Everything you need to know about diverticulitis

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 your diet is heavy in highly refined processed foods and light in fruits, veggies and whole grains, you're missing a vital ingredient for a healthy colon: fibre, the indigestible part of food.

• Without fibre — a natural stool softener — constipation is often the order of the day, causing pressure to build up inside your colon (large intestine).
• Over time, the colon walls weaken and a lot of little pouches, called diverticula, start bulging out like weak spots in an inner tube.
• This is called diverticulosis; it’s quite common, occurring in 50 percent of Canadians between ages 60 and 80, and in nearly everyone older than that.
• Diverticulosis rarely causes problems; in fact, most people don't even know they have it unless it’s discovered during testing for another ailment.
• Diverticulosis can become serious, however, if food particles get trapped in the pouches and bacteria build up. The resulting inflam­mation and infection is the basis of a condition called diverticulitis.
• Characterized by an intense abdominal pain that’s hard to ignore, diverticulitis often comes on suddenly, producing a tenderness in your lower left abdomen. The infection may also give you fever, chills, vomiting, cramping and constipation.

Although diverticulitis is often simple to treat, in rare cases people develop complications.

• In the most severe cases, diverticula become filled with pus and develop into abscesses. Sometimes these will perforate, allowing the infected pus to leak into your abdominal cavity. This is called peritonitis, a life-threatening condition requiring emergency surgery.
• An infection that spreads outside your colon can also lead to another problem, a fistula, which occurs when the tissue of one organ — in this instance, your colon — sticks to another organ, and the infection burrows into it. With diverticulitis, the other organ is often the bladder, and the result can be a severe urinary tract infection.
• Sometimes an infection can leave scarring, resulting in adhesions or bands of connective tissue that can constrict the bowels and cause blockages.

•  Antibiotics to battle inflammation and infection.
•  Analgesics for pain and bed rest until symptoms ease up.
•  Liquid diet to let colon heal, then increased fibre to prevent recurrences.
•  If necessary, surgery to deal with complications.

• See a gastroenterologist instead of an internist or family physician. In a recent study, people with diverticulitis who were treated by gastroenterologists had a shorter hospital stay and were less likely to need readmission.
• Avoid enemas. Even though they may seem like a good solution for a problem that results from constipation, they can actually aggravate diverticulitis symptoms.
• The seed controversy. For years it’s been standard medical wisdom that if you have diverticulitis, you should steer clear of nuts, seeds and popcorn because they get trapped in diverticula and cause inflammation. It turns out, however, there is no scientific evidence to support this. Most doctors now tell their patients that they themselves should be the judge of what they can eat. So, if they don't bother you, go ahead and have strawberries, tomatoes, sunflower seeds, cashews and all your favourite dishes that contain seeds and nuts.

• For the latest medical and nutritional treatments for diverticulitis, and ways to cope with digestive illness, contact the Canadian Association of Gastroenterology in Oakville, Ontario (1-888-780-0007 or www.cag-acg.org).

Keep this guide in mind and reduce your risk by making healthier lifestyle choices. For more information and treatment options, be sure to contact your doctor.