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15 replies

Can antibiotics cause pouchitis?

SpookySpookyMember
I was recently on antibiotics (clarithromycin) for an unrelated chest/sinus infection. The antibiotics did a number on my system and while I was on them, I had terrible cramping, butt burn and increased frequency for the duration. I've been off them now over a week, almost 10 days now, but I'm still having excessive gas and very painful butt burn (my bottom is very sore) as well as some vague aching in the pouch area, though my stools are not any more watery than usual and my frequency (but for the gas) is essentially about the same. I did increase my probiotics to try to offset the antiobiotic effect, but I was really hoping things would be improving by now. I've only had pouchitis once before, over 3 years ago, but this feels slightly similar. I'm wondering if this might be pouchitis, and if the clarithromycin could have caused pouchitis? My pouch was fine before I went on these antibiotics. Or could it be that am I still feeling the effects of the antibiotics or even the aftereffects of the infection on my system? I don't have a GI and my surgeon discharged me last year, so there isn't really anybody I can call for advice.
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SpookySpookyMember
Thanks. I don't really think I developed pouchitis independently either. The pouch was fine before I started the clarithromycin so whatever happened I feel was directly caused by the antibiotics. I'm going to see how things go for the next few days; I'll continue with my increased probiotics and I'll try adding a few doses of pepto as well to see if that settles things down. That said, I am going to make a point to ask for an alternative antibiotic if I'm ever prescribed clarithromycin again. The side effects simply aren't worth it, and definitely worse than the infection I had.
Lynne2Lynne2Member
Antibiotics can really mess with the intestinal flora. I think your instincts are good to increase your probiotics right now. I’d also watch your diet and especially avoid sugar, coffee, alcohol, and other irritants. The idea is to feed the good bacteria and get it to take over in the ongoing good vs. evil bacteria battle in the gut.

I was recently on antibiotics for horrible bronchitis that was out of control. It took awhile for my pouch to get back in order after I finished the course of antibiotics. In addition to bacterial probiotics, I also take a probiotic yeast Saccharomyces boulardii, which I believe helped my recovery. You may need a course of Cipro or something to deal with your pouch right now, but I’d start with seeing what you can do without them.

Good luck and keep us posted.
SpookySpookyMember
L.Mac, thanks, I think you hit it right on the head. I am trying to avoid the cipro/flagyl route, so the goal for me now is to try to restore the balance of flora in my gut. Thinking back to when I did have pouchitis, I don't think I'm quite at the stage where I'd want to go on cipro anyway. Besides, in the past, my surgeon has suggested using antibiotics only as a last resort, preferring to try to manage things with probiotics first. Anyway, a few years ago I had Norwalk virus and my pouch was out of whack for about 3 weeks. I may just need to be patient and try to let things stabilize, but the butt burn in particular is quite painful. I may also try switching to a bland diet for a few days too.

Thanks again for all the suggestions!
Jan DollarJan DollarModerator, RN, retired
Also, don't forget that antibiotics are notorious for causing yeast/fungal infections (the itching you mention raised my eyebrows!). Plus, antibiotics are implicated in most C. difficile infections, which Cipro would be the opposite of what you need.

You may just want to double your probiotics or adding different strains, before anything else.

Jan Smiler
SpookySpookyMember
Thanks Jan. I (hopefully) don't think it's c.diff because I'm not having any diarrhea; my symptoms at this stage are essentially excess gas and butt burn. I have more soreness than itching, but it could be yeast so that is something to consider as well. I'll continue with the doubling up of probiotics for the time being and see if I can't straighten this out myself.
R Rebe0505Member
spooky you said you do not have a dr. now i think if you do not use surgeon anymore you need to find a g.i who is knowlegeable about jpouches under any circumstances..

beyond that i would not rule out c-diff and i had it once without the regular symptoms of diarrhea etc..dr. shen had me tested for cdiff and sure enough i had it..butt burn is the worst except maybe for the delightful broken glass feeling!

again it is so interesting how different we all are some of us take antibiotics all the time for pouchitis or whatever you want to call it..butt burn urgency,frequency and others think the antibiotics cause it..you could also call your pharmacist (a great source of info for me on drugs) find out what the antibiotic is capable of causing..if it is your symptoms than you nailed it and time and probiotics will help if not you need to explore other things..
SpookySpookyMember
Hi Rebe0505,

Thanks! I am actually doing better this week. I still have a little more gas than is the norm for me, but the other symptoms seem to have settled down a bit. I really do think a lot of my problem was a bad reaction to the antibiotics, and then trying to rebalance the intestinal flora once I discontinued them.

And yes, your suggestion about having a GI is well taken. In fact I have been in the process of trying to get a new one since my surgeon discharged me last fall. In Canada, it's almost impossible to get into a specialist without a referral from another physician, so my options have been somewhat limited. My former GI has been of no help (though he never really was very helpful *LOL*); in fact I haven't seen him since he referred me to the surgeon over 5 years ago. Any time I did have a question, his office would tell me he couldn't see me, and to call the surgeon. Anyway, I am seeing my GP for my annual physical in a few weeks, and one of my priorities will be to ask for a referral to a new GI. Hopefully that will get the ball rolling for me to find somebody who I can have on standby for any pouch issues if and when they arise.
CTBarristerCTBarristerMember
Spooky,

Toronto is an enormous city and I have to think there is a good GI with significant J Pouch experience somewhere in that big city. Hopefully another Canadian poster will see this and post a name or send you a PM.

I live in the State of Connecticut which has a smaller population than Toronto and live 5 minutes away from a great GI who trained under the famed Dr. Bo Shen of Cleveland Clinic. There is one other regular poster on this board also treating with him (kjeane).

Hopefully you will get to the right GI and get the treatment you need, soon. Good luck.
SpookySpookyMember
My problem isn't really finding a doctor, there are plenty, but actually getting an appropriate referral. In order to see a specific GI, I would need one of my existing doctors to refer me. I am hoping to get a referral to Dr. Cohen, or failing that, another GI at Mt. Sinai downtown. They are the primary centre for j-pouch surgery in the city and in fact the province. I think that would be my best bet.
Last edited by Spooky
FM Former Member
hi was reading through this thread as on June 6 I had a root canal. they put me on anti botic, i was having terrible cramping, looser stool than usual. I am now in Korea for business. NOt a happy camper. my butt is killing me even with calmospetine. liquid stools...not sure if I can get a probiotic over here. it is 4:30 in the morning over here. I'm here for another week. I kept hoping things would get better. I have immodium with me. hasn't helped but maybe will try again...just venting..and wish I wasn't so far from home & really hope this is just the antibiotic reaction and not pouchisitis.
R RocketMember
I don't know if antibiotics can cause pouchitis, but I do know that for me, when ever I take antibiotics or a pain killer (like I needed after I had a root canal last year), it increase by trips to the bathroom. I get the runs, more cramps, butt burn and so forth.

Then of course when you are so sick, you need plenty of bed rest which you cannot get because you are in the bathroom all the time.

Last year, I decided not to take the pain killer for the root canal. My mouth was in excuriating pain for the rest of the day once the novocain wore off. But I had to decide to pick my poison if you will.

So I do all I can to stay off of antibiotics when I get an infection like the flu, other then Tylenol. Of course Tylenol does not work for pain like a root canal, but Advil does but that does not work for someone without a colon because of the excess bleeding from this.

Rocket
T TrudieCMember
Spooky posted:
I was recently on antibiotics (clarithromycin) for an unrelated chest/sinus infection. The antibiotics did a number on my system and while I was on them, I had terrible cramping, butt burn and increased frequency for the duration. I've been off them now over a week, almost 10 days now, but I'm still having excessive gas and very painful butt burn (my bottom is very sore) as well as some vague aching in the pouch area, though my stools are not any more watery than usual and my frequency (but for the gas) is essentially about the same. I did increase my probiotics to try to offset the antiobiotic effect, but I was really hoping things would be improving by now. I've only had pouchitis once before, over 3 years ago, but this feels slightly similar. I'm wondering if this might be pouchitis, and if the clarithromycin could have caused pouchitis? My pouch was fine before I went on these antibiotics. Or could it be that am I still feeling the effects of the antibiotics or even the aftereffects of the infection on my system? I don't have a GI and my surgeon discharged me last year, so there isn't really anybody I can call for advice.

My bouts of pouchitis seem to be precluded by sinusitis or a sinus infection even if I don't go on antibiotics. 

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