for long periods of time has a less favorable result, but bismuth toxicity is still quite rare. OTOH people who think that PB is great and antibiotics are terrible are just fooling themselves.

Scott,

I am not understanding the science behind your post. If you take PB 3-4 times per day you are killing whatever bacteria is trying to populate the bowel. It makes no sense to me as a strategy to take probiotics with PB or antibiotics and I was specifically told not to by my Doctor. When we tried VSL #3 it was cold turkey. That being said I do try to eat a lot of natural probiotics but spending a lot of money on something from which you are getting a seriously diluted effect (if any) doesn’t seem either sensible or cost efficient and I also question whether it’s empirically effective. I think in the words of my GI specialist, “VSL #3 is a very expensive placebo” (for most chronic Pouch inflammation cases).

CT, there are numerous ways that probiotics + antibiotics might work just fine. I’ll suggest just a few, which should hint at a much more complex system than “antibiotics kill all probiotics, so why bother?”

1. Antibiotics (and Pepto-Bismol) are actually quite selective. They kill some bacteria species (or strains) readily, and they are completely harmless to others. In between are dose-dependent effects, bacteria that are killed at high doses only.
2. Antibiotics (and PB) don’t have a perfectly continuous effect, especially in the gut. A little while after the medicine is taken, the level in the gut is very high. For most antibiotics the blood level peaks somewhat later, though it’s not clear whether the blood level has a significant effect on bacterial flora.
3. As time passes, the level in the gut (and the blood) drops, down to what’s called a “trough level.” Depending on the spacing of the doses and the half-life of the drug, the trough level can be very low indeed. This is a bit murkier in the gut than the blood, since level can’t be measured easily and the drugs usually aren’t metabolized in the gut, but antibiotics leave the gut over time, just like the blueberries you had for breakfast. Some is absorbed, and some is excreted.
4. The benefit of probiotics (and the mechanism) are poorly understood, but it doesn’t seem to follow a simple “plant the seeds and the field will thrive” model. They seem to need to be taken daily to accomplish their effects. This suggests that they don’t have to live forever, or even for a long time, in order to have benefit. They (temporarily) adjust the gut microbiome, and then the next dose does it again. So assuming you’re not killing them *all* on the way to the pouch, the survivors will have their beneficial (albeit temporary) effect.
5. I take my antibiotics once daily because a) it’s more convenient, b) it seems to work just as well as divided doses, and c) it provides more time for a probiotic-hospitable gut.
6. Although it’s far from a controlled experiment, my symptoms are nonexistent at a top dose of VSL. Things aren’t so nice at a lower dose. Maybe it’s a placebo, but I’d rather have an *effective* placebo than nothing at all.