Foods Are Sometimes Our Enemies
When colonic diverticula cause trouble, although Cure Diverticulitis in asymptomatic patients is neither cost-effective nor clinically useful, the presence of diverticula is commonly noted when the colon is studied for another reason via barium enema, colonoscopy, computed tomography (CT) scan, or ultrasound. When symptom less diverticula is discovered, it is important to inform the patient of the possible implications without giving cause for great anxiety. It may help to have the patient read an informative pamphlet and then to discuss the patient's questions or worries.
Follow-up when diverticulosis is asymptomatic consists of providing counseling about dietary measures that presumably reduce the risk of inflammation and further formation of diverticula. Keeping the colon active and maintaining regular bowel habits is an effective approach for inhibiting further herniation.
The best advice is the same as you would give to any patient interested in maintaining a sound diet: Eat sensible amounts of foods low in saturated fats and refined sugars, keep caffeine at a moderate level, and include high-fiber choices on a regular basis. Very large meals, even of the most sensible foods, may cause gas or peristaltic problems that put high pressure on the colon. At least 30 g/d of fiber is the usual recommendation.
The rationale is to increase stool volume and keep the diameter of the colonic lumen large enough to avoid closure during contraction. Since "regularity" means different things to different people, emphasize that having a bowel movement every two or three days is "regular" if that is the patient's usual pattern and if the stools remain soft, formed, and easy to pass. One bowel movement a day is probably ideal, but two a day, or even more, are harmless as long as the stools are formed. Another important point that patients tend to be unaware of is that adequate dietary fiber or a fiber preparation can minimize pressure in the colon: when hardened matter piles up in the colon, gas may rise high enough to rupture a weakening diverticulum. Dissuade the patient from frequent or habitual laxative use by explaining that reliance on laxatives prevents rather than aids regularity. In addition, laxatives or enemas increase colonic pressure. The explosive, watery stools brought on by laxatives may be highly irritating as well. Despite the plethora of information about dietary fiber in the popular press, many patients consider the only significant sources of dietary fiber to be grain products, especially bran. While bran is an important source of fiber, a patient's awareness of other high-fiber foods may need expansion. For instance, many fruits and vegetables, with or without their skins, raw or cooked, provide up to 7 or 8 g of fiber per serving. The list of these foods is so varied that practically anyone can get 30 g/d of fiber without adding anything unfamiliar or unappetizing to the diet.
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