Diagnosis & Treatment of Diverticular Disease

How is diverticular disease diagnosed?

Once suspected, the diagnosis of diverticular disease can be confirmed by a variety of tests. Barium x-rays (barium enemas) can be performed to visualize the colon. Diverticula are seen as barium filled pouches protruding from the colon wall. Direct visualization of the intestine can be done with flexible tubes inserted through the rectum and advanced into the colon. Either short tubes (sigmoidoscopes) or longer tubes (colonoscopes) may be used to assist in the diagnosis and to exclude other diseases that may mimic diverticular disease. In patients suspected of having diverticular abscess causing persistent pain and fever, ultrasound and cat scan examinations of the abdomen and pelvis can be done to detect collections of pus fluid.

Treatment for diverticular disease:

Many patients with diverticulosis have minimal or no symptoms, and do not require any specific treatment. A high fiber diet and fiber supplements are advisable to prevent constipation and the formation of more diverticula. Patients with mild symptoms of bloating or abdominal pain may benefit from anti- spasmodic drugs such as chlordiazepoxide (Librax), dicyclomine(Bentyl), Donnatal, and hyoscyamine (Levsin). Some doctors also recommend avoidance of nuts, corn, and seeds to prevent complications of diverticulosis. Whether these diet restrictions are beneficial is uncertain.

When diverticulitis occurs, antibiotics are usually needed. Oral antibiotics are sufficient when symptoms are mild. Some examples of commonly prescribed antibiotics include ciprofloxacin (Cipro), metronidazole(Flagyl), cephalexin(Keflex), and doxycycline(Vibramycin). Liquid or low fiber foods are advised during acute diverticulitis attacks. In severe diverticulitis with high fever and pain, patients are hospitalized and given intravenous antibiotics. Surgery is needed for those with persistent bowel obstruction or abscess not responding to antibiotics.

Specific treatment for diverticular disease will be determined by your physician based on:

• your age, overall health, and medical history
• extent of the disease
• your tolerance for specific medications, procedures, or therapies
• expectations for the course of the disease
• your opinion or preference

Treatment may include increasing dietary fiber intake by eating foods such as the following:

• whole grain breads, cereals, and other products
• fruit, such as berries, apples, and peaches
• vegetables, such as broccoli, cabbage, spinach, carrots, asparagus, and squash
• beans

In the past, avoiding foods with small seeds, such as tomatoes or strawberries, was suggested because it was believed that particles could lodge in the diverticula and cause inflammation. Consult your physician regarding which foods you should avoid.

Treatment for diverticulitis may also include:

• medications (to control pain)
• medications (for infection and inflammation)
• medications (to control muscle spasms)
• resting the colon, with liquid diet and bed rest
• preventing or minimizing complications, such as the following:
  • infection
  • perforations or tears
  • blockages
  • bleeding

Hospitalization may be required for acute attacks with severe pain or infection. Surgery may be necessary in some cases.

Surgery for diverticulitis

Diverticulitis that does not respond to medical treatment requires surgical intervention. Surgery usually involves drainage of any collections of pus and resection of that segment of the colon containing the diverticuli, usually the sigmoid colon. Therefore, surgical removal of the bleeding diverticula is necessary for those with persistent bleeding. In patients needing surgery to stop persistent bleeding, exact localization becomes crucial to guide the surgeon. Sometimes, diverticula can erode into the adjacent bladder, causing severe recurrent urine infection and passage of gas during urination. This situation also requires surgery. Sometimes, surgery may be suggested for patients with frequent, recurrent attacks of diverticulitis leading to multiple courses of antibiotics, hospitalizations, and days lost from work.

What can be done to prevent Diverticular Disease?

Once formed, diverticula are permanent. No treatment has been found to prevent complications of diverticular disease. Diet high in fiber increases stool bulk and prevents constipation, and theoretically may help prevent further diverticular formation or worsening of the diverticular condition. Some doctors recommend avoiding nuts, corn, and seeds which can plug diverticular openings and cause diverticulitis. Whether avoidance of such foods are beneficial is unclear. Patients with known diverticular disease that develop unexplained fever, chills or abdominal pain should notify their doctor because of the possibility of the complication of diverticulitis. A better understanding of the way diverticula form and become infected will hopefully lead to discovery of more effective ways to manage these common conditions.