Treating diverticulitis: medications and procedures

This painful intestinal condition is widely believed to be "lifestyle-related," the unhappy result of too little fibre in your diet. Most cases can be treated with medication and rest, and future flare-ups prevented by making healthier lifestyle choices.

If caught early, a mild case of diverticulitis often clears up after two or three days with oral antibiotics, bed rest, a clear liquid diet to allow your colon to heal and an analgesic for the discomfort. If you have severe pain or a serious infection, your doctor will probably want to hospitalize you so that medications and fluids can be delivered intravenously.

About 20 percent of those who suffer repeated diverticulitis flare-ups will require surgery to recover from intestinal complications. If you have any of the following symptoms, you should get emergency medical treatment right away: bloody stools, a persistent high fever, inability to have a bowel movement, or severe abdominal pain or tenderness.

• If your symptoms are mild, your doctor will probably prescribe two antibiotics. Even though you're likely to feel better in a few days, be sure to stay on these drugs for the full course prescribed.
• For pain, consult your doctor about taking an analgesic. If you have bleeding or a history of peptic ulcer disease, you should avoid non-steroidal anti-inflammatory drugs (NSAIDs) because they can hinder blood clotting. It may be safest to take acetaminophen (Tylenol), but you may need something stronger, so ask your physician first.

If your symptoms are more severe, your doctor may hospitalize you to get intravenous antibiotics, pain relievers and fluids, as well as intravenous feeding to give your inflamed colon a complete rest. For most people, this leads to a full recovery.

If your diverticulitis doesn't respond to medication, or you have frequent or severe attacks, your doctor may recommend surgery. (This is particularly true if you're under age 50, as diverticulitis tends to be more aggressive and recur more often in younger people.)

Although a small abscess can be drained with a relatively minor procedure, more invasive surgery may be needed to eliminate a large abscess, remove a fistula or clear an obstruction in your intestine. And if you develop perforations or peritonitis, you'll need emergency surgery to clean the infection out of your abdominal cavity.

• Whatever the complication, the surgeon usually treats it by removing the diseased part of your colon and reattaching the cut ends in a partial colectomy. If you have widespread inflammation, you may need two operations. First, the surgeon clears away the infection in your abdominal cavity, removes the affected part of your colon and attaches the healthy colon to a temporary opening in your abdomen, a colostomy, which serves as an artificial anus. A bag is attached to the opening to receive stools and keep them completely away from the infected area. Once the inflammation clears up, in a second operation, the surgeon will reattach the ends of your colon and close the hole in your abdomen, and your bowel movements will return to normal.
• If you have diverticular bleeding, it normally stops by itself. However, your doctor may still want to perform a colonoscopy. If you have very heavy bleeding, the doctor may also take specialized X-rays. If the bleeding doesn't stop by itself, sometimes it can be controlled by injecting vasopressin, a drug that constricts your arteries. As this can be dangerous, especially in older people, your doctor may recommend a partial colectomy instead.