Only about 20% of patients with diverticulosis ever have symptoms which lead them to seek medical help. Most people never know that they have diverticula. For those individuals who have cramping pain and constipation believed to be due to diverticulosis, the usual prescription involves increasing the fiber in the diet. This can be done by adding special diet supplements of bran or psyllium seed, which increase stool volume. Bleeding diverticula can usually be treated by bed rest, with blood transfusion needed for more severe bleeding (hemorrhaging). In cases of very heavy hemorrhaging, medications which encourage clotting can be injected during the course of a diagnostic angiography.
While there are almost no situations when uncomplicated diverticulosis requires surgery, giant diverticula always require removal. This is due to the very high chance of infection and perforation of these diverticula. When giant diverticula are diagnosed, the usual treatment involves removing that portion of the intestine.
Treatment for uncomplicated diverticulitis usually requires hospitalization. "Resting the bowel" is a mainstay of treatment, and involves keeping the patient from eating or sometimes even drinking anything by mouth. Therefore, the patient will need to receive fluids through a needle in the vein (intravenous or IV fluids). Antibiotics will also be administered through the IV. Some physicians will agree to try treatment at home for very mildly ill patients. These patients will be put on a liquid diet and receive oral antibiotics.
The various complications of diverticulitis need to be treated aggressively, because the death rate from such things as perforation and peritonitis is quite high. Abscesses can be drained of their infected contents by inserting a needle through the skin of the abdomen and into the abscess. When this is unsuccessful, open abdominal surgery will be required to remove the piece of the intestine containing the abscess. Fistulas require surgical repair, including the removal of the length of intestine containing the origin of the fistula, followed by immediate reconnection of the two free ends of intestine. Peritonitis requires open surgery. The entire abdominal cavity is cleaned by being irrigated (washed) with a warmed sterile saltwater solution, and the damaged piece of intestine is removed. Obstructions require immediate surgery to prevent perforation. Massive, uncontrollable bleeding, while rare, may require removal of part or all of the large intestine.
During any of these types of operations, the surgeon must make an important decision regarding the quantity of intestine which must be removed. When the amount of intestine removed is great, it may be necessary to perform a colostomy. A colostomy involves pulling the end of the remaining intestine through the abdominal wall, to the outside. This bit of intestine is then fashioned so that a bag can be fit over it. The patient's waste (feces) collect in the bag, because the intestine no longer connects with the rectum. This colostomy may be temporary, in which case another operation will be required to reconnect the intestine, after some months of substantial healing has occurred. Other times, the colostomy will need to be permanent, and the patient will have to adjust to living permanently with the colostomy bag. Most people with colostomies are able to go on with a very active life.
Occasionally, a patient will have such severe diverticular disease that a surgeon recommends planning ahead, and schedules removal of a portion of the colon. This is done to avoid the high risk of surgery performed after a complication has set in. Certain developments in a patient will identify those patients who are at very high risk of experiencing dangerous complications. Such elective surgery may be recommended:
when an older individual has had several attacks of diverticulitis
when someone under the age of 50 has had even one attack
when treatment does not get rid of a painful mass
when the intestine appears to be narrowing on x-ray examination (this could suggest the presence of cancer)
when certain patients begin to regularly experience painful urination or urinary infections (this suggests that there may be a connection between the intestine and the bladder)
when there is any question of cancer
when the diverticular disease appears to be progressing rapidly
Rosalyn Carson-DeWitt MD, The Gale Group Inc., Gale, Detroit,