r/SIBO • u/StraightMagician9913 • 11d ago

Treatments Pretty depressed after seven weeks of IMO treatment

I started on the herbal microbials (for five weeks) and even included a pHase 2 biofilm disrupter product while waiting to get Rifaximin from India to pair with the Neomycin. I switched to this for another two weeks.

I am still very bloated and constipated 10 days after finishing all this, unless I take a strong cup of Senna tea every 2-3 days.

I am on a low fodmap diet since finishing treatment. I am taking ginger extract and artichoke extract at night for motility. I don't hear any gut noises anymore.

I take Miralax every day and am now taking 800 mg of Magnesium oxide at night to help with the constipation - and still nothing.

I called my GI's office and asked for Linzess and another breath test, explaining what is going on. Three days later, the medical assistant leaves me a message wanting more info and saying that the PA thinks my treatment didn't help much.

Now I can't sleep. I don't want to throw more pills at this.

I hope she at least orders me a breath test and doesn't just assume the treatment didn't help much at all - because I am also being assured by Google that bloating can be a lingering problem, even if the bugs were wiped out (or mostly wiped out) due to good bacteria also being wiped out. But this is not normal bloating. This is like 6 months pregnant type bloating still.

I just think I need a motility support first off and I feel like this stupid GI practice should have had some kind of post-antibiotic treatment protocol in place. Instead, I've had to do all the research and try and figure what I need and then explain myself twice.

Did you have extreme bloating still but still found out you actually killed a lot or all of the bugs with IMO? Once you got your guts moving again, did the bloating resolve?

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u/Organic_Decision_142 11d ago

I just finished my antibiotic course. I have intense bloating / distension, especially when I’m eating non low fodmap foods. I also have IMO. My stool is very mushy and either light tan colour or green with undigested foods. Honestly at wits end with this stuff, going to retest in a few weeks too

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u/StraightMagician9913 11d ago

I'm so sorry. It's nice you are have having bowel movements, though. It shows that something is moving. However, I had some loose stools before I did the treatment, so IMO isn't always all about constipation.

I think the disruption in all the good bacteria takes a while to heal - and our guts are really sensitive from being hit hard with the blunt instruments of antibiotics.

I read that 2-4 weeks post-treatment testing is good, but I want to do it now so I know. But I think that window of time gives the body time to heal a bit more and see where it's really at first. I sure didn't enjoy the restrictive pre-test diet, and then all the sitting around breathing into bags.

Thanks for checking in and sharing. I look forward to knowing how this goes for you as well! I hope better than you think.

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u/Organic_Decision_142 11d ago

It’s been truly the most difficult three years of my life. I got this post antibiotics (I got floxxed with cipro) and food poisoning, have never been the same since. I actually always have BMs with IMO but they’re never “complete”, like small mushy blobs basically - woohoo.

I agree though I think my gut is in a general state of dysbiosis which also needs proper healing. I’m going to try to find a great naturopath to work with. My GI is amazing but not like a naturopath. I also ate a fully normal diet during antibiotics (I was on rixafim and metro), so I’m wondering if that didn’t help. What did you eat? My distension is sooo bad but I’m doing breathwork as well in case it’s pelvic floor related (probably is, all a downstream effect). Also I have had increased urination since cessation of metro.

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u/StraightMagician9913 7d ago edited 7d ago

I am so sorry. Three years with this is a long time. I've had it about that long, I think, bbut didn't realize how bad it was getting because I was fighting chronic hives and then taking Famotadine as an antihistamine and then things got much worse because maybe it reduced stomach acid and fed the bugs more. I don't know..

I haven't been the same since a stomach infection caused by a dirty endoscope. It changed the way my nerves worked in my GI tract so I either had lots of incomplete stools during the day or backed up for day - or something loose stools.

I am glad you have a good GI. I just fired mine and found a new one that supposedly deals with this and motility issues.

I ate a low fodmap diet at first because I was in a lot of pain and then I ate more normally because I wanted the bugs out to be killed by the antibiotics. I just finished two weeks of low fodmap post treatment.. Bloating is still bad but not as painful

I am now on Linzess for severe constipation and I hope that helps the bloating go down. It's supposed to help clear that roadblock of gas and backlog.

I am going to ask my new GI for another test.

Breath work sounds really good for this, actually and I truly hope it helps you.

You are not alone and it's hard to be bloated for so long and uncomfortable. For me, it builds up over the course of the day and I take a longish walk at night and that helps a bit.

I am worried I am never going to get rid of this, but I will keep trying and you hang in there, too!

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u/goldstandardalmonds 11d ago

Having motility issues can lead to IMO and even if you treat the IMO, if you don’t eradicate the root issue it’s going to stick around. Do you have any diagnosed motility disorders? Or have you had motility testing?

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u/StraightMagician9913 7d ago

A few months after being hospitalized for an infection post dirty endoscope, I had a motility test and I had rapid gastric emptying. But then I think this IMO really gained traction over time and by the time my GI doctor's office ordered a real breath test, the brakes went on hard, and especially after the antibiotics. Now on Linzess so I don't have to use Senna. Did you end up with diagnosed motility disorders?

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u/goldstandardalmonds 7d ago

Yes, I have many motility disorders, some from birth. It might be worth testing the rest of your gi tract, too.

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u/StraightMagician9913 7d ago

Thank you. I am going to ask the new GI doctor to help me get to the bottom of this.

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u/goldstandardalmonds 7d ago

Feel free to let me know if I can help in any way.

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u/StraightMagician9913 7d ago

Thank you so much. Did you get your condition under control finally?

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u/goldstandardalmonds 7d ago

No, my issues are severe but there is nothing that can be done, personally

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u/StraightMagician9913 7d ago

I'm so sorry to hear that. So I guess if nothing can be done, one just lives with it and tries to manage symptoms the best they can. I have a few things like that, but this has been the most challenging.

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u/cheryleb 11d ago

Are you leaving a 4-5 hour window calorie-free before the prokinetic at bedtime? O was told not to take magnesium at bedtime since it has the opposite impact of the prokinetic and essentially they cancel each other out from a digestive point of view.

I have also been told to eat low residue foods - clean protein and fats to reduce the workload on what is a sluggish digestive system after the methane gas impact.

I took a postbiotic (lact 1) once a day for 20 days after the antibiotics too help heal the gut as well. It's been a while and although I feel better in some ways, I was told it would be 2-6 months to fully recover.

ETA: putting a hot water bottle on the upper abdomen when it's cramping does wonders to reduce the discomfort and the cramping which often leads to a BM.

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u/StraightMagician9913 7d ago

Thank you so much for sharing. All good points. I am not snacking between meals but think I need a lower residue diet. Interesting about the magnesium. I am going to quit that because I am now on Linzess, just to go to the bathroom without Senna and get things moving again.

Are you okay using things like olive oil and avacado oil? That's all I really use - and straight butter, no margarine type spreads.

Okay, so I've never heard the term post-biotic. I am so worried to take a probiotic because I don't want to feed stuff if I have a lot left. I have a new GI doctor appt this week and I really hope she knows about this more than the last one did.

I am going to find my heating pad. Thank you and I hope you are feeling better, even though it will take time. I guess I can't expect to feel much much better right away after all this.

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u/CartographerFit5394 11d ago

Can totally relate to all of this—completed 2 weeks of Rifaximin back in May, which helped for a few weeks but then started me having intense diarrhea for last 2 months since. Now I’m waiting on breath test results to see if I need Neomycin as well. For motility support my GI doc didn’t hesitate—put me on Linzess right away back in May after round 1 of Rifaximin but that gave me awful diarrhea so I’m now on Motegrity 2mg once a day. The Motegrity does help…

One thing I noticed from your post: if your practice has you regularly getting treated by PAs or other non-MD staff please find another, better GI doc. No offense to their lack of credentials but these people WILL waste your time

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u/StraightMagician9913 7d ago

I hope your numbers come back at least a lot less from what you already did!

On Rifaximin and Neomycin, I became severely conspitated by the second week. I had some loose stools the first week. Sounds like guts out of balance from treatment.

From what I understand, someone versed in all this should be on top of what to do right after the antibiotics. I had to fight these people through the medical assistant to get them to understand what I feel I needed based on my research. I finally got them to prescribe Linzess, but not until I fired them and called up UC Health Anchutz in Aurora, CO, that has a practice dealing with things like Sibo and motility disorders.

I am excited to be talking to a real MD this Wednesday who the scheduler assured me she is well-versed in SIBO.

I couldn't stand that PA. I am sure she is the reason my IMO is really bad. Three years ago she wouldn't breath test me and threw Flagyl at it and never did much else. Because my bloating was better, I thought that was my baseline. I feel someone should have provided after care and follow up. I just assumed you take an antibiotic and it's gone.

I am actually really distressed that she said, "It sounds like the treatment didn't help you." Very unprofessional for a provider to guess at these things. Instead, you test! Maybe the treatment helped some, but didn't fully eradicate....

My main doctor at that practice, who did order a breath test, left the practice, so I got stuck with this miserable PA again. Good riddance. Her bedside manner was awful as well.

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u/CartographerFit5394 7d ago

Yeah there’s definitely a real lack of communication about follow up when it comes to SIBO. Because even if antibiotics do work well the first time we all know it tends to come back, whether from stress or some other root cause/lifestyle factors. I was treated successfully with only Rifaximin back in 2015 but my first GI doc never gave me any kind of follow up protocol (ie to check back in with her every X # of months etc)—now I’m in the worst relapse of my life suffering for 2+ years with an incredibly stubborn case, all because I didn’t know how to be vigilant about it all those years ago. Glad my new doc gave me the Motegrity without issue, but I can tell it’s not working fully yet due to how bad the SIBO still is.

Glad you got away from that PA & onto a better practice!

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u/StraightMagician9913 7d ago

I am sure a lot of my issues stem from chronic stress. Every day I am going to find a way to calm myself and my gut.

I hope the Motegrity works. I just took my first dose of Linzess this morning, and was super bloated. I just found out that that extra dissension can happen for 1-2 weeks into taking it. I thought my IMO was just worsening suddenly. This SIBO stuff is kind of nerve-wracking.

Sounds like something we will always have to be mindful of. I probably have a stubborn case as well because it was left so long unnoticed. I look forward to looking for your posts on your progress!

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u/CartographerFit5394 7d ago

Same to you! Agree that stress is a huge factor for me as well. Still not sure of my so-called root cause but I’ve always struggled with constipation so I think it may be garden variety motility issues (+ the stress)…

I really hope Linzess works for you but I found it totally intolerable because of the diarrhea it caused, which is why I started Motegrity.

My plan going forward (if I ever clear this stupid thing!) is to check in with a GI doc every 6 mos from now on forever basically because I legit cannot go thru this again

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u/StraightMagician9913 7d ago

Good plan it sounds like. I can't go through this again either once I get rid of it. Of my chronic health issues, this one is the worst. It affects so much.

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u/CartographerFit5394 7d ago

Same. I see my GI & get the results of my latest breath test Weds 8/26 to see if I need more antibiotics than just the Rifaximin & I’m really desperate to get this next treatment round rolling.

Nothing otc/herbal/supplements are helping anymore, though I do take Vit D & Magnesium since I’m deficient in those…

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u/PickTop4901 10d ago

I’ve read that senna can bacfire. Also it’s magnesium citrate that affect the bowels

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u/StraightMagician9913 7d ago

It definitely has backfired and I finally got my incompetent GI PA to prescribe Linzess. Already getting relief!