Diverticulosis and Diverticulitis - Blue Cross and Blue Shield of

Diverticulosis
and Diverticulitis
Managing Two Common Colon Conditions
Trouble in Your Colon
You may be having trouble in your colon (the large intestine). Small
pouches may have formed in your colon wall. Many people have this
condition, called diverticulosis. If these pouches become infected or
inflamed, a painful and more serious condition called diverticulitis
has developed. Aging may contribute to colon conditions. But eating
plenty of unprocessed, high-fiber foods may make a difference in the
health of your colon.
A low-fiber, high-fat diet
can lead to an unhealthy colon.
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Pain is a common symptom of
diverticulitis.
Making Your Colon Healthier
This booklet is not intended as a substitute for
professional medical care. Only your doctor can
diagnose and treat a medical problem.
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You and your doctor can discuss how to control your diverticular
condition. Diet changes or medications may be enough to bring relief.
In severe cases, surgery may be needed. Either way, the better you
understand your body and your condition, the more you’ll benefit
from treatment and be able to avoid colon problems in the future.
Pressure Causes Pouches
A healthy colon is a flexible tube lined with muscles. These muscles help
move stool (waste) through your colon into your rectum (the lower
part of the colon) and out of your body. With enough fiber and water,
stool stays soft and passes smoothly through your colon. But if pressure
builds up inside your colon, diverticulosis may occur.
3
Diverticulosis: Pouches Form
Without enough fiber and water in your digestive
system, stool becomes harder. Your colon’s muscles
have to squeeze more to move the harder stools
through your colon. That extra pressure can cause
the lining of the colon wall to bulge out into pouches
called diverticula. This usually occurs in the
colon’s muscular, lower left section (sigmoid),
though it can also occur in other parts of the colon.
Diverticula may take years to develop and there
are often no noticeable symptoms. If you do have
symptoms, they might include mild cramping,
bloating, constipation, diarrhea, or urgency. In
rare cases, heavy rectal bleeding can occur with
diverticulosis. Any bleeding, even small amounts,
should be reported to your doctor.
Diverticula
Diverticulitis: Pouches Are Infected
Diverticulitis occurs when the diverticula become
infected or inflamed. The cause of these infections
is unknown, but it’s possible that they begin when
stool lodges in the opening of the diverticula.
Infection can lead to complications such as swelling
or rupturing of the ­diverticula. Symptoms often
include pain, fever, and chills. In severe cases,
infection of the abdominal cavity (peritonitis)
may result.
Infected
diverticula
Your Evaluation
To diagnose your colon condition, your doctor will take your medical
history, examine you thoroughly, and do one or more diagnostic tests.
After the evaluation, your doctor will talk with you about a treatment
plan to control your condition.
Your Medical History
and Physical Exam
What are your symptoms?
If you feel pain, where exactly
4 do you feel it? Have you had
similar problems in the past?
What kinds of food do you
normally eat? Your doctor will
ask you questions like these
before doing a physical and
rectal exam. Your stool may
be examined, as well.
Diagnostic Tests
Diagnostic tests such as a barium enema, sigmoidoscopy, or colonoscopy
may be used to help pinpoint your problem or rule out other colon disorders.
Imaging tests, such as a CT scan, may also be done for further evaluation.
Barium Enema
Flexible Sigmoidoscopy
Colonoscopy
Barium highlights your colon,
showing abnormalities such as
pouches in the wall or narrowing
of the colon. After your colon
is filled with liquid barium,
x-rays are taken.
To get a closer look at the
inside of the lower colon, your
doctor inserts a thin, flexible,
lighted tube into your rectum.
Tissue samples may be removed
and examined, if necessary.
If problems are suspected
higher up in your colon, a
longer, flexible, lighted tube
is used to provide an inside
view of your entire colon.
Managing Your Condition
Treatment for your diverticular condition depends on its severity.
If you have a mild case of diverticulosis, changing your diet may be
all you need to do to keep the condition under control. Your doctor
may also prescribe medications to help relax your colon and relieve
pain. Diverticulitis often requires additional treatment.
If You Have
Diverticulosis
A high-fiber, high-liquid diet
helps your colon function normally.
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FIBER
If your diverticulitis symptoms
are mild, your doctor may begin
treatment with a temporary
liquid diet and oral antibiotics.
Then, if your symptoms are
relieved, a high-fiber diet
may be started. If your
diverticulitis is severe, you
may need hospitalization and
IV (intravenous) antibiotics.
Surgery may be necessary if
other types of treatment don’t
successfully control your
problem, or if complications
develop.
Medications can help
relieve pressure in your
colon and ease pain.
WATER
If You Have
Diverticulitis
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The two main keys to controlling
diverticulosis are liquid and fiber
(roughage). Fiber absorbs water
as it travels through your colon,
helping your stool stay soft and
move smoothly. Plenty of liquids
and high-fiber foods can often
keep diverticulosis in check.
Over-the-counter stool-bulking
agents may also help. Some
cases of diverticulosis may
require stool softeners or
antispasmodic medications for
pain. Talk with your doctor about
how exercise may also help.
Hospital care is needed
for some severe cases of
diverticulitis.
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If You Need Surgery
If your symptoms don’t improve with nonsurgical treatment, you
may need surgery to remove part of your colon. This may be done
through open surgery or laparoscopy. Open surgery is done
through a single incision made in the abdomen. With laparoscopy,
surgery is done using special instruments inserted through small
incisions. Your doctor will discuss your surgical options with you. In
some severe cases of infection, emergency surgery may be necessary.
Before surgery, you may be
asked to drink a laxative solution
and follow a clear diet to cleanse
your colon. A doctor will tell you
about the type of anesthetic that
will be used to keep you asleep
and pain-free during surgery.
As You Recover
Since your colon won’t be able
to handle solid food right away,
you’ll be given IV medications and
fluids for a few days after surgery.
Within a day or two you will get up
and walk around. This improves
both your circulation and your
bowel function. The nurses will
help you with breathing exercises
to prevent lung problems such
as pneumonia. You’ll go home
in about a week. Once you’re
home, you’ll probably be back
to your normal activities within
3 to 6 weeks.
Colon Surgery: Resection
6
To remove the problem area,
an incision is made in your abdomen
and the affected section is taken out.
Diverticula in other parts of your colon
usually do not need to be removed.
Preparing for Surgery
To reconnect the colon, the two
remaining ends are reattached. In
some cases, a procedure called a
colostomy is needed to create a temporary opening for waste elimination.
Risks and Complications
As with any surgery, complications are rare, but possible. These
may include bleeding, infection, or injury to surrounding nerves.
Your doctor will talk with you about any other risks associated
with your particular surgery.
Keys to Colon Health
After you’ve been treated for diverticulosis or diverticulitis, you can help
keep your colon healthy with the right diet. Include plenty of high-fiber
fruits, vegetables, and whole grains in your meals. Also, drink plenty of
liquids such as water and juice. Your doctor may also recommend avoiding
seeds and nuts. Small diet changes can prevent future problems.
Get Enough Fiber
1 medium apple = 4 grams
1 medium pear = 4 grams
1 medium orange = 3 grams
1 c. strawberries = 3 grams
5 dried prunes (uncooked) = 3 grams
1/3 c. all-bran cereal = 10 grams
1/3 c. wheat flakes = 3 grams
1/3 c. shredded wheat = 3 grams
2 slices whole-wheat
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1/2 c. cooked frozen peas = 4 grams
1/2 c. cooked fresh spinach = 2 grams
1/2 c. cooked frozen corn = 2 grams
1/2 c. cooked green beans = 2 grams
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1/2 c. cooked lentils = 8 grams
1/2 c. cooked kidney beans = 6 grams
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3 T. unprocessed wheat bran = 6 grams
3 T. unprocessed oat
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You need 25to 30 grams of fiber
each day to keep your colon
working at its best. It’s easier
than you may think to add fiber
to your diet. Try choosing the
fiber-rich foods listed at the
right. For even more fiber, you
can add pure (unprocessed)
bran to your food or drinks. You
can top cereal with pure bran,
add it to a baking recipe, or stir
it into some juice. Your doctor
may also recommend a stoolbulking agent such as psyllium
or methylcellulose.
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• When you exercise, take water
with you to replenish the liquid your
body loses.
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• With your meals and between
meals, drink plenty of liquids.
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• At work, bring a bottle or a jug of
water with you. Pour yourself a cup
every hour or so.
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Liquids help your body to digest
food and move it through your
system. Most people should drink
at least 8 glasses of liquid each
day (but avoid coffee and sodas,
since they may cause spasms
and pressure in your colon). Talk
with your doctor and consider
the following ideas:
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A Healthier Life
The same habits that help keep your colon healthy
also help keep your whole body healthy. Along
with getting enough of the right food, you need
to get enough exercise and rest. Play your favorite
sport. Take walks. Keep stress under control by
making time to relax. You’ll feel a lot better.
Take our Patient Survey. Help us
help other patients. Please visit
www.kramesurvey.com to provide
your feedback on this booklet.
Consultants:
Ernest F. Ribera, MD, Gastroenterology
Peter A. Volpe, MD, Colorectal Surgery
With contributions by:
Michael F. Flynn, MD, Gastroenterology
Stuart Glassman, MD, General Surgery
Also available in Spanish
www.kramesstaywell.com 800.333.3032
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