Diverticulosis and Diverticulitis Treatment

How are diverticulosis and diverticulitis treated?

High-fiber diet: Studies have shown that a high-fiber diet can help prevent diverticular disease in people who already have diverticulosis.  Dr. Jones may recommend a slow increase in dietary fiber to minimize gas and abdominal discomfort.

Fiber supplements: Dr. Jones may recommend taking a fiber product such as methylcellulose (Citrucel) or psyllium (Metamucil) one to three times a day. Fiber products should be taken with at least 8 ounces of water.

Medications: A number of studies suggest the medication mesalazine (Asacol), given either continuously or in cycles, may be effective at reducing abdominal pain and G.I. symptoms of diverticulosis. Research has also shown that combining mesalazine with the antibiotic rifaximin (Xifaxan) can be significantly more effective than using rifaximin alone to improve a person’s symptoms and maintain periods of remission, which means being free of symptoms.

Probiotics: Although more research is needed, probiotics may help treat the symptoms of diverticulosis, prevent the onset of diverticulitis, and reduce the chance of recurrent symptoms. Probiotics are live bacteria, like those normally found in the G.I. tract. Probiotics can be found in dietary supplements and in some foods, such as yogurt.

To help ensure coordinated and safe care, people should discuss their use of complementary and alternative medical practices, including their use of dietary supplements and probiotics, with Dr. Jones.

Diverticulitis with mild symptoms and no complications usually requires a person to rest, take oral antibiotics, and be on a liquid diet for a period of time. If symptoms ease after a few days, the health care provider will recommend gradually adding solid foods back into the diet.

Severe cases of diverticulitis with acute pain and complications will likely require a hospital stay. Most cases of severe diverticulitis are treated with intravenous (IV) antibiotics and a few days without food or drink to help the colon rest. If the period without food or drink is longer, the person may be given parenteral nutrition—a method of providing an intravenous (IV) liquid food mixture through a special tube in the chest. The mixture contains proteins, carbohydrates, fats, vitamins, and minerals.

What are the complications of diverticulitis and how are they treated?
Diverticulitis can attack suddenly and cause complications, such as

  • An abscess—a painful, swollen, pus-filled area just outside the colon wall—caused by infection
  • A perforation—a small tear or hole in the diverticula
  • Peritonitis—inflammation of tissues inside the abdomen from pus and stool that leak through a perforation
  • A fistula—an abnormal passage, or tunnel, between two organs, or between an organ and the outside of the body
  • Intestinal obstruction—partial or total blockage of movement of food or stool through the intestines

These complications need to be treated to prevent them from getting worse and causing serious illness. In some cases, surgery may be needed.

Abscess, perforation, and peritonitis: Antibiotic treatment of diverticulitis usually prevents or treats an abscess. If the abscess is large or does not clear up with antibiotics, it may need to be drained. After giving the person numbing medication, a radiologist inserts a needle through the skin to the abscess and then drains the fluid through a catheter. The procedure is usually guided by an abdominal ultrasound or a CT scan.

A person with a perforation usually needs surgery to repair the tear or hole. Sometimes, a person needs surgery to remove a small part of the intestine if the perforation cannot be repaired.

A person with peritonitis may be extremely ill, with nausea, vomiting, fever, and severe abdominal tenderness. This condition requires immediate surgery to clean the abdominal cavity and possibly a colon resection at a later date after a course of antibiotics. A blood transfusion may be needed if the person has lost a significant amount of blood. Without prompt treatment, peritonitis can be fatal.

Fistula: Diverticulitis-related infection may lead to one or more fistulas. Fistulas usually form between the colon and the bladder, small intestine, or skin. The most common type of fistula occurs between the colon and the bladder. Fistulas can be corrected with a colon resection and removal of the fistula.

Intestinal obstruction: Diverticulitis-related inflammation or scarring caused by past inflammation may lead to intestinal obstruction. If the intestine is completely blocked, emergency surgery is necessary, with possible colon resection. Partial blockage is not an emergency, so the surgery or other procedures to correct it can be scheduled.

When urgent surgery with colon resection is necessary for diverticulitis, two procedures may be needed because it is not safe to rejoin the colon right away. During the colon resection, the surgeon performs a temporary colostomy, creating an opening, or stoma, in the abdomen. The end of the colon is connected to the opening to allow normal eating while healing occurs. Stool is collected in a pouch attached to the stoma on the abdominal wall. In the second surgery, several months later, the surgeon rejoins the ends of the colon and closes the stoma.

Eating, Diet, and Nutrition
The Dietary Guidelines for Americans, 2010, recommends a dietary fiber intake of 14 grams per 1,000 calories consumed. For instance, for a 2,000-calorie diet, the fiber recommendation is 28 grams per day. The amount of fiber in a food is listed on the food’s nutrition facts label. Some of the best sources of fiber include fruits; vegetables, particularly starchy ones; and whole grains. Dr. Jones or a dietitian can help a person learn how to add more high-fiber foods into the diet.

Scientists now believe that people with diverticular disease do not need to eliminate certain foods from their diet. In the past, health care providers recommended that people with diverticular disease avoid nuts, popcorn, and sunflower, pumpkin, caraway and sesame seeds because they thought food particles could enter, block or irritate the diverticula. However, recent data suggest that these foods are not harmful. The seeds in tomatoes, zucchini, cucumbers, strawberries and raspberries, as well as poppy seeds, are also fine to eat. Nonetheless, people with diverticular disease may differ in the amounts and types of foods that worsen their symptoms.