Diverticulosis

Q: About two weeks ago, I awoke in the middle of the night with severe pain in my left side, and not wanting to bother my doctor in the middle of the night, I waited until morning and then called him. I was sent to the ER, and they diagnosed diverticulosis, and I was put on an antibiotic for 10 days. I finished that about three days ago, and now I feel better, but I am a little nauseated, and whenever I go to the bathroom and have a stool, I believe that I may be bleeding from my rectum. I am not sure where the blood is coming from. Any suggestions? 

A: The pain that you experienced could have been related to diverticular disease (complications or diverticulitis), but there is no objective evidence to say that for sure. 

Diverticulosis (the presence of pouches on the outside of the colon) can cause constipation, diarrhea or rectal bleeding, and diverticulitis (inflammation of the pouches) usually causes left-sided abdominal pain, fever and an elevated white blood cell count. 

Once you are completely recovered after antibiotics, you may benefit from a colonoscopy to look for a cause of lower gastrointestinal bleeding and to document the presence of diverticula. During an acute episode of diverticulitis, a CT scan of the abdomen and pelvis is the best test to look for inflammatory changes or an abscess, fluid collection or sinus tract. Good luck to you. 

Q: Is there any new research on the effects of seeds and nuts in the diet of a person with diverticulosis? Some past research has shown that people with diverticulosis can eat nuts and seeds and that the past advice to avoid them is false. 

A: Diverticula of the colon can become blocked by fecal contents leading to focal inflammation (diverticulitis). It had been proposed that eating nuts and seeds can increase the possibility of blocking the openings of the diverticula. In fact, the increased risk of diverticulitis resulting from seeds is small. We now encourage people with diverticulosis to increase the amount of fiber in their diet. 

Q: I just turned 35 and, after an entire lifetime of battling chronic constipation, have been diagnosed with diverticulosis. From the little I know of the disease, I understand that there is no cure. The past four months have been a living hell for me. I cannot eat solid food; my belly is continually bloated. I cannot have a bowel movement without using a major blowout laxative, but using a laxative is a double-edged sword, as it causes a good two to three days of severe gas and bloating. My colon is continually in spasm, and my entire abdominal cavity feels like it is crawling with ants. 

Today, I had a colonoscopy that confirmed the diagnosis of diverticulosis. The only thing I've been told is to take fiber. I have no hope. I have been eating a high-fiber diet for years with supplements. I exercise daily with a personal trainer. What else am I supposed to do to combat these symptoms? 

A: There are several aspects of your story that are unique. The frequency of diverticulosis increases with age. You are relatively young to have this problem. Also, the severity of your symptoms is more marked than that experienced by many other patients.  

Your treatment should focus on bowel function. To treat your constipation, we suggest that you try a natural laxative (e.g., fiber). Even though you are eating a high-fiber diet, the addition of an agent like Metamucil often improves symptoms. You can also add Lactulose, Miralax or another type of laxative to the Metamucil. 

Sometimes the more powerful agents have cramps associated with laxatives. If you can avoid this pain, you would be better off. There are some surgeons who will offer a subtotal colectomy operation to remove much of the diverticulae and thereby improve symptoms. Unless you have had documented episodes of diverticulitis, you should avoid the surgical option.