Diverticulitis

[UConnJulie]

Just wondering if anyone has any personal or professional experience with it.

It appears that my husband has an acute bout of it (his first). We seem to have caught it early. His pain started yesterday and he saw his doc today and he has given him prescriptions for two antibiotics. He is to call his MD tomorrow at 10:00 am with an update. Then he might be looking at a CTScan or something else.

He is not running a fever.
His abdomen is very distended and rather firm.
He has not pooped since yesterday morning.
He's in quite a lot of pain ... to the point where it hurts to take a deep breath and he can't stand up straight.

Of course, the doc told him nothing about what to or not to eat. I have done some research, and have an idea about what he needs to do NOW and what changes he needs to make down the road once things are healed.

Just curious what anyone else's experience has been.

(And Gabe, if you're reading this, you need not reply! )

Thanks!

[James Newman]

I generally start patients out on a liquid diet and advance it slowly over the course of a day or two giving the gut a chance to rest and reduce inflammation. It is very important to avoid much roughage, small seeds, nuts, berries, etc during the inflammatory phase (itis) of diverticular disease. Some of the smaller things may need to be avoided in the future depending upon tolerance. You will see lots of things to be avoided during the osis phase in some literature but it isn't well supported. The theory, however, is to avoid irritating the diverticula further. The following will support that goal as well much more efficiently:

As inflammation and pain subside (osis) increase the fiber and fluid intake concurrently. This should be done slowly and a good number is to shoot for 35-50 grams per day. Maintaining consistent intake of fiber and fluid are the hallmarks of the diet once you are in the diverticulosis phase.

I didn't see any mention of pain meds. This tends to slow down the bowels. I am assuming his pain is in the LLQ? Keep me posted, I will keep him in my thoughts. The Doc is likely wanting to r/o associated peritonitis, perforation, abcess, etc.

Hope this helps....

N e w m a n

[UConnJulie]

Originally Posted by James Newman

I generally start patients out on a liquid diet and advance it slowly over the course of a day or two giving the gut a chance to rest and reduce inflammation. It is very important to avoid much roughage, small seeds, nuts, berries, etc during the inflammatory phase (itis) of diverticular disease. Some of the smaller things may need to be avoided in the future depending upon tolerance. You will see lots of things to be avoided during the osis phase in some literature but it isn't well supported. The theory, however, is to avoid irritating the diverticula further. The following will support that goal as well much more efficiently:

As inflammation and pain subside (osis) increase the fiber and fluid intake concurrently. This should be done slowly and a good number is to shoot for 35-50 grams per day. Maintaining consistent intake of fiber and fluid are the hallmarks of the diet once you are in the diverticulosis phase.

Hope this helps....

N e w m a n

Newman, thank you, YOU ROCK! This is exactly the kind of information that I was hoping for.

I was planning on liquids until his pain subsides ... he's not happy about it, but I convinced him after sharing Gabe's story.

Tonight he had tomato soup.

Do you think a protein shake would be okay? (milk, gemma)
How about bananas pureed in with it?

Can he drink coffee (with cream and sugar)?

Any other meal ideas? He gets kind of cranky when he can't eat ...

[James Newman]

What has he been doing so far as far as liquids? I tend to start people out on clears for a few awhile. Ie: Broth, Juice, Jello, Coffee (no cream), water, popsicles, pulpless juice. Then work my way up to Full Liquid. Ie: Cream soups without the little bits of stuff, dairy products, and all the other liquids. I would add the protein shake with some puree banana during this time frame.

Typically depending on the severity of the case, I would say the process on liquids would be 2-3 days (both clears and full liq). Then advance the diet to low fiber, bland, tender sorts of things. As condition improves add 5-7 grams of fiber per day + adequate fluid and ambulation. This will also help the bowel movement some more too.

N e w m a n

[UConnJulie]

OK cool.

His doctor didn't tell him any of this. Just basically, "take these antibiotics" and "you probably need a CTScan but it's hard to get people in" and "call me tomorrow at 10:00 am".

I asked him what he should/shouldn't eat and he said the doc never talked to him about that. Crazy.

I wanted to start him with apple juice and he said he was starving. So I figured the tomato soup would be okay. (It was Campbell's not homemade, so it's mostly red colored sugar water anyways!!)

He refuses Jello.

I'll get some popsicles and more juice. And I'll make chicken soup tomorrow (or broth that is).

He is lactose intolerant. Would that make a difference on milk? (He normally drinks it and just deals with the gas. Nice, huh?!)

[James Newman]

Sounds like a plan. I always give preference to the clear liquids while in the acute phase. Soy milk would be fine, but I am pretty sure he doesn't want the gas at this time. We don't want to add any extra intracolonic pressure. This is why they don't give morphine anymore for the pain.

Also should he be unable to take the liquids or develop a temp >101 (some docs use 100.5) of course you would probably want to contact the Doc or ED.

[UConnJulie]

Ahhh ... I was wondering why they didn't give him anything for pain. He's pretty uncomfortable.

I do have soy milk as I have a whey allergy ... I'll give him that instead.

I also read somewhere that he would benefit from probiotics ... is it good to start that now or wait until his pain is better and/or finished with the abx?

I also read about him taking digestive enzymes and also upping the fiber.

[James Newman]

Inasmuch as I am a fan of probiotics, wait until after the abx and acute phase has resolved. Here is my thinking: There is a possibility of a perforation and the integrity of the gut could be compromised. There is much speculation about translocation of beneficial gut bacteria and its benefit or harm once outside the gut and within the body. I avoid probiotics where this might be a possibility. Hard to say either way, but I err on the side of caution. (that whole do no harm thing).

As far as enzymatic therapy, I could see them being beneficial when you start adding more protein into the diet. Though, I don't know that it would be completely necessary.

[UConnJulie]

OK, cool.

You're the best!!