Diverticulitis

Source: Adapted from Know Your Options: The Definitive Guide to Choosing The Best Medical Treatments, Reader

What is diverticulitis?

If your diet is heavy on highly refined processed foods and light in fruits, veggies, and whole grains, you’re missing a vital ingredient for a healthy colon: fibre. Without fibre—a natural stool softener—constipation is often the order of the day, causing pressure to build up inside your colon (large intestine). Over time, the colon walls weaken and a lot of little pouches, called diverticula, start bulging out like weak spots in an inner tube. This is called diverticulosis: It’s quite common.

Diverticulosis rarely causes problems. Most people don’t even know they have it unless it’s discovered during testing for another ailment. Diverticulosis can become serious, however, if food particles get trapped in the pouches and bacteria builds up. The resulting inflammation and infection is the basis of a condition called diverticulitis. Characterized by intense abdominal pain that’s hard to ignore, diverticulitis often comes on suddenly, producing a tenderness in your lower left abdomen. The infection may also give you fever, chills, vomiting, cramping, and constipation.

Who is at risk for diverticulitis?

Diverticulitis tends to be more aggressive and recur more often in younger people.

Treatment for diverticulitis

If caught early, a mild case of diverticulitis often clears up after two or three days of oral antibiotics, bed rest, a clear liquid diet to allow your colon to heal, and an analgesic for discomfort. If you have severe pain or a serious infection, your doctor will probably want to hospitalize you so medications and fluids can be delivered intravenously. About 20% of those who suffer repeated diverticulitis flare-ups will require surgery to recover from intestinal complications. If you have any of the following symptoms, you should get emergency medical treatment right away: bloody stools, a persistent high fever, inability to have a bowel movement, or severe abdominal pain or tenderness.

Medications for diverticulitis

If your symptoms are mild, your doctor will probably prescribe two antibiotics: metronidazole (Flagyl) and a second broad-spectrum antibiotic, such as ciprofloxacin (Cipro) or amoxicillin/clavulanate (Augmentin). You’re likely to feel better in a few days, but stay on these drugs for the full course prescribed.

For diverticulitis pain, consult your doctor about taking an analgesic. If you have bleeding, avoid nonsteroidal anti-inflammatory drugs (NSAIDs), such as aspirin or ibuprofen: They can hinder blood clotting. It may be safest to take acetaminophen (Tylenol), but you may need something stronger, so ask your physician first.

If your symptoms are more severe, your doctor may hospitalize you to get intravenous antibiotics, pain relievers, and fluids. You may get intravenous nutrition, too, to give your inflamed colon a complete rest. For most people, this leads to a full recovery.

Lifestyle Changes

For a milder case of diverticulitis, once you have your medications in hand, the best thing you can do is climb into bed and rest until you’re feeling better. Watch your diet, too. Initially, you’ll need to stay on liquids and soft foods. In a few days, your doctor will probably start you on a low-fibre diet. After about a month, you’re likely to get the go-ahead to begin introducing high-fibre foods and start exercising. Your doctor will probably want you to drink plenty of water throughout your recovery.

Related Procedures for Diverticulitis

If your diverticulitis doesn’t respond to medication, or you have frequent or severe attacks, your doctor may recommend surgery. (This is particularly true if you’re under age 50 and have even one severe attack.) Although a small abscess can be drained with a relatively minor procedure, more invasive surgery may be needed to eliminate a large abscess, remove a fistula, or clear an obstruction in your intestine. If you develop perforations or peritonitis, you’ll need emergency surgery.

The surgeon usually treats any complication by removing the diseased part of your colon and reattaching the cut ends in a partial colectomy. If you have widespread inflammation, you may need two operations. First, the surgeon clears away the infection in your abdominal cavity, removes the affected part of your colon, and attaches the healthy colon to a temporary opening in your abdomen. This colostomy serves as an artificial anus. A bag, attached to the opening, receives stools and keeps them completely away from the infected area. Once the inflammation clears up, the surgeon performs a second operation to reattach the ends of your colon and close the hole in your abdomen. Your bowel movements will return to normal.

Diverticular bleeding normally stops by itself, but your doctor may still want to perform a colonoscopy. This examination of your colon uses a long, flexible scope to find the source of the bleeding. If you have very heavy bleeding, the doctor may also take specialized x-rays to locate the problem. Bleeding that doesn’t stop by itself can sometimes be controlled by injecting vasopressin, a drug that constricts your arteries. This effect can be dangerous, especially in older people, so your doctor may recommend a partial colectomy instead.

Questions for Your Doctor

• How long before I can resume my normal activities?
• What are the chances that I’ll need surgery?
• If I can’t tolerate a high-fibre diet, are there other ways to help my digestive tract?

Living with Diverticulitis

If you are living with diverticulitis, here are a couple of quick hints to help you cope:

• See a gastroenterologist instead of an internist or family physician.
• Avoid enemas. Even though they may seem like a good solution for a problem that results from constipation, they can aggravate diverticulitis symptoms.

Prevention of diverticulitis

If you have diverticulosis or you’ve recovered from a bout of diverticulitis, a trouble-free digestive tract should be a top priority. There’s plenty you can do to keep your colon healthy:

• Increase your fibre.
• Eat your vegetables and fruits—they’re fibre-rich too. A good start is five daily servings of fruits and vegetables, cooked or raw, and preferably, unpeeled when possible.
• Go when you need to. When you feel the urge to move your bowels, head for the bathroom right away rather than waiting.
• Drink lots of fluids, at least eight glasses a day of water, juices, and soups. This helps move the added fibre through your digestive system.
• Get regular exercise. Three to five times a week go for a brisk walk, ride your bike, jog, swim, or dance around the house.
• Use a bulk-forming laxative for occasional constipation. Good choices are products containing psyllium (Metamucil) and calcium polycarbophil (FiberCon). Don’t forget dried fruits: They’re a natural laxative and good source of fibre.