HI all,

I have a flare now of cuffitis / diversion colitis in my diverted pouch for 4 months now. Now I appear to have rectovaginal fistula. Its not super painful.

From reading other posts on this I am thinking my treatment plan is to go start with antiobiotics (I have a script for flagyl already which I was going to try for the diversion colitis/cuffitis).

Then hopefully I will be able to access humira soon.. seeing rheumatologist on Monday to the application to go in. Other than surgery, that seems like the best approach? any other thoughts?

As my pouch is diverted I don't have waste coming through, so I am thinking it's not an urgent surgical matter??

Original Post

It's unlikely to be an urgent surgical matter. Why a rheumatologist instead of a gastroenterologist? 

Treatments for diversion pouchitis are usually local: short chain fatty acid enemas, 5-ASA suppositories or enemas (e.g. Canasa), or steroid foam or enemas. Are you using one or more of these? I don't think antibiotics will help much.

HI Scott, sorry I should have made that clearer. Am seeing rheumatologist for enteropathic arthritis - for which he is going to get me onto Humira for. I have read some case studies where this has been shown to be effective for fistulas also. So I am hoping the Humira may help on a few fronts that  I have going on - arthritis, cuffitis/div. colitis and the fistula. I've tried the treatments you mention above and they have helped me. Only thing I haven't tried yet is antibiotics. I have read mixed reports on the success of these for div/ colitis  / cuffitis so I have been reluctant to use them, but am getting desperate now.

SAFF, I'm guessing you meant to write that the local treatments *haven't* helped. Hopefully you've given them enough time (at least a couple of weeks) and considered combinations of them.

One wacky idea that you'd really need GI guidance for would be to use Flagyl gel, which is intended for vaginal use, applied rectally. I'm sure there's no research on this, so you (and your doctor) would be flying blind. Taking it orally isn't likely to get where it's needed. Good luck!

OK thanks Scott - yes I meant 'haven't' worked. I try them for at least two weeks yes. Probably haven't exhausted combinations though.

I raised the flagyl concern with my doc. about not getting to my pouch but he said it works through the blood stream so should be effective still..but I agree youd think it would be more effective with full passage through the gut. Good to know about the flagyl gel - hadn't heard of that. will check it out. THanks,

SAFF, Flagyl does come as a rectal suppository in some countries. I see that you're in Australia, so it might be available to you without my wacky idea. Your doctor is partially correct, that the Flagyl is absorbed into the blood in either case. However, we don't really know how antibiotics help in pouchitis, we just make some reasonable guesses. A higher gut concentration of antibiotic may be very important to success.

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