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Hi All Who Lurk,

I haven't been on this site for so long, I had to re-register, but I hope that speaks to doing well! I have a permanent ileo with a very short small bowel, so have rapid transit time and every other day pouching. Currently I"ve had a problem with recurrent UTIs and have difficulty finding the right antibiotic. Several cause rampant diarrhea and consequent rapid dehydration with extreme painful leg and foot cramps. So much loose waste means pouching multiple times per day because nothing has a chance to seal up before the next deluge....The waste also smells very strong, like it did right after each of my surgeries. I assume the odor, frequency, thinness, dehydration, cramping are all due to the antibiotics. I've taken keflex, bactrin, and now Macrobid (nitrofurantoin monoh)....Any suggestions for getting through this? Last week I had to discontinue the Keflex, got oral thrush, and now the UTI has returned. I am eating lots of fermented foods and will try taking probiotics again. I'd welcome anyone's help with what seems to be the antibiotic knocking out my good gut flora....

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Hey, didn't your handle use to be Sierra Barb? Welcome back! Sorry you are in such a pickle with the UTI. Gee, is it possible you have a small bowel C. difficile infection? With all those antibiotics, I'd sure wonder. But what do do about the stupid UTI. Long time ago I had problems with recurrent UTIs and my urologist put me on long term, low dose Septra (same as Bactrim), for a year. Took are of the UTIs and didn't mess up my gut. But, that was before colectomy (but long after my UC diagnosis).

Jan Smiler
Jan Dollar
HI Jan, Thanks for the quick response. Yep, same Sierra Barb - could remember my old moniker but not the login...so just reregistered. Yes, I had a course of Septra last year, but thought I was allergic to it: such severe leg & foot cramps as I've never experienced, antic-feeling, inability to sleep while on it - I mean several days up...If I remember, research turned up quite a few others with similar symptoms, and I think, while the drug is the most common UTI remedy here, it's been banned in UK....Anyway, my internist was sure I was simply dehydrated, but I've gone through periods of IV hydration a couple times a week, so I know what that feels like. I was consuming at least 3 liters a day, but ileo sluicing can wreck havoc even with that consumption. I had a milder but similar response on keflex last week, so now am on Macrobid. How would I know if I had a c diff infection? It's a culture, no? I feel perfectly normal when I'm not on meds for UTI. Hike, kayak, cook, eat, write, all with zeal....Maybe I need to look at longer term something....I am seeing a nephrologist intermittently, and he determined that my long-time liquid waste and sluicing is due, not to inadequate fluid consumption,but lack of salt - so lack of ability to hold onto fluids. Now taking sodium bicarb and that really helps! I will talk to his office but waiting to hear your other suggestions/response Thanks again. Barbara
SF
Thanks, Jan. I drink cranberry juice, but apparently I should take extract all the time (and the juice is the sweetened kind, not good for my gut flora). I only have three more days of the Macrobid, so I"ll wait it out to see if my gut symptoms abate. Right now I feel just as I did when my J pouch was chronically infected and I was perpetually on antibiotics. It seems pretty clear that this time, the prior antibiotics were doing in the gut balance, so I"m taking probiotics again. In your experience, does that help even when one is on antibiotics or antiseptics (I didn't know that's how Macrobid works as the Rx was phoned in)?
SF
Macrobid, a urinary antiseptic, is supposed to act only in the urinary tract, because the kidneys concentrate it there. It is not supposed to alter colon bacteria, I guess becauseit is absorbed before it gets there. Still, it can cause C. diff infections in some people. But, with no colon, maybe your risk of gut flora effect may be higher. I couldn't find much in the way of info about probiotics with Macrobid, but I would think it should be fine to take with it, just space it out from the Macrobid doses.

Here is a link with lots of info about UTIs and the urinary tract:
http://www.urologyteam.com/node/359

Jan Smiler
Jan Dollar
Thanks for the link, Jan, and for info on Macrobid. My gut flora seems to be returning, so the Macrobid must be working as you described, although in the link, it's not listed as an antiseptic but as an antibiotic. The UTI still may be present, so I'm upping fluid and getting a cranberry supplement. It's been so hard to stay hydrated: I sluice waste through my ileo, and only recently started on sodium bicarb after seeing a nephrologist. That's helped with diarrhea. I take heavy doses of the equivalent of benefiber (it's no longer avail) - bought 50# of it from Archer Daniels Midland. Both Methenamine and the D-mannose sound interesting if I can't lick the UTI. I think the imbalance in gut flora I had was from the prior use of Keflex. I"m taking the probiotics regularly, as well - can't hurt.

The article you linked is excellent. Section on vaginal thinning applies to me. I am very careful about hygiene but had no idea the very high percentage of UTIs attributable to e. coli. Thanks again - as is familiar from my prior time here, I feel I have a skillful ally in your responses.
SF

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