Newly diagnosed with diverticulosis.

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Hi. Any advice of best place to start to find out how to manage the condition? Dietician perhaps? Specialist gastroenterologist?

Thanks

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  • Posted

    Hi Claire

    Welcome to the Diverticular Disease (DD) Forum.  You say you have been diagnosed with Diverticulosis, which means you have little pockets, called diverticula, in your colon.  You did not say you have any symptoms, like pain, cramps, fever, altered bowel movements.  If you do not have symptoms that's great, as it means it's not an active attack of Diverticulitis.  From your wording and time of posting I am guessing you are USA or Canada based, but please correct me if I'm wrong.  The reason is, I am UK based and here the treatment is very different, far less aggressive.

    I would start by reading the article on this website about Diverticular Disease, as it is very comprehensive and clear.  If you were to see a Dietician, a Specialist Gastroenterologist and a Surgeon, you would be told 4 different ways of managing!!  Each have their own agenda, and that is why it's so difficult to know what to do.  The people on this forum can tell you of their experiences, but they are all different as well.  What works for one does not necessarily work for someone else.  Also you might get a biased picture, as the people who recover from an attack usually stop posting, so most posts are from people experiencing, or still experiencing problems.

    If you are symptom free, the best way to manage is through careful eating.  This means drinking plenty of water and following a healthy diet, small portions, with soluble fibre.  The Internet will explain the difference between soluble and insoluble fibre, and give you examples. I was also advised to reach and maintain a healthy weight and exercise regularly.  When I was first diagnosed I was told it was important to keep my bowels well emptied, without straining, as that was bad for the Diverticula.  I was prescribed a Psyllium Husk (Fybogel in the UK, Metamucil in the USA).  It bulks and softens the stools, making them easier to pass, and keeps me regular.  I have happily taken it for 18 years - that's how long I have been managing - but it does not suit everyone.  It is not a laxative and takes a couple of weeks to become fully effective.

    There are plenty of posts here about the food you are advised to eat.  You will find everyone is different, and what affects one person is fine for someone else.  Another reason why the advice is so woolly!  Many of us kept a food diary to see if any particular food gives us pain.  For me it is gluten and wheat products, and full fat products like milk, cheese.  I switched to gluten free bread and pasta, and have 0% milk, reduced fat cheese and dairy alternatives like almond milk.  Others find they cannot eat raw vegetables, nuts, seeds, skins, corn, red meat - all sorts of things.  I would advice you to skin your vegetables and fruits and remove all the seeds and pips.  They are good fibre, but not so much for sufferers with DD.  whatever you do, don't sit down with a large bowl of All Bran, try something gentler like Bran Flakes, and check your portion size first.

    If you have symptoms, that is a different story.  If you are in the USA you would probably get whipped into hospital, put on intravenous antibiotics for a few days, then discharged with Flagyl and Cipro for at least 2 weeks, or longer.  Both are very strong, have major side effects and strip out all your good gut bacteria along with the bad.  Initially you would be on a clear fluid only diet - broth, tea, applesauce etc for at least 48 hours.  With the side effects of the drugs you might well not want to eat anyway.  Then you would be placed on a bland fibre free (as far as possible) diet like white bread, white pasta, steamed white fish, grilled chicken, scrambled egg, usually for a week or more.  As the symptoms subside you will then slowly be able to re-introduce SMALL portions of fibre, building up.  All the time you should keep a food diary, to see if any foods bring a worsening of the symptoms.  It takes weeks for the pain to go, and your bowels to return to anything like normal, as the side effects wear off, your insides heal, and your food intakes become more normal.  Most people take probiotics to replace good bacteria lost through the medication.  I also take pure Aloe Vera juice, a natural remedy which promotes internal healing.  There are many other suggestions on the Forum.

    In the UK you are treated at home by your GP with just 7 days antibiotics, due to concerns that you might develop antibiotic resistance - that does not seem to trouble USA doctors.  Also the USA doctors are what I call chop happy, whereas in the UK surgery is only the very last resort.  For some people surgery is essential, for their health and quality of life, but I was advised to avoid surgery whilst I could manage through diet. 

    If you start to get symptoms, usually a niggling pain lower left quadrant, the best thing is to have just 48 hours clear fluids and see if everything subsides.  If it does not then it's time to see the doctor.  It is too easy to dash straight to the doctor at the first twinge, for what is actually nothing, but it does take time to learn the difference.  This is not a one off thing which goes away on it's own, it's with you for life, and it's easy to became complacent - I know the hard way.  You will need to find your own way - what works for you, but I have lead a normal active life with this, taking part in competitive sport.  Good luck.

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    • Posted

      Hi Felicia. Thankyou so much for your comprehensive reply. I’m in Australia. I don’t have any symptoms. The condition was revealed in my first ever colonoscopy. Your words about living a normal life have heartened me and now I have to get on with living and learn what I can about managing the condition. I am confused about what sort of fibre is acceptable and so I will seek the advice of a dietitian I think. Managing anxiety is another area to look in to. Thanks again for sharing your personal experience. It really has helped. Best wishes Claire
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    • Posted

      Hi Claire

      If you were just diagnosed through a routine well person colonoscopy with no symptoms you have been scared for almost nothing.  It's good to know you have diverticula, so you can modify your diet accordingly, to prevent symptoms ever developing.  BUT:  Now for the statistics bit (my former occupation).  50% of people aged 50 in modernised countries have diverticula, rising to 70% aged 80.  That includes Australia of course.  Of those who have them, 75% never develop symptoms or have an attack.  In the UK we don't have colonoscopies as routine, so most of us never know.  I had symptoms and an attack so that's how I found out.  Diet is not the only culprit - there is a genetic component, plus conditions like obesity and high blood pressure can exacerbate it and I have all three!  I’ve found the article I was referring to.  It’s got more detailed diet information so you  could save yourself a hefty consultation fee!

      Diverticula Diverticulosis, Diverticular Disease, Diverticulitis

      Authored by Dr Colin Tidy , Reviewed by Dr John Cox on 27 Nov 2017 | Certified by The Information Standard

      Diverticula of the colon are common in older people. They commonly cause no symptoms, and in most cases no treatment is needed. However, a high-fibre diet is usually advised to help prevent complications. In some cases, diverticula cause pain and other symptoms. Sometimes a diverticulum may bleed and cause a sudden, painless bleed from the back passage (anus), which can be heavy. In some cases, one or more diverticula become infected to cause diverticulitis. This can cause severe tummy (abdominal) pain and high temperature (fever). A course of medicines called antibiotics may be required. Complications caused by diverticulitis - such as a collection of pus (abscess) or a perforated bowel - are uncommon, but are serious.

      What are diverticula?

      A diverticulum is a small pouch with a narrow neck that sticks out from (protrudes from) the wall of the gut (intestine). 'Diverticula' means more than one diverticulum. They can develop on any part of the gut but usually occur in the colon (sometimes called the large bowel or large intestine). They most commonly develop in the section of the colon leading towards the back passage (rectum). This is where the stools (faeces) are becoming more solid. This is on the left-hand side of the tummy (abdomen). Several diverticula may develop over time. Some people eventually develop many diverticula.

      Who develops diverticula?

      Diverticula are common. They become more common with increasing age. About half of all people in the UK have diverticula by the time they are 50 years old. Nearly 7 in 10 have diverticula by the time they are 80 years old.

      What causes diverticula?

      The reason why diverticula develop is probably related to not eating enough fibre. Fibre is the part of food that is not digested.

      Your gut (intestine) moves stools (faeces) along with gentle squeezes of its muscular wall. The stools tend to be drier, smaller, and more difficult to move along if you don't eat much fibre. Your gut muscles have to work harder if there is too little fibre in your gut. High pressure may develop in parts of your gut when it squeezes hard stools. The increased pressure may push the inner lining of a small area of your gut through the muscle wall to form a small diverticulum. 

      What are the symptoms and problems caused by diverticula?

      It is common for no symptoms to develop - called diverticulosis

      In about 3 in 4 people who develop diverticula, the diverticula cause no harm or symptoms. The term diverticulosis means that diverticula are present, but do not cause any symptoms or problems. In most cases, the condition will not be known about as there are no symptoms. Sometimes diverticula are discovered as an incidental finding if you are having tests such as colonoscopy or barium enema for other reasons.

      Diverticular disease

      This term is used when diverticula cause intermittent, lower tummy (abdominal) pain or bloating (without swelling (inflammation) or infection - discussed later). The pain is usually crampy and tends to come and go. The pain is most commonly in the lower left part of the tummy (abdomen). You may get ease from pain and bloating by going to the toilet to pass stools (faeces). Some people develop diarrhoea or constipation, and some people pass mucus with their stools. It is not clear how diverticula cause these symptoms.

      Symptoms of diverticular disease can be similar to those that occur with a condition called irritable bowel syndrome (IBS). However, IBS usually affects younger adults. So, symptoms that first develop in a younger adult are more likely to be due to IBS and symptoms that first develop in older people are more likely to be due to diverticular disease. However, in some cases it is difficult to tell if symptoms are due to diverticular disease or to IBS.

      A diagnosis of diverticular disease is usually made by confirming the presence of diverticula and by ruling out other causes of the symptoms. Note: the symptoms of diverticular disease, especially if they start in an older person, can also be similar to those of early bowel cancer. Therefore, tell a doctor if you develop these symptoms, as some tests may need to be arranged. For example, a test called colonoscopy may be advised. To carry out this test, a doctor uses a special flexible telescope to look into the bowel. This can confirm the presence of diverticula, and rule out bowel cancer.

      Diverticulitis (infection)

      Diverticulitis is a condition where one or more of the diverticula become inflamed and infected. This may occur if some faeces get trapped and stagnate in a diverticulum. Germs (bacteria) in the trapped faeces may then multiply and cause infection. About 1 in 5 people with diverticula develop a bout of diverticulitis at some stage. Some people have recurring bouts of diverticulitis. Symptoms of diverticulitis include:

      A constant pain in the abdomen. It is most commonly in the lower left side of the abdomen, but can occur in any part of the abdomen.

      High temperature (fever).

      Constipation or diarrhoea.

      Some blood mixed with your stools.

      Feeling sick (nauseated) or being sick (vomiting).

      Obstruction, abscess, fistula, and peritonitis

      An infected diverticulum (diverticulitis) sometimes gets worse and causes complications. Possible complications include:

      A blockage (obstruction) of the colon.

      A collection of pus (abscess) that may form in the abdomen.

      A channel (fistula) that may form to other organs such as the bladder.

      A hole (perforation) in the wall of the bowel that can lead to infection inside the abdomen (peritonitis).

      Surgery is usually needed to treat these serious but uncommon complications.

      Bleeding

      A diverticulum may occasionally bleed and you may pass some blood via your back passage (anus). The bleeding is usually abrupt and painless. The bleeding is due to a burst blood vessel that sometimes occurs in the wall of a diverticulum and so the amount of blood loss can be heavy. A very large bleed requiring an emergency blood transfusion occurs in some cases. However, the bleeding stops on its own in about 3 in 4 cases. Sometimes an operation is needed to stop the bleeding. Sometimes just a slight bleed occurs.

      Note: always report bleeding from the bowel (via your anus) to a doctor. You should not assume bleeding is from a diverticulum. Other more serious conditions such as bowel cancer need to be ruled out. 

      What is the treatment for diverticulosis?

      As diverticulosis means diverticula with no symptoms, there is no need for any treatment.

      However, a high-fibre diet is usually advised. A high-fibre diet is generally considered a good thing for everyone anyway - whether you have diverticula or not. Adults should aim to eat between 18 and 30 grams of fibre per day. Fibre helps to make larger and softer stools (faeces) and helps to prevent constipation. Also, a high-fibre diet may prevent further diverticula from forming. This may reduce the risk of developing problems in the future with diverticula, such as diverticulitis. See the next section for more details of a high-fibre diet.

      What is the treatment for diverticular disease?

      Diverticulosis diet

      A high-fibre diet is usually advised as it helps to keep stools (faeces) soft and bulky and reduces pressure on the colon. It can ease pain, bloating, constipation and diarrhoea and prevents hard stools becoming lodged within the pouches. It can also help to prevent the formation of further diverticula, which may reduce the risk of the condition getting any worse.

      We need about 18 g of fibre each day, which should come from a variety of high-fibre foods. You may have symptoms of wind and bloating if you suddenly increase the amount of fibre you eat. Any increase should be gradual to prevent this, and to allow your gut (intestine) to become used to the extra fibre. A useful guide is to make one change every few days. For example, start by swapping white bread for wholemeal bread. Introduce something new every few days, such as adding beans or extra vegetables to a casserole or Bolognese, or having a piece of fruit for pudding.

      High-fibre foods to include:

      Whole grains, fruit and vegetables.

      Wholemeal or wholewheat bread and flour (for baking).

      Wholegrain breakfast cereals such as Bran Flakes, Weetabix®, muesli, etc.

      Brown rice and wholewheat pasta.

      Wheat bran.

      Beans, pulses and legumes.

      Meeting the government recommendation of eating at least five fruit and vegetable portions each day will make sure that you are well on your way to getting plenty of fibre. A portion is about 80 g or what roughly fits in the palm of your hand. Apples, pears, oranges, blueberries, strawberries, broccoli, asparagus and dried figs are all excellent fibre sources.

      Fibre supplements may be advised if a high-fibre diet does not ease symptoms. Several types are available at pharmacies, health food shops, or on prescription. A pharmacist will advise you. Although the effects of fibre supplements to ease symptoms may be seen in a few days, it may take as long as four weeks.

      Note: some people have a different response to fibre than others. So it is very much trial and error as to what is most suitable for you. Some people report that a high-fibre diet or certain fibre supplements cause some persistent mild symptoms such as mild pains and bloating. This may be to do with the type of fibre being consumed. Insoluble fibre, found in cereals, wheat bran and nuts, may cause more wind and bloating. Eating a lot of bran-based foods or taking bran supplements can particularly aggravate symptoms in some people. Therefore, it may be helpful to have more soluble fibre (the type of fibre that can be dissolved in water), found mostly in fruit and vegetables. However, many foods contain both types of fibre, so when introducing a new high-fibre food, monitor your symptoms and adjust your diet accordingly.

      Dietary sources of soluble fibre include oats, ispaghula (psyllium), nuts, flax seeds, lentils, beans, fruit and vegetables. A fibre supplement called ispaghula powder is also available from pharmacies and health food shops.

      Insoluble fibre is chiefly found in corn (maize) bran, wheat bran, nuts and some fruit and vegetables.

      Fluids

      You should have lots to drink when you have a high-fibre diet or fibre supplements. Aim to drink at least two litres (about 8-10 cups) per day. Try to obtain your fluid intake mainly from water, but tea, coffee and herbal teas all contribute. Fizzy drinks and juice drinks contain a lot of sugar so try to limit these. If you want to include fruit juice, one 150 ml glass each day only counts as a portion of fruit. Choose varieties that are 100% fruit juice and do not contain added sugar.

      Paracetamol

      Paracetamol can ease pain if a high-fibre diet or fibre supplements do not help so much to ease pain. Other types of painkiller are not usually used for diverticular disease. 

      What is the treatment for diverticulitis?

      When symptoms are not too severe

      If you develop diverticulitis you will normally need a course of antibiotic medicine and be encouraged to drink plenty of clear fluids. You may need some strong painkillers for a while. If the infection is not too severe then symptoms may well settle with this treatment.

      Diverticulitis diet

      To prevent further bowel irritation during a flare-up of symptoms, a bland, low-fibre diet may be most suitable. This should only be short-term and you should gradually re-introduce normal, high-fibre foods into your diet once your symptoms have eased. It can be helpful to introduce one food at a time so that you can see which foods make your symptoms worse.

      High-fibre foods to avoid during flare-ups include:

      Fruit and vegetable skins.

      Nuts and seeds.

      Wholegrain products (eg wholemeal bread, wholewheat pasta, brown rice, wholegrain cereals and oats).

      Beans, lentils and legumes.

      Raw vegetables or raw/dried fruits such as apricots, raisins, dates, figs and berries.

      Low-fibre foods to include:

      White grains such as bread, pasta, rice and noodles.

      Plain cakes/crackers.

      Potatoes with skins removed.

      Milk and dairy products such as cheese and yoghurts.

      Soft, ground/tender meats and fish (avoid gristly meats/bones).

      Eggs.

      Tofu.

      Well-cooked/canned fruit and vegetables with seeds and skins removed.

      Low-fibre cereals such as Rice Krispies® and corn flakes.

      Fats and oils - for example, olive oil, rapeseed oil, and butter.

      If symptoms are severe, your doctor may also advise a clear liquid diet for about two days to allow the colon to rest. Suitable clear liquids include:

      Water.

      Clear juices without pulp, such as apple, cranberry or grape juice.

      Broths and clear soups.

      Herbal teas, tea and coffee without milk.

      Ice lollies.

      Jelly.

      Diverticulitis - when to go to hospital

      If symptoms are severe or prolonged then you may need to be admitted to hospital. You may be given antibiotics and fluids directly into a vein via a drip (intravenous fluids). You may also need to have painkilling injections. You may also be admitted to hospital if the symptoms are not too severe but do not settle after a couple of days of treatment at home.

      If complications develop

      As mentioned earlier, some people with diverticulitis develop complications such as:

      Bowel blockage (obstruction).

      A collection of pus (an abscess).

      A channel (fistula) that may form to other organs.

      A tummy (abdominal) infection (peritonitis).

      Surgery is usually needed to treat these serious but uncommon complications. For example, surgery is sometimes needed to drain an abscess or to remove a badly infected part of the colon.

      Treatment of bleeding diverticula

      As mentioned earlier, a large bleed requiring an emergency blood transfusion sometimes occurs in people with diverticula. However, the bleeding stops on its own in about 3 in 4 cases. Sometimes an operation is needed to stop the bleeding. 

      A final note

      See a doctor if you have a change in the pattern of your toilet habit. For example, a sudden change from your normal bowel habit to persisting constipation or diarrhoea, passing blood or mucus, or new pains. Even if you are known to have diverticula, a change of symptoms may indicate a new and different gut (intestinal) problem. Call an ambulance urgently if you have a large amount of bleeding from the bowel.

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    • Posted

      Hi Felinia. Oh I just can’t express how much your email has helped me. Everyone over 50 is encouraged to have a colonoscopy here in Australia. I am 66 and am the only person I know on my age group who hadn’t had one. So I was freaked out when I got sent away with a piece of paper saying this is what they found.  I had it done in a public hospital so there is no after session to explain what you have explained here. I’m so glad I reached out via this forum. Thanks to your kindness I can now concentrate on preventative diet. 

      Thankyou Claire

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    • Posted

      Hi Claire

      I'm 68 myself!  If you've reached 66 with no symptoms, that's very good.  With hindsight I had symptoms for many years before I was diagnosed, but just told it was IBS without testing.  My tests showed only DD, no signs of IBS, so I was misdiagnosed all those years ago.  Had I known, I would have taken more care.  Having been through what many are facing for the first time now, and come out the other side, I'm happy to relate my experiences.  I'm not a medical person, and cannot help much with those poor people who have multiple issues though.  Best wishes

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    • Posted

      Hi Felinia

      I think you have a lovely way of communicating your knowledge and experience and it’s certainly helped me. There’s a need for doctors advice for sure but also for words from others who have been through stuff and really know what it’s like. 

      Kind regards 

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  • Posted

    Holiday Felicia 

     I’m 34 and six weeks ago I had a ct scan as I had right sided pain and diaherra  for a week I’ve also been diagnosed  with a perforated bowel from diverticular disease. The most common perforation is at the sigmoid part of ur colon mine was right at the top right hand Conor the thick walled part I spent 8 days in hospital and the docs were amazing!!! If I had of went to surgery I was getting a bag so we thought the infection with antibiotics I had followed the dietician advice on eating a low residue diet which for me was really hard and I’m a very active and healthy person who would normally avoid white bread and white pasta etc. But I think I’m having another really bad flare up I have had really severe loose bowls and I’m in so much pain, the last time I cudnt eat and that cause my body to start shutting down so this time I am eating and it’s killing me I’m taking paracetamol and drinking plenty of fluids the noises coming from my tummy is not normal they are there constantly and I can hear them bubbling away, I mean my husband and kids are starting to freak out I don’t know wether to go back to docs or just try and hold off any advice from anyone would help. I’m expecting a letter to have a colonoscopy anytime now

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    • Posted

      Hi Pauline

      You need to get to a doctor as soon as possible, particularly if you are running a temperature.  You may need antibiotics, although hopefully, it is just a bad tummy upset.  But in view of your past perforation you should not take any risks.  I do think you should give your tummy a rest and just stick to fluids until you've seen a doctor though.  If you are having a flare, they won't be able to do the Colonoscopy - another reason for getting to your doctor.  Hope you feel better soon.

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