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Hi folks. I had a  3 stage ileo anastomosis in 2014. I was fortunate to have one of the most experienced surgeons in the UK (I now live in Spain).  Everything's been great, until a few months ago, when I started to get what  I would describe as a distended abdomen. It occurs perhaps once or twice each week and doesn't seem to relate to any particular food I've eaten. Unfortunately, it can be quite 'fatiguing' and a little uncomfortable. I started to take VSL#3 a few weeks back and increased my fluid intake and the fluid and/or VSL appeared to make a positive difference. However, I have now had the same issue, since this, which has prompted this post. I considered pouchitis, but having read the list of issues, I'm not sure whether this could be the prob....   I don't take any meds, apart from 'as and when' loperamide (2-4mg 2-4 times each week, nightly). I do take vits and supplements - and have done so for quite a few years: COQ10, turmeric golden paste, raw multivit, algae omega 3, vit D3 (vit D3 due to very low D levels, which I only recently discovered was prob caused by having no colon!).

I was considering taking a couple of weeks of metronidazole, to see whether it may help, but not sure if that's a good course of action?

I'm in otherwise very good health.

Any advice or information will be very gratefully received!

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This doesn’t sound like pouchitis to me. Have you noticed being more gassy during/after the distention episodes? If it’s gas we can talk about things to try to reduce that (e.g. Beano, SIBO treatment, etc.). Another possibility is frequent partial obstructions, which fits with the distention and discomfort. Obstructions can be tricky, but you might get relief from switching to a liquid-only diet at the first sign of trouble. You can also try increasing your water intake in general, which can (for some folks) prevent the problem. Increasing fluid is particularly helpful if this is more constipation than obstruction (i.e. the stool is a bit too thick, rather than the intestinal passage is slightly narrowed).

Some of the things you’re taking could be contributing to the problem. You could try skipping the loperamide for a few weeks to see if the pattern changes. You could similarly try skipping the supplements for a few weeks, except perhaps the vitamin D. I take a lot of VSL, but I wouldn’t if I didn’t have a pouchitis problem.

It’s best to change one thing at a time in most cases, so you can honestly interpret the results if things improve. Good luck!

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