Diverticulosis and Diverticulitis Treatment

  • Treatment

    You may need to be hospitalized if you have an acute attack accompanied by severe pain or infection. Urgent treatment usually consists of antibiotics and a liquid diet to restore fluid and electrolyte balance. In cases where the symptoms are localized and the physician believes you can take the antibiotics and maintain the recommended diet, her or she may send you home with instructions to return immediately if the symptoms worsen, the fever increases, or the diet is not tolerated.

    In the most severe cases, you will be hospitalized and given intravenous antibiotics, fluids, and pain treatment. Meanwhile, your physician will perform tests to determine whether abscesses are present, or if hemorrhaging is occurring. Abscesses may be drained using a long needle guided by CT imaging. If the infection and inflammation does not improve with antibiotics and minimally invasive procedures, surgery may be performed.

    Emergency surgery may be required when complications such as large abscesses, perforations, or peritonitis occur. Because these complications are potentially life-threatening, emergency surgery may be required to remove the affected tissue and repair the colon.

    For most people with diverticulosis, increasing fiber in the diet is the only necessary treatment. It is also important to avoid eating nuts and seeds and foods like popcorn. These foods can get caught in a diverticular outpouching and become infected.Table 02 Fiber softens stools and reduces pressure in the colon. The American Dietetic Association recommends a diet including 20 g to 35 g of fiber a day. Sources include cereal, bran, fruit, or vegetables. Your physician may also recommend taking a fiber product (eg, Citrucel or Metamucil) once a day for additional fiber.

    Drinking plenty of water can make the transition to a high-fiber diet easier. Try to drink six to eight glasses of water daily.

    Table 2.  Food High in Fiber

    Food Quantity Fiber (grams)
    Fruits
    Apples 1 3 g
    Raspberries 1 cup 6 g
    Tangerine 1 2 g
    Peach 1 1 g
    Vegetables
    Broccoli 1/2 cup 1 g
    Brussels Sprouts 1/2 cup 3 g
    Carrots 1 2 g
    Cauliflower 1/2 cup 1 g
    Zucchini 1 cup 1 g
    Acorn squash 3/4 cup 4 g
    Cabbage 1/2 cup 2 g
    Tomato 1 2 g
    Asparagus 1/2 cup 1 g
    Spinach 1/2 cup 1 g
    Potato, peeled 1 2 g
    Romaine lettuce 1 cup 1 g
    Legumes
    Black-eyed peas 1/2 cup 4 g
    Lima beans 1/2 cup 4 g
    Kidney beans 1/2 cup 3 g
    Cereals
    Brown rice 1 cup 3 g
    Oatmeal 2/3 cup 3 g
    Whole wheat cereal 1 cup 3 g
    Whole wheat bread 1 slice 2 g

    Your doctor is the best source of information on the drug treatment choices available to you.

    Surgery may be required when attacks are frequent and severe and do not respond to other treatment. Because diverticulitis in younger patients is often aggressive and frequently recurs, many physicians recommend surgery after the first episode of severe disease. Older patients are generally treated more conservatively, with surgery considered only after a second severe attack.

    Colectomy, the removal of the diseased part of the colon, has the best long-term prognosis. Surgery involves removing the affected part of the colon (usually the sigmoid colon) and reattaching the remaining sections together. This type of surgery is called a sigmoid, or left colectomy.

    If the inflammation has spread widely, more extensive surgery called a colostomy may be needed. In a colostomy, the surgeon removes the diseased part of the colon, and creates a temporary hole in the abdomen, called a stoma. He or she then attaches the remaining healthy colon to the stoma. A bag is then attached to the opening to catch stools. After the inflammation subsides and the patient heals, the surgeon will reattach the remaining colon to the rectum, closing the stoma.

    Abnormal connections between organs or tissues (fistulas) may also require surgery. A fistula between the bladder and the bowel may cause air to pass through the urethra. Also, feces may be mixed in the urine. A fistula from bowel to bowel may cause no symptoms. A fistula from the bowel to the skin is rare, but would cause soiling at the site of the skin exit. Treatment for fistulas is always surgical.

    The prognosis is excellent for most people with diverticulosis. Approximately 70% to 75% of people who have diverticulosis do not go on to develop more severe disease. Adding fiber to the diet may reduce the risk of complications.

    Most people who have had a single bout of diverticulitis will never have one again. Of those individuals with simple diverticulitis who were treated as outpatient (a majority of cases), 85% will get better with conservative therapy, and 30% will go on to have a second attack. People who have second attacks have an increased risk of having further attacks. After a second attack, surgery may be recommend.

    If you've had surgery, you may continue to have abdominal pain. Most people who have a long history of diverticulitis and frequent flares continue to have symptoms after hospitalization, while those with a long history and infrequent flares have fewer symptoms after hospitalization. Similarly, about 25% of patients who have surgery for diverticulitis continue to have abdominal pain. Patients who have more of their original colon remaining after surgery tend to have fewer recurrent symptoms.

    After treatment, patients with diverticulitis should be watchful for any new symptoms that could indicate a change in the condition.

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