Pouchitis is a form of inflammatory bowel disease.  All IBDs are caused by autoimmune disorder.  Thus the same autoimmune defect that led to the form of IBD that caused your surgery likely caused the pouchitis as well.  Surgery does not cure autoimmune disorder.  It cuts out inflamed tissue.  The process that caused the inflammation is still at work in your body.

Yes, Aleve or any NSAID can cause pouchitis. It's well documented. When taking those meds for migraines, I got pouchitis. When I took just a couple of Excedrin (which I didn't realize is another NSAID, as is regular aspirin) I had bleeding but not pouchitis. I was put on a soft diet for a week and things were fine after that, but I won't be using any of those meds anymore.

Rose

Rose,  thank you for taking time to read my post and I appreciate your reply.  It makes perfect sense now with regard to the Aleve.  Like you I will no longer take that stuff for pain relief and will continue to keep on cycling.

Steve

Good news: Cycling does not cause pouchitis. You might try Tylenol as an alternative treatment for minor pain, though pay attention to the dose limits on the label and avoid significant alcohol consumption while taking Tylenol.

If I were you I would not automatically conclude that the Aleve caused the pouchitis and if you stop the Aleve, all will be well.  It's true that NSAIDs can cause pouchitis but more often they cause bleeding and ulcers and usually only when used excessively.  These kind of nonmedical-expert cause-effect conclusions are dangerous.  Also, if you were on antibiotics and they improved your symptoms, that is a sign to me that perhaps it wasn't the Aleve.  Aleve doesn't create bacterial overgrowth.  If the antibiotics worked, they worked because they killed bacteria that was causing an inflammatory response.

There are lots of threads on this board in which posters look for easy scapegoats, but sometimes the easy scapegoats do not exist.

Steve,

Some clarification might help here in light of other responses you've received. My pouch is 23 yrs. old. The first time I had pouchtitis was about 8 yrs. ago. I was indeed using NSAIDS frequently, as I often had migraines and found that NSAIDS worked well in stopping them. I probably used NSAIDS over the course of a few months. Then I began having frequency, urgency and leaking. This continued for a couple of weeks. Then came the lower back pain and extreme fatigue for about a week. Last came the bleeding, which caused me to head for the emergency room.  I was hospitalized bec. of the bleeding and was given tests. I did have pouchitis which included some ulcers. I was treated with Cipro, Flagyl and cortisone enemas. I was fine after this episode. This wasn't bacterial overgrowth, but it was treated the same way with antibiotics.

My next episode was about 4 yrs. ago. I had 2 Excedrin tablets (not realizing they, too, were NSAIDS), one in the morning and one later in the day. By the evening I had some very light bleeding. I had no other symptoms. I was referred by a nurse to the G.I./pouch expert M.D. (this was a weekend), who actually told me this was a clear reaction to the NSAIDS. He told me to stay away from fiber and eat soft foods for a week or so, as the small intestine lining is very delicate and it needed to heal. He would not prescribe meds, as there were no other symptoms of pouchitis and this event came on very suddenly. He did warn me that if it didn't resolve rapidly, that I should call again. His on-call nurses actually stayed in touch all weekend. This problem did rapidly resolve and I've been fine in the ensuing (NSAIDS-free!!) years. 

NSAIDS can cause GI ulcers and other mucosal problems in people having normal GI systems. Those of us having j-pouches are even more at risk because we are using our small intestines as a holding tank. Our ramped-up autoimmune systems may also contribute to this sensitivity. In 23 yrs. with the pouch, I've had only these two episodes of bleeding, one being pouchitis and the other irritation which was nipped early and didn't develop into pouchitis. Had I continued taking Excedrin, I have no doubt that I would have had full-blown pouchitis with ulcers, as in my earlier case.

I am relating what happened in my case in hopes that it can help another. I would definitely consult with my doctor and follow up on this. I'm not making random cause-effect here. G.I. doctors made the diagnoses with my history in mind. I would not assume that your situation is NSAIDS-induced until you speak with your doctor. It's always best to check things out. We are indeed very special beings with our unique plumbing.

Rose

whoa that's an interesting piece of news about the link, whether it was the actual cause this time or not.

but whatever you do, please do stop taking NSAIDS its a definitive no no for people with known gastrointestinal issues.

I have a friend who probably caused 5 strictures along her gi tract post jpouch installation 30 years ago because of regular NSAID use. she had figured that colectomy killed the UC so no need to worry about NSAID use any longer. CC docs made that guess. She has to get dilations routinely for said strictures, but maybe doesn't have a revised dx of Crohn's and "merely" stricture complications.

curiously as well. I am in the midst of an endurance training small research study with my doc. I run half marathons and am training for my 2nd marathon, a couple of years ago, after running 17.5 miles I went in for a routine dilation pouchoscopy and my jpouch was a train wreck. this led to the supposition from my doc that my endurance running was the proximate cause, so that's a long winded circle back to perhaps the long endurance rides aggravate the jpouch. I will be very curious to see the results of this study.

That's the thing, I had acquired the pouchitis while on the week long ride and it just so happened that I had a sigmoidoscopy the following Monday after the ride.  That's when my GI saw an inflamed pouch and put me on the meds.  Things have vastly improved for the better.

Scott, thank you for the Tylenol suggestion.  I'll give it a try with caution of course as you said.

Steve