My first suggestion is purchase Calmoseptine Ointment (about $7/4 oz tube on eBay).  It is God sent for external irritation, pain, bleeding.  It is also used by hospitals for ostomy openings or any surgical wound that is irritated. I carry a tube in my purse. It sounds to me that you need to change antibiotic.  They mutate after a while and no longer function properly. Obviously, ask your physician.   Take care of yourself.

Probiotics might make a difference,  you will probably have to use Visbiome or something similar to see a difference. Also following the low fodmap diet for maximum gas reduction.

@Drbev603 posted:

My first suggestion is purchase Calmoseptine Ointment (about $7/4 oz tube on eBay).  It is God sent for external irritation, pain, bleeding.  It is also used by hospitals for ostomy openings or any surgical wound that is irritated. I carry a tube in my purse. It sounds to me that you need to change antibiotic.  They mutate after a while and no longer function properly. Obviously, ask your physician.   Take care of yourself.

I never had external irritation, so creams are not necessary

But i agree i need some new antibiotics. But what other is there too choose from except cipro and Flagyl?

@PouchLogic posted:

Probiotics might make a difference,  you will probably have to use Visbiome or something similar to see a difference. Also following the low fodmap diet for maximum gas reduction.

I talked to my gi about prebiotics. But they wouldn't prescribe me some because they can't go good for it. But I'm gonna try to reach out to my GP today i believe that i can only get visbiome here in Norway.

I feel all your pain. Dealing with most of your symptoms at this time too. I take a probiotic daily, VSL#3. You can buy directly from the manufacturer. It is a little pricey, but I would pay anything to feel better! I am also taking antibiotic Xifaxin. 3x a day for 14 days. It is expensive as well but my Dr sends a coupon along to the pharmacy which helps. I do try to follow the Fodmap diet to reduce gas.

I hope you find relief soon!
Mrs. P

I would recommend trying probiotics, too.

Even when on antibiotics, I reduce taking Cipro & Flagyl to once at late evening after some days, when inflammation has calmed down. In the morning I take probiotics instead. While I tried VSL#3 many years ago, now I usually buy a probiotic with many different bacteria stems from a web-store.  I feel it gives me a good balance for antibiotics use over some weeks.

And I would avoid pushing hard on the toilet. It only promotes hemorrhoids. Try moving your upper body or breathing deaply, also exhaling completely narrowing the belly. For me that helps to get things moving.

Gas is another subject. I usually don't produce too much, but the problem is I can't get rid of it completely when on the toilet. There is always a bunch of it left afterwards. Even if it does not trouble me, there is a higher pressure inside the bowel. It worsens digestion, promotes inflammation and gives me a higher frequency of BM. So I got used to evacuate gas after using the toilet (at home). As I can't pass gas standing up or sitting, I have to do some 'gymnastics' to let the gas escape in upward direction.

You don't need a script for Visbiome. Since the double dose just cost double the regular dose and you can just double a regular dose if needed. Only the double dose requires a script.

@Bent-Arne posted:

I never had external irritation, so creams are not necessary

But i agree i need some new antibiotics. But what other is there too choose from except cipro and Flagyl?

In addition to Cipro and Flagyl people have used rifaximin, Tindamax, Augmentin, and a few others for pouchitis. Sometimes a combination of two works better than one alone, but a single antibiotic will generally have fewer side effects. If it’s definitely pouchitis and none of the antibiotics are working then a biologic medication might do the trick.

If the major issue is gas then it might be SIBO, which is usually treated with rifaximin or doxycycline for a few months. If the major issue is that it’s hard to poop then I hope you’ve been examined for a stricture at the bottom of the pouch (as one possibility). Another possibility is pelvic floor dysfunction, which seems to respond to pelvic floor physical therapy, though that can be hard to find. If you secretly have cuffitis then rectal mesalamine would be worth trying. Pushing “like hell” is apt to make everything worse, and may add a problem or two. Temporarily flushing the pouch with a catheter might turn out to be preferable to aggressive pushing, but that can feel like a big step.

@PouchLogic posted:

You don't need a script for Visbiome. Since the double dose just cost double the regular dose and you can just double a regular dose if needed. Only the double dose requires a script.

I only find a scripted version here in Norway unfortunately..

@Scott F posted:

In addition to Cipro and Flagyl people have used rifaximin, Tindamax, Augmentin, and a few others for pouchitis. Sometimes a combination of two works better than one alone, but a single antibiotic will generally have fewer side effects. If it’s definitely pouchitis and none of the antibiotics are working then a biologic medication might do the trick.

If the major issue is gas then it might be SIBO, which is usually treated with rifaximin or doxycycline for a few months. If the major issue is that it’s hard to poop then I hope you’ve been examined for a stricture at the bottom of the pouch (as one possibility). Another possibility is pelvic floor dysfunction, which seems to respond to pelvic floor physical therapy, though that can be hard to find. If you secretly have cuffitis then rectal mesalamine would be worth trying. Pushing “like hell” is apt to make everything worse, and may add a problem or two. Temporarily flushing the pouch with a catheter might turn out to be preferable to aggressive pushing, but that can feel like a big step.

The issue with popping is only when im inflamed. When things calm down i have no issues

I will nag about some other antibiotics during the next week.