Using strict diet, oregano etc? Or is the only way to eliminate completely with antibiotics? I believe my pouchitis is very mild, just mild aching which tends to come and go or at least I don't notice it during much of the day and increased frequency but nothing too bad, it's mild enough I can actually live with it in this state, but is it unhealthy and damaging to Maintain a case of pouchotis? Two questions in there I guess.
The answer to your questions is yes and yes. It will not get better and will get worse in all likelihood. It will be a slow deterioration and your urgency/frequency will increase and then when you finally get the proper treatment you should have had in the first place (antibiotics and/or Remicade) it will be harder to treat.
i have treated Pouch inflammation with antibiotics for 23 years, and since 2015 Remicade as well. I am good and none the worse from the treatment.
I agree with CT, with an exception. Are you absolutely certain you have pouchitis? If it has not been verified, you may well have some other issue like IPS or bacterial overgrowth. Those may not get worse without medical treatment and are likely safe to "live with" or attempt control with dietary changes or supplements.
Symptoms of pouchitis can be vague, but generally do not come and go.