What should a person with diverticulosis do in order to limit the spread of the condition and prevent complications from occurring?
Diverticulosis treatment requires the very best of medical and surgical judgment. While a diverticulosis diet cannot be eradicated by proper treatment, two things of a constructive nature may definitely be done. The condition can be kept from progressing any further, by removing such causes as constipation, avoiding cathartics, avoiding heavy lifting, etc. The existing diverticula can be spared irritation by avoiding irritating enemas, harsh cathartics, irritating foods, etc. In this manner, the patient can be spared the complication of diverticulitis.
Should diverticulitis occur, it is by no means the serious thing it was in the days before the sulfa drugs and the antibiotics were used for diverticulitis treatment. With these two very useful implements at hand, most cases of diverticulitis can be definitely controlled. Only where the diverticulitis has proceeded to the point of perforation need surgery be invoked. Certainly surgery which would have for its object the removal of all diverticula, would be unjustified. In my opinion, and that of other conservative surgeons, the same may be said of colostomy. It is not justified in any but exceptional cases.
My own opinion, based on a specialized experience, is that the control of the condition lies largely in the proper diet. With the suitable diet, by far the majority of patients can learn to live with the condition and be the better for the handicap. It is the old story of having an incurable disease and then treating it well. The patient helps his general nutrition, as well as avoiding trouble locally, by learning what is the best diet for himself.
Diverticulosis Diet
The diverticulosis diet which has given my patients the most satisfactory results is, contrary to general opinion, not the concentrated diet but a bulk diet. When people are put on a low residue diet, there is continuous contraction of the muscular fibres of the colon. This increases the pressure in the colon and thus aggravates the existing pockets and may indeed produce new ones. The bulk diet, however, is well tolerated, is far more convenient to follow, and is certainly better for the patient. It is given in detail in the following paragraph along with diverticulitis foods to avoid.
Eating plenty of cooked fruits and cooked vegetables, especially the leafy and fibrous vegetables gives bulk to the bowel content. So, too, does coarse bread and cereals. Since proper bulk and consistency serve to stimulate the intestinal musculature, they aid the movement and the tone of the fibers of the intestinal wall. Plenty of water along with sufficient roughage as suggested above will prevent the stool from becoming hard and small, two conditions which aggravate diverticula. On the contrary bland bulk and an abundance of water will aid adjustment of the bowel to the presence of these “blow-out” pockets or diverticula and tend to retard their progression.
Diverticulitis Foods to Avoid
Naturally, diverticulitis foods to avoid for these cases must exclude articles of food containing seeds since these pass through the food digestion canal undigested and by a perverse fate seem destined to get no where else but into these pockets. Once there, they cause much irritation and lead to some of the complications mentioned above.
Diverticulosis Surgery
Of course, many cases of diverticulitis have come to surgery. In fact, at one time an abdominal operation was performed for the eradication of the condition. During this operation, the entire affected part of the colon was removed. The mortality was so high, however, that it may well have caused the coining of the phrase: “Operation successful, but the patient died.” Later surgeons abandoned this idea and merely made an opening in the colon in order to short-circuit the bowel content. For many reasons this method, however, proved unsatisfactory both to patient and to doctor.
Occasionally, as briefly mentioned before, these little pockets become filled with pus and burst. When this occurs, peritonitis is imminent and more than one case has been diagnosed as appendicitis. Needless to say, when this occurs it is definitely a surgical problem. However, with the present availability of penicillin and other anti-bacterial medicines, such a situation need not be fatal.
Whenever bleeding occurs without the presence of hemorrhoids, one must suspect diverticulosis. Very often the blood is only slight in amount and appears mixed with a stool or with mucus. If the doctor cannot find any “pockets” by means of instrumental examination with a rectosigmoidoscope, he will certainly avail himself of what is known as a barium enema study of the colon. This will very clearly outline the condition. Indeed it is hard to tell the difference from certain other conditions such as ulcerative colitis, cancer of the colon, or polyps without making a series of studies with x-ray enema.
