Questions & Answers About Diverticulosis

Q: About 2 weeks ago I awoke in the middle of the night with severe pain in my left side, and not wanting to bother my doctor in the middle of the night, I waited until morning and then called him. I was sent to ER and they diagnosed diverticulosis and I was put on an antibiotic for 10 days. I finished that about three days ago and now I feel better but I am a little nauseated and whenever I go to the bathroom and have a stool I believe that I may be bleeding from my rectum. I am not sure where the blood is coming from. Any suggestions?

A: The pain that you experienced could have been secondary to diverticular disease (diverticulosis or diverticulitis) but there is no objective evidence to state that with certainty.

Diverticulosis (the presence of pouches on the outside of the colon) can present with constipation, diarrhea or rectal bleeding and diverticulitis (inflammation of the pouches) usually presents with left sided abdominal pain, fever and an elevated white blood cell count.

Now that you are feeling a little better after antibiotics, you may benefit from a colonoscopy to look for a cause of lower gastrointestinal bleeding and to document the presence of diverticula (pouches that form on the outside of the colon). During an acute episode of diverticulitis, a CT scan of the abdomen and pelvis is the best test to look for inflammatory changes or an abscess, fluid collection or sinus tract. Good luck to you.

Q: Is there any new research on the effects of seeds and nuts in the diet of a person with diverticulosis? Some past research has shown that nuts and seeds can be eaten and that avoiding them is a fallacy.

A: Diverticula of the colon can become blocked by fecal contents leading to focal inflammation (diverticulitis). It had been proposed that eating nuts and seeds can increase the possibility of blocking the openings of the diverticula. In fact, the increased risk of diverticulitis resulting from seeds is small. Patients with diverticulosis are now encouraged to increase the amount of fiber in the diet.

Q: I just turned 35 and after an entire lifetime of battling chronic constipation have been diagnosed with diverticulosis. From the little I know of the disease, I understand that there is no cure. The past four months have been a living hell for me. I cannot eat solid food; my belly is continually bloated. I cannot have a bowel movement without using a major blow-out laxative but using a laxative is a double-edged sword as it causes a good 2-3 days of severe gas and bloating. My colon is continually in spasm and my entire abdominal cavity feels like it is crawling with ants.

A: Today I had a colonoscopy that confirmed the diagnosis of diverticulosis. The only thing I've been told is to take fiber. I have no hope. I have been eating a high-fiber diet for years with supplements. I exercise daily with a personal trainer. What else am I supposed to do to combat these symptoms?

There are several aspects of your story that are unique. The frequency of diverticulosis increases with age. You are relatively young to have this problem. Also, the severity of your symptoms is more marked than that experienced by many other patients. The finding of diverticulosis at colonoscopy is important, but should not prevent your physician from doing a small bowel study to exclude other causes for your symptoms.

Treatment should be focused on improving bowel function. To treat your constipation, I suggest that you try a natural laxative e.g., fiber. Even though you are taking a high fiber diet, the addition of an agent like Metamucil often improves symptoms. One can also add Lactulose, another type of laxative, to the Metamucil.

Sometimes the more powerful agents have cramps associated with laxatives which can be quite excruciating and if you can avoid this pain, you would be better off. There are some surgeons who will offer a subtotal colectomy operation to remove much of the diverticulae and thereby improve symptoms. Unless you have had documented episodes of diverticulitis, you should avoid the surgical option. Surgery will result in a period of diarrhea ( often several months) and you may still have the same abdominal pains.

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