How To Treat Flare
The first step in managing a flare-up of diverticulitis is to see a healthcare provider for advice.
For uncomplicated diverticulitis, which means mild symptoms and no complications, treatment will likely start at home. A liquid diet may be recommended for a few days. A clear liquid diet includes juices without pulp, gelatin, broths, tea, coffee, and clear sodas.
When symptoms start to get better, the diet can be expanded to include the soft foods found in a low-fiber diet. At this point, high fiber foods such as nuts, fibrous fruits and vegetables, popcorn, and seeds should be avoided.
After doing well with a low-fiber diet, foods with fiber might be added slowly back into the diet as tolerated.
For more serious symptoms, antibiotics might also be needed in addition to changes to the diet. They could be prescribed and taken at home.
When the symptoms are more serious, hospitalization might be needed. Antibiotics, pain medications, and fluids are usually given through an IV. Other treatments might also be used, along with either complete gut rest or a clear liquid diet.
How Is Diverticulitis Treated
If your diverticulitis is mild, your healthcare provider will prescribe an oral antibiotic, such as metronidazole , trimethoprim-sulfamethoxazole , ciprofloxacin or amoxicillin and clavulanic acid . Rest, taking over-the-counter medications for pain and following a low-fiber diet or a liquid diet may be recommended until your symptoms improve. Once your symptoms improve, you can slowly return to soft foods, then a more normal diet, which should be one that includes many high-fiber foods. You and your healthcare provider will discuss the specifics of your treatment plan.
If your diverticulitis is severe, you have rectal bleeding or are having a repeat bout of diverticulitis, you may be admitted to the hospital to receive intravenous antibiotics, IV fluids or possibly be considered for surgery.
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How Is Diverticulitis Diagnosed
If you have symptoms of diverticulitis, its important to be seen by your healthcare provider to get the correct diagnosis.
First, your healthcare provider will ask you about your medical history including your current symptoms, the types of foods you normally eat, how often you have bowel movements and other questions about your bowel movements, and will review any medications you are currently taking. Your healthcare provider will check your abdomen for pain and tenderness.
Other tests that may be performed or ordered to help diagnose your condition include:
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What Is A Diverticulitis Flare
Most diverticula cause no symptoms. However, in some cases the pouches may fill with feces and may become swollen and infected. This may cause an abscess and may even cause a tear or hole in the gut wall. Such episodes are called diverticulitis flares.
Such flares cause pain on the left side of the belly, blood in stools and abdominal cramps. In case of complicated diverticulitis, there may be abscess formation in the pouches causing fever and swelling or inflammation of the abdomen .
Living With Diverticulitis: Get The Full Scope Of Symptoms Treatment And Prevention
Constipation. Diarrhea. Abdominal cramps. People expect gastrointestinal disorders to manifest with unpleasant, easily recognizable symptoms. But most patients with diverticulosis, one of the most common gastrointestinal conditions, dont even know they have it!
Diverticulosis occurs when small, bulging pouches form inside weak areas of the colon, with the majority of cases occurring in the sigmoid colon the lower part of the large intestine. In the U.S., 35% of adults age 50 or younger and 58% of adults age 60 or older have diverticulosis.
People with diverticulosis might not experience symptoms or complications that require treatment. Patients can learn they have the condition when they get a colonoscopy, X-ray, or CT scan for an unrelated gastrointestinal issue.
But in fewer than 5% of patients with diverticulosis, the diverticula become inflamed or infected, causing diverticulitis a condition that does typically cause symptoms such as:
- Pain in the lower left abdomen
- Lack of appetite
Many people who experience these symptoms delay seeking care because theyre embarrassed, or they fear that gastrointestinal surgery with a colostomy bag will be their only treatment option. However, most patients with diverticulitis can manage their symptoms with antibiotics and lifestyle changes. By learning how we diagnose and treat this disease, you can feel more comfortable asking for help sooner.
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Can I Still Get Diverticulitis If Ive Had The Affected Part Of My Colon Removed
If the affected area of your colon is removed, another surgery is usually not needed. The most common location for diverticulitis is the sigmoid colon, which is the S-shaped near end portion of your colon. Although this is the most common location, its possible for diverticula to form in other areas of your colon. Because each person is different, be sure to ask your healthcare provider, surgeon, or colon specialist about your risk for return appearance of diverticulitis.
The 4 Dangers Of Diverticulitis
One of the biggest mistakes that most people suffering from diverticulosis or diverticulitis make is that they treat their condition like it is any other common digestive problem. Since much of the damage to the digestive tract takes place out of sight and without symptoms, most sufferers are unaware of the true danger brewing in their bowels.
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How To Treat Uncomplicated Diverticulitis
A sudden attack can be frightening, and if youve never felt pain like this in your abdominal area, you may imagine the worst. But if a CT scan or a barium enema X-ray diagnoses diverticulitis with no other problems, you should be able to complete your recovery at home.
Treatments for uncomplicated diverticulitis include:
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Give Acupuncture A Try
Acupuncture is an alternative medicine that can help reduce pain, including the painful cramping people with diverticulitis often experience. After assessing a client’s needs during the first visit, the practitioner will develop a customized treatment plan to target his or her specific issues. In addition to managing the pain of diverticulitis, acupuncture may also help to reduce swelling, ease stiffness, and calm muscle soreness.
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Treating Diverticulitis Flare Without Antibiotics
I’m interested as to whether any of you has been able to successfully handle flares simply by dietary changes . The usual antibiotic regimen of Flagyl and Cipro make me so ill that I’d rather have the diverticulitis symptoms. Seriously, I felt like I wanted to die last time I tried this and wound up not completing the courses.
Two questions, in particular:
- How long did it take for the symptoms to completely disappear?
- How slowly did you work back into your normal diet that is, how many weeks was it till you were eating as you were before the flare.
Posted 3 years ago
l also eat a lot of fibre and loads of fruit and veg. l rarely eat meat apart from chicken as l find when l eat red meat l get pain as its hard to digest. l always cook from scratch and never eat processed food of any kind. it works for me and l have regular bowel movements which is extremely important if l do find myself becoming constipated l nip it in the bud. Even if my stools are pellet like this is a form of constipation so l take a stool softener. l dont have pain on a regular basis only if l eat something hard to digest which l rarely do. trial and error.
What Is The Best Imaging Technique In Patients With Suspected Alcd What Is The Role Of Ultrasound In Patients With Alcd
In patients with suspected ALCD, we suggest contrast-enhanced CT scan of the abdomen as the imaging technique of first choice .
We suggest to use US in the initial evaluation of patients with suspected ALCD where it is performed by an expert operator. It has wide availability and easy accessibility. A step-up approach with CT performed after an inconclusive or negative US may be a safe approach for patients suspected of acute diverticulitis .
Radiological imaging techniques that are used for diagnosing ALCD in the emergency setting are US and CT. Currently, CT is the established method of choice when compared to US and most guidelines cite the high accuracy and other advantages of CT. This approach is the gold standard for both the diagnosis and the staging of patients with ALCD due to its excellent sensitivity and specificity . CT scan can also rule out other diagnoses such as ovarian pathology, or leaking aortic or iliac aneurysm.
A systematic review and meta-analysis of studies that reported diagnostic accuracy of the clinical diagnosis and diagnostic modalities in patients with suspected diverticulitis was published in 2014. Summary sensitivity estimates for US were 90% versus 95% for CT . Summary specificity estimates for US were 90% versus 96% for CT .
Magnetic resonance imaging, which is not constrained by the operator dependency limitation of compared to US , until now is currently difficult to perform at in the emergency department.
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What Are The Causes Of Diverticulosis And Diverticulitis
Aging and heredity are primary factors in the development of diverticulosis and diverticulitis, but diet also plays a role. Eating a diet low in fiber and high in refined foods may increase the risk. Indeed, in Western societies, an estimated 10% of people over 40 eventually develop diverticulosis the figure reaches at least 50% in people over 60. Diverticulitis will occur in about 10%-25% of those with diverticulosis.
Though it hasnt been proven, some researchers think that if you are often constipated and usually strain when you have a bowel movement, you may create enough pressure in the intestinal walls to weaken them and begin the development of diverticular pouches. Another school of thought is that not enough fiber in the diet is responsible. The lack of fiber leads to increased bowel wall strain to move stool through the colon. That then causes increased local pressures that lead to the formation of pouches at weak points in the colon wall. The increased pressure along with undigested food caught in these pouches can erode the diverticular wall, causing inflammation and possible bacterial infection, which can result in diverticulitis.
How Are Diverticulosis and Diverticulitis Diagnosed?
If you think you have either diverticulosis or diverticulitis, talk to your doctor. Your doctor can perform tests to diagnose the conditions including:
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Diverticulitis Diet: Foods To Avoid
Diverticulosis is a condition that typically affects the lower portion of the large intestine or colon. While the cause of diverticulosis is unknown, it’s most common in people over 40. Some people develop sac-like pockets called diverticula along the lining of the colon. When these diverticula get inflamed or infected, diverticulosis becomes diverticulitis. This illness can cause severe abdominal pain, bloating and gas, fever and chills, and abnormal bowel function. The development of diverticula is often linked to dietary habits. Avoid these foods to prevent diverticulosis and control symptoms of diverticulitis.
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Is It Time To Change Practice
The answer to this question will depend in large part on your current practice, but even before this most recent RCT, my approach to diverticulitis had changed. These trials suggest that it is not all that important for me to make the diagnosis of uncomplicated diverticulitis. For many well appearing patients with left lower quadrant pain in whom I would have ordered imaging for diverticulitis in the past, I now forgo imaging. I treat the patients symptoms, often check some labs, and perform a repeat exam. If there are no indications of complicated disease, I will frequently just treat their symptoms with NSAIDs and a few days of modified diet, whether or not their official diagnosis is diverticulitis. Knowing that antibiotics dont seem to help, I now reserve the CT for situations where the patient is not improving or appears unwell, to look for complications or an alternative diagnosis.
Based on the lack of evidence, the American Gastroenterological Association Institute guidelines suggest that antibiotics should be used selectively, rather than routinely, in patients with acute uncomplicated diverticulitis. . Unfortunately, the guideline doesnt really provide any further advice on what selectively means, so it is hard to know who should and shouldnt be treated. Similar guidelines suggesting more selective use of antibiotics have been released by numerous other organizations.
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Should Laparoscopic Lavage And Drainage Be Recommended In Patients With Diffuse Peritonitis Due To Diverticular Perforation
We suggest performing laparoscopic peritoneal lavage and drainage only in very selected patients with generalized peritonitis. It is not considered as the first line treatment in patients with peritonitis from acute colonic diverticulitis .
In 2014, the first results from the RCT DILALA were published . Initial diagnostic laparoscopy showing Hinchey III disease was followed by randomization between laparoscopic lavage and colon resection and stoma. Morbidity and mortality after laparoscopic lavage did not differ when compared with the Hartmann procedure. Laparoscopic lavage resulted in shorter operating time, shorter time in the recovery unit, and shorter hospital stay with the avoidance of a stoma. In this trial, laparoscopic lavage as treatment for patients with perforated diverticulitis Hinchey III disease was feasible and safe in the short-term. In 2015, the results of SCANDIV study were published . Among patients with likely perforated diverticulitis and undergoing emergency surgery, the use of laparoscopic lavage vs. primary resection did not reduce severe postoperative complications and led to worse outcomes in secondary endpoints. These findings do not support laparoscopic lavage for treatment of perforated diverticulitis. In the same year, the result of LADIES study was published. This showed that laparoscopic lavage was not superior to sigmoidectomy for the treatment of purulent perforated diverticulitis .
Potential regimens include the following:
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Uncomplicated Diverticulitis And Diet
For years, patients have been instructed to consume a clear-liquid or low-residue diet , or even to deprive themselves of food for bowel rest during the diverticulitis flare . Several guidelines have supported this. A survey conducted in the Netherlands in 2011 showed that 83.2% of participating gastroenterologists and surgeons advised some form of bowel rest , but the Dutch guideline of 2012 stated that an unrestricted diet could also be advised .
In the prospective, observational study published by Isacson et al. in 2015, patients with confirming CT scan for uncomplicated diverticulitis were enrolled to receive recommendations on oral intake of fluids for the first 48 h followed by a liquid diet and then moving on to a complete diet as tolerated. Readmission within 1 month with or without complications was defined as a management failure. In total, 155 patients were included in the study, and only four patients had treatment failure. Five patients had a recurrence within the 3-month follow-up period.
A prospective, uncontrolled study of an unrestricted diet in 86 patients with uncomplicated diverticulitis concluded that this was well tolerated, although 8% had serious adverse events and 20% had ongoing symptoms .
Add Ground Flaxseed To Your Diet
Ground flaxseed is rich in fiber, which serves as a stool softener. This makes the passing of bowel movements faster and easier on the digestive system, thus reducing strain. Most adults should aim to consume 15 grams of ground flaxseed per day. You can add the nutrient to salad, porridge, yogurt, or other dishes easily without any significant change in flavor, but a big change in digestive health.
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Should An Early Colonic Evaluation Be Planned In Patients Treated Non
In patients with diverticular abscesses treated non-operatively, we suggest to plan an early colonic evaluation .
In patients with CT-proven uncomplicated diverticulitis treated non-operatively, we do not recommend routine colonic evaluation .
Colonic localized abscess is an uncommon, but possible, presentation of an occult colon malignancy, and it may mimic complicated diverticular disease . It has been demonstrated that the risk of malignancy after a CT-proven uncomplicated diverticulitis is low and, in the absence of other indications, routine colonoscopy may not be necessary. A systematic review investigating the rate of colorectal cancer found by colonoscopy after an episode of uncomplicated diverticulitis was published in 2014 . Nine studies met the inclusion criteria and included a total number of 2490 patients with uncomplicated diverticulitis. Subsequent colonoscopy after an episode of uncomplicated diverticulitis was performed in 1468 patients . Seventeen patients were diagnosed with CRC, having a prevalence of 1.16% . Hyperplastic polyps were seen in 156 patients , low-grade adenoma in 90 patients , and advanced adenoma in 32 patients . The results of this review demonstrate that unless colonoscopy is regarded for screening in individuals aged 50years and older, routine colonoscopy in the absence of other clinical signs of CRC is not required in patients following an episode of acute uncomplicated diverticulitis.
Hispanic Americans And Diverticulitis
The rate of hospitalization among Hispanic Americans with diverticulitis is similar to that of Black Americans, about 32 per 100,000 cases. However, Hispanic Americans are less likely to need surgery for recurrent diverticulitis, and theyre also less likely to have diverticular bleeding, according to research.
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What Foods Are High In Fiber
High-fiber foods include:
- Whole grain foods such as breads, pasta, crackers, barley, brown rice and oatmeal.
- Berries and other fruit.
- Vegetables, such as broccoli, cabbage, spinach, carrots, asparagus, squash and beans.
- Brown rice.
- Bran products, made from rice, corn, wheat, oats, barley rye and millet.
- Cooked dried peas and beans.
Besides preventing constipation, eating a high-fiber diet helps lower blood pressure, reduces blood cholesterol, improves blood sugar and reduces the risk of developing certain intestinal disorders such as colorectal cancer.
For more tips and food examples of high-fiber foods, visit: