Dear Dr Makis
Following an episode of very severe pain in my abdomen, I was admitted to hospital and needed treatment with antibiotics and fluids through a drip. I had a scan and a colonoscopy and was told I had diverticulitis. The pain has thankfully gone and I do not want to go through the experience again. What should I be doing to prevent the pain from happening again?
Diverticula is the medical term to describe small bulges that stick out of the colon wall. A diverticulum is a small pouch with a narrow neck that sticks out from the wall of the gut. They most commonly develop in the section of the colon leading towards the back passage. This is where the stools (faeces) are becoming more solid.
Diverticula are common. They become more common with increasing age. About half of all people have diverticula by the time they are 50 years old. The reason why diverticula develop is probably related to not eating enough fibre. Fibre is the part of food that is not digested but helps the digestive system to produce healthy soft stools. The gut moves stools along with gentle squeezes of its muscular wall. The stools tend to be drier, smaller, and more difficult to move along if there is insufficient fibre in the diet. The gut muscles have to work harder if there is too little fibre in the diet. High pressure may develop in parts of the gut when it squeezes hard stools. The increased pressure may push the inner lining of a small area of the gut through the muscle wall to form a small diverticulum.
In about 75% of people with diverticula have no symptoms. Some may develop pain, bloating, constipation or diarrhoea, this is referred to as diverticular disease. Infection and inflammation may occur when faeces become trapped in the diverticula. This causes more severe pain, is associated with a fever and feeling unwell. This is referred to as diverticulitis and it sounds like this is why you needed to go to hospital.
To try and prevent symptoms of diverticular disease and diverticulitis occurring, a high-fibre diet is usually advised as it helps to keep stools soft and bulky and reduces pressure on the colon. It can ease pain, bloating, constipation and diarrhoea and prevents hard stools becoming lodged within the pouches. It can also help to prevent the formation of further diverticula, which may reduce the risk of the condition getting any worse.
We need about 18 g of fibre each day, which should come from a variety of high-fibre foods. Symptoms of wind and bloating may develop if suddenly increasing the amount of fibre eaten. Any increase should be gradual to prevent this, and to allow the gut to become used to the extra fibre. A useful guide is to make one change every few days, for example, starting by swapping white bread for wholemeal bread. It is helpful to introduce something new every few days, such as adding beans or extra vegetables to your meals or having a piece of fruit for pudding.
High-fibre foods include whole grains, fruit and vegetables. Wholemeal or wholewheat bread and flour. Wholegrain breakfast cereals such as muesli. Brown rice and wholewheat pasta, beans, pulses and legumes are also a rich source of dietary fibre.
Insoluble fibre, found in cereals, wheat bran and nuts, may cause more wind and bloating. Eating a lot of bran-based foods or taking bran supplements can particularly aggravate symptoms in some people. Therefore, it may be helpful to have more soluble fibre (the type of fibre that can be dissolved in water), found mostly in fruit and vegetables. Dietary sources of soluble fibre include oats, ispaghula (psyllium), nuts, flax seeds, lentils, beans, fruit and vegetables. A fibre supplement called ispaghula powder is also available from pharmacies and health food shops.
It is also important to drink plenty of fluids when having a high-fibre diet or fibre supplements. The aim should be to drink at least two litres (about 8-10 cups) per day. Fluid intake should be mainly from water, but tea, coffee and herbal teas all contribute.
Sticking to this diet should help prevent any further problems. If however, you do develop severe pain or feel unwell then it is important you consult with your doctor.
Dr Makis offers medical advice via his monthly article in the Paphos Post newspaper. If you require personal medical advice, contact your own GP in the first instance. For further information about Veramedica Medical Center, please contact us.