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Need some advice please.  I recently had my third case of pouchitis since my take down in May of 2011.  My doctor (a new one since my original doc retired) put me on a 10 day course of 500 mg Flagyl 3 times per day plus 500 mg of Cipro 2 times a day.  As always, I felt better by day 2.  Except for the side effects of the Flagyl.  It makes me so sick that I find it hard to function.  I took my last dose two weeks ago.  Within the last five days, I've noticed that my stool is sometimes yellow again and the butt burn is increasing.  And the frequency has increased the last couple of days.  Do you think the pouchitis is returning?  I can hardly bear the thought of taking Flagyl again.  Also, I have had a yearly scope since my takedown and there has always been inflammation.  Should I be doing something to treat that inflammation and could that be causing these symptoms.  I'm just questioning what normal is lately.  Should I expect to have only 4 or 5 bm per day and no butt burn?  Or is more frequency and butt burn just a part of life.  I've never had fewer than 6 or 7 bm since my takedown.  Sorry for running on.  Any input would be appreciated!

 

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Have you ever tried just Cipro for pouchitis? That works quite well for many folks. I don't know if your pouchitis is returning, but it sounds like it might be. Most of us stop counting BMs. As long as there's no urgency or pain 5 vs. 7 is a small difference as long as you have indoor plumbing. Could you delay your BMs a bit to reduce the frequency, or do you think you would have accidents? Some people reduce the frequency with bowel slowers (like Imodium) or bulking/firming agents (like Metamucil). Not everyone gets the result they want with these, but it's very easy to try. Metamucil also helps some folks with butt burn, and others try Cholestyramine to control it. A simple barrier cream, like zinc oxide, can prevent butt burn if it's external, and others use more exotic creams and skin treatments. Good luck!

I agree with Scott.  I actually think that the docs should prescribe one or the other at first, and then try the combo if they don't work alone.  For me, all those antibiotics would be overkill.  To treat mine, which is chronic and not what you are dealing with, I have great effectiveness with small dosages even just once a day on either the Flagyl or the Cipro alone.  

Something else that may be worth trying for you...if you start off on those higher dosages, maybe taper down at the end so you aren't going from so much medication to none.

all good input.

sharing my current attempt at quelling pouchitis: I took a blast of Tinidazole, 2000mg one day, and am now only on 3 Flagyl 500mg / week (M W F). seems to be helping albeit not yet perfect. 

and seriously after 30 years of this, I barely take note of how many times I go, unless I make the effort to do so. its irrelevant as long as I have access to indoor plumbing life is acceptable.

 

So today things have been great.  No urgency and much fewer trips to the bathroom.  I did call my doc yesterday, but she is out of town.  Still haven't heard back from the nurse practitioner.  Wonder just how much experience she has with jpouch cases.  Maybe I was just having a couple of bad days?  Can pouchitis come and got like that?  Dang this confusing stuff!

 

others know more about pouchitis. but I don't think pouchitis just comes and goes without some meds. I mean theres a big debate about pouchitis, Jan and others have posted a bunch of different academic papers, there's almost a belief that there are different phenotypes. but I digress, if it was just in passing, its possible you simply ate something that irritated the pouch, so yeah maybe you inflamed it a little ie gave it "itis" but to my mind that's not pouchitis.

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