Pouchitis isn’t usually from a pathogen (though C. diff *is* classified as a kind of pouchitis). In any case, the problem is a bacterial imbalance, or possibly an immune response to some normal gut bacteria. Sterilizing the pouch contents might be useful prior to surgery, but it would also eliminate large numbers of helpful bacteria.

You could make an argument for trying this as a last resort in cases that are no longer responding to any of the usual treatments, prior to abandoning the pouch. The iodine solution would have to be diluted appropriately - at the wrong dose I suspect it could be toxic.

The frequent success of antibiotics against pouchitis *does* suggest that in many cases a pathogen is indeed involved -- otherwise antibiotics would not do anything. Why would bacterial imbalance or immune response to normal gut bacteria be corrected by antibiotics (i.e. bactericides)?

@KarlaGreece posted:

The frequent success of antibiotics against pouchitis *does* suggest that in many cases a pathogen is indeed involved -- otherwise antibiotics would not do anything. Why would bacterial imbalance or immune response to normal gut bacteria be corrected by antibiotics (i.e. bactericides)?

Karla, antibiotics don’t affect all bacteria, and they don’t affect all bacteria equally. Each antibiotic has a huge affect on the mixture of bacteria in the gut, by killing some, weakening others, and leaving many others unaffected. Different antibiotics target different sets of bacteria. Iodine just kills everything.

Yes I agree with Scott

I know we are all motivated to feel better but this is a strong chemical that might really make you very sick. I’ve used tap water enemas before bed -tap water is as far as I’m going.
(Plus I’ll never use anything made by Purdue Pharma!)

Thank you very much Scott for your advice. I was just wondering: The surgeons say that the only reason the do the J-Pouch is to relieve someone from having an ostomy bag -- so if the J-Pouch is just an "internal" ostomy bag, so to speak, it would (???) be OK if it didn't have any good bacteria as long as it is clear of bad bacteria that cause pouchitis. After all whetever bacteria (external) ostomy bags have does not affect anything; so maybe (just maybe) a case can be made for a "sterile" (via betadine) J-Pouch that, although a "substitute" colon, does not really perform any actions of the real colon, it is just a passive reservoir, that can only cause trouble when infected by bad bacteria which cannot be "defeated" by the good ones; therefore if all bacteria (good and bad) were to be eliminated, maybe (again just maybe) pouchitis could go away, because the loss of good bacteria is of no significance, as when one has an (external) ostomy bag whose bacteria (good or bad, many or few) do not play any role whatsoever.

Thank you again Scott for taking the time to answer some probably naive questions, but for a woman who lost her colon in 2015 (UC) and is battling pouchitis on-and-off since 2017, seeking miracle cures is a way to keep hope alive.

This reminds me of a thread a few years back on hydrogen peroxide enemas to treat bowel disease.I spoke to my gastroenterologist on hydrogen peroxide enemas and he told me absolutely under no circumstances should I use hydrogen peroxide to treat J Pouch or bowel inflammation. He said he studied the use of hydrogen peroxide when he did his fellowship at Yale and that studies showed that (a) it caused colitis in many users and (b) it oxidizes and the oxidization causes a dissipation of the lining of the intestine.  I would be concerned by a similar possible oxidizing action from iodine.

Karla, the J-pouch is living, active tissue - it’s probably best to be gentler with it than you would be with a plastic bag. There’s not a lot known about what would be an ideal microbiome for a J-pouch, and it might even vary from person to person based on immune system differences. In any case, have you methodically gone through the full set of conventional pouchitis treatments? There are a variety of antibiotics, and they can be used in combination when necessary. If that doesn’t do the trick there are a variety of biologic medications that may work very well - they’re certainly worth a try. Maybe you need a better gastroenterologist?

Scott (Scott F), Kate (KateNet) & CTBarrister, it is so good to get to know people who help -- thank you all. After all sorts of antibiotics, ready for biologics (UC in 2015 at age 54, J-Pouch in 3 stages in 2016, pouchitis on-and-off since 2017 treated unsuccesfully and repeatedly with antibiotics and alternatives like vsl#3). Given that biologics (Remicade, Stelara) failed miserably during the UC era, not too much optimism (rather the opposite). It is just that betadine has been used (and still is) for over 6 decades (200mg suppository or equivalent as enema) by a zillion women around the globe, for vaginal infections (and cleansing just for hygiene, it is sold as such over the internet "as we speak") with considerable success and with an *excellent* safety record. It sounds like too good to be true -- and, certainly, it is rather surprising that the MDs, have never tried it (or maybe they have and we don't know it). With such a safety record (for internal use in a limited area) one could argue that it is not a bad idea (especially since it does have success, although not 100% of course, against vaginal infections/bacterial-overgrowth/microbes-fungi-viruses-etc). Standard gastroenterologists' reply about all the above: Never heard of it -- do you want to go ahead with biologics or don't you? They do tend to have an attitude that sick people better do what they are told and not waste doctors' time with questions.

While googling for "betadine and proctitis", to see if I might be able to try something new in order to alleviate myself of the extreme pain I'm experiencing, I came across your post about "betadine and pouchitis", which I first read as proctitis.  Your concerns and questions are very similar to mine, and even though this is a fairly old post, I was wondering if you'd seen this study or not.  I will be seeing my surgeon next month, and will be asking him about the possibility of using this product off-use.  I will return here afterward (have bookmarked the post), and let you know what he thinks.  Both of our issues are bowel-related, so there might be some overlap with treatment options.  Sorry, I forgot to include the link https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6756802/