In the short run, is he using Imodium or Lomotil? In the longer run (since you'd need a new prescription), perhaps a different antibiotic would work better - there are about six or so that are commonly used for pouchitis. Does he use VSL #3? That won't help immediately, but it sometimes helps over a couple of weeks.

Thank you for the reply    He was taking lomotil 2 tablets 4 times a day but was hospitalized in November due to a partial small bowel obstruction.  They took him off it then and things have been fine.  But the last few weeks have just been miserable for him.  Will look into the VSL.  What other antibiotics do they use for pouchitis?  I thought it was only Cipro and Flagyl?

In the archives here you'll find a variety of antibiotics other than Cipro and Flagyl used for pouchitis: Augmentin, Tindamax, and Xifaxan come to mind immediately. Xifaxan in particular helps some people a great deal and isn't absorbed systemically, but it's *very* expensive and didn't do a darn thing for me.

I can't tell if the Lomotil caused or contributed to the earlier problem. I've never taken that much Lomotil, but I have certainly taken it before going out and at bedtime. Perhaps call the doctor to chart a more moderate course with Lomotil? One speeding ticket wouldn't keep me off the highway forever, but I might drive slower.

I hesitate to recommend soluble fiber (e.g. Metamucil, Citrucel, Benefiber), because it will increase bulk. OTOH it will also tend to firm up the stool, which might help a little bit if used in moderation (sometimes complete liquid is a a bit harder to hold in). If you do try this, keep the doses reasonable and don't experiment before a final exam (or other Major Event).

Is he doing kegels? It's not a cure, but sometimes it's the difference between an accident and a close call.

Finally, has he been tested for C diff? He might need to be off antibiotics for a while for the test to work reliably. The PCR test is the best one in common usage.

What are the symptoms of cdiff?  He has no fever, appetite is fine just this constant urgency and accidents

C diff can vary in symptoms, but troublesome diarrhea is most common. If I had his symptoms, I'd discuss the possibility with my doctor, at least to get tested to rule it out.

Thanks Scott for all of your help - will call his doctor in the a.m.