Conditions

Diverticular Disease and Diverticulitis

Diverticula are small pea or grape sized, sac-like protrusions that develop in the lower part of the large intestine, or colon, and project into he abdominal cavity. They typically form if an individual suffers from frequent constipation. The presence of diverticuli is called diverticulosis.

Generally attributed to a low-fiber diet of refined and processed foods, diverticulosis is characterized by chronic constipation alternating with diarrhea, and excessive flatulence. Cramping pain may occur in the affected part of the gastrointestinal tract, and the area may be tender to the touch.

A small percentage of people with diverticulosis go on to develop diverticulitis, or inflammation of the diverticuli. Diverticulitis develops when bits of fecal matter become trapped in the diverticula and cause infection.

Signs and Symptoms:

• Cramping
• Severe abdominal pain
• Nausea
• Fever
• Constipation, diarrhea
• Flatulence
• Painless rectal bleeding

If diverticulitis is ignored and remains untreated, complications can occur. A stricture can develop, narrowing the intestines at the site of the inflammation, or a fistula (abnormal opening that connects one part of the intestine to another) may occur. Or an abscess may form in or around the colon, and peritonitis can develop. Peritonitis is an inflammation of the peritoneum, the membrane that forms the protective lining of the abdominal cavity.

Symptoms of peritonitis include:

• Swelling
• Severe abdominal pain
• Nausea
• Vomiting
• Chills
• Fever
• Rapid heartbeat
• Dehydration

Diagnosis:

Diagnosis of diverticulitis may involve a barium enema. Sigmoidoscopy or colonoscopy may be performed as well. In these procedures the physician uses a narrow, flexible tube to view the affected parts of the colon directly, and, if necessary, to remove tissue samples for biopsy.

Treatment Options:

With mild symptoms, outpatient treatment includes clear liquid diet and oral broad-spectrum antibiotics. Inpatient treatment includes bowel rest by administration of total parenteral nutrition and intravenous broad-spectrum antibiotics. Patients improving within 72 hours can resume oral diet and are discharged with oral antibiotics. High-fiber diets and psyllium supplements are recommended following acute episode. Within 6 weeks, colonoscopy or barium enema is performed. Elective surgery is recommended if attacks recur; generally, surgery is performed once an acute attack has resolved. Patients under 40 (more aggressive disease), who deteriorate within 24 to 48 hours, or those who have severe complications, are treated urgently with surgery.

Traditional Treatments:

• Uncomplicated diverticulitis is usually treated with multiple antibiotics, such as metronidazole (Flagyl, Metric, Protostat) and ciprofloxacin (Cpro), or sulfamethoxazole plus trimethoprim (Bactrim, Co-trimazole, Septra), depending on your individual tolerance to these drugs.
• If the disease becomes acutely painful, hospitalization and treatment with intravenous fluids and antibiotics may be required.
• If the bowel is obstructed, it may be necessary to insert a tube that runs from the nose down to the stomach to suction out fluids so they do not accumulate at the site of obstruction.
• If diverticulitis does not respond to antibiotic treatment, surgery may be required. An estimated 20 to 30 percent of people hospitalized for diverticulitis require surgery to remove the diseased section of the colon. The remaining sections of the colon are then joined together. In some cases, a temporary colostomy may be necessary.
• If peritonitis develops, emergency surgery to remove the diseased section of the intestine is required, followed by aggressive antibiotic therapy.
• If diverticular disease is not well developed, you may be able to avoid surgery by increasing the amount of fiber and water in your diet. Bulking agents, such as psyllium and oat bran, may be recommended. You will want to start with a small amount and gradually increase your intake over a period of three to four weeks to avoid gas and bloating.

Complementary and Alternative Therapies:

Nutrition plays an important role in the prevention and treatment of diverticulosis. Specific dietary factors have been correlated with the incidence of diverticular disease and may play a role in minimizing exacerbations and improving outcome. Nutritional supplementation and herbal remedies may help prevent and treat diverticular disease.

Nutritional Supplementation:

• Probiotic supplements are essential for a healthy intestinal tract, especially if you must take antibiotics. Follow label directions.
  Fiber (oat bran, psyllium, and ground flaxseeds are good sources) helps prevent constipation. It also helps prevent infection by preventing accumulation of wastes in pouches in the colon walls. Take as directed on label. Take 1 hour before meals with a large glass of liquid and take separately from other supplements and medications.
• Vitamin B complex is needed for all enzyme systems in the body and for proper digestion. Use a complex that supplies 100 mg of each major B vitamin 3 times daily.
• If you are suffering from acute inflammation, take 500 mg of bromelain three times a day, between meals.
• To insure full digestion, take a full-spectrum digestive enzyme supplement.
  Warning: Long-term supplementation with pancreatin is not advised, as it can cause your pancreas to reduce its own production of this enzyme.
• The essential fatty acids present in borage oil, evening primrose oil, and flaxseed oil help reduce inflammation and ease the passage of stools by providing lubrication. Use all three on a rotating basis. Take 1 tablespoon twice a day until the condition is resolved.
• To reduce inflammation and help heal the mucous membranes of the colon, take an antioxidant formula that contains 400 IU of vitamin E daily.
  Warning: If you are taking blood thinners consult your physician before taking supplemental vitamin E.
• Glutamine, though, may prove beneficial in the prevention and treatment of diverticular disease.

Alternative Therapies:

• Aloe vera resolves constipation, and will help heal the mucous membranes of the colon. Take _ cup twice a day.
• If the condition is stress related, take a cup of chamomile or linden tea two or three times daily. It is best to alternate them with oat straw tea.
• Garlic is a time-honored remedy with strong antibacterial properties. Take 500 mg two or three times daily.
• Goldenseal is an antibacterial herb that is valuable in all cases of acute infection. Take 250 to 300 mg two or three times daily for one week.
  Warning: Do not take goldenseal during pregnancy. If you have a history of cardiovascular disease, diabetes, or glaucoma, use goldenseal only under a doctor's supervision.
• Alfalfa is a good natural source of vitamin K and valuable minerals. Take 2,000 mg daily in capsule or extract form.
• Pau d'arco has an antibacterial, cleansing, and healing effect. Drink two cups of pau d'arco tea daily.
• Other herbs beneficial for diverticulitis include cayenne, chamomile, papaya, red clover, and yarrow extract or tea.
  Warning: Do not use chamomile if you have an allergy to ragweed. Do not use chamomile on an ongoing basis as an allergy to ragweed may develop.
• The homeopathic remedy, Belladonna, can be useful for abdominal pain and cramping that comes on suddenly and are relieved by firm pressure; especially with constipation.
• Bryonia is a homeopathic remedy for abdominal pain that is worse with movement and is alleviated by heat; especially with vomiting, constipation, and dry, hard stools.
• Colocynthis is a homeopathic remedy for cutting, cramping abdominal pains that are better with pressure; especially when accompanied by restlessness and diarrhea.

General Recommendations:

• Consume an adequate amount of fiber and lots of quality water. You may prefer to supplement your diet with a bulk product and/or a stool softener that contains methylcellulose or psyllium.
• Eat plenty of green leafy vegetables.
• When an attack or pain begins, give yourself a cleansing enema using 2 quarts of lukewarm water and the juice of a fresh lemon. This helps rid the colon of undigested and entrapped foods and relieves pain.
• On the day of an acute attack, take 4 charcoal tablets or capsules with a large glass of water to absorb trapped gas. Always take charcoal separately from medications and other supplements, and do not take it for prolonged periods, as it absorbs beneficial nutrients as well.
• During severe attacks, use liquid vitamin supplements for better assimilation and put all vegetables and fruits through a blender. Eat steamed vegetables only. Baby foods are good until healing is complete.
• To relieve pain, massage the left side of the abdomen. Stand up and do stretching exercises.
• Clay tablets are beneficial. Take them as directed on the product label on and empty stomach upon rising.
• Check stools daily for blood.
• Try to have a bowel movement at the same time each day. Take fiber first thing in the morning, before breakfast, to help the bowels move at this time.
• Do not overuse laxatives; they can irritate the colon wall.
• Exercise tends to decrease incidence of symptoms.

Warnings:

• If there is even a suspicion that shock is developing, you should call for emergency medical assistance.
• Do not use chamomile if you have an allergy to ragweed.
• Do not use chamomile on an ongoing basis as an allergy to ragweed may develop.
• Do not take goldenseal during pregnancy.
• If you have a history of cardiovascular disease, diabetes, or glaucoma, use goldenseal only under a doctor's supervision.
• If you are taking blood thinners consult your physician before taking supplemental vitamin E.
• Long-term supplementation with pancreatin is not advised, as it can cause your pancreas to reduce its own production of this enzyme.