Natural Treatments And Remedies For Diverticulitis
Occasionally cystoscopy, to demonstrate colovesical fistula, or angiography and technetium red cell scanning, to demonstrate a source of colonic blood loss, may be required.
Patients with a change in bowel habit, blood per rectum or recurrent abdominal pain will require outpatient investigation to determine the cause of their symptoms. Rigid sigmoidoscopy and barium enema or total colonoscopy are the mainstays of investigation. Asymptomatic diverticulae are present in at least one in three of those aged over 65 and therefore diverticulitis can only be safely diagnosed when the clinical picture is compatible and there is no other identifiable pathology, especially malignancy.
Provided the patient has no systemic upset, patients with acute diverticulitis do not always require admission to hospital and can be treated effectively at home with oral antibiotics (amoxycillin with clavulanic acid, and metronidazole for five days), oral fluids, analgesia and bed rest. If pain either does not settle within a few days, worsens or becomes more generalised, or if the patient develops systemic signs (that is, a rising pulse rate or temperature), emergency referral to hospital is required. Patients who present with generalised abdominal pain and/or signs of peritonitis require emergency referral to hospital.
Uncomplicated disease may be treated with dietary manipulation. A high fibre diet and/or pharmacological bulking agents such as ispaghula husk are recommended and patients should be advised to drink plenty of fluid. Pain due to smooth muscular spasm may be adequately relieved with antispasmodics such as mebeverine. The role of surgical resection in uncomplicated disease is controversial and should not be undertaken lightly. Laparotomy and myotomy (division) of the hypertrophied sigmoid smooth muscle has rightly been condemned to the history books. Elective surgery Complications such as fistulae or strictures will require surgical resection of the diverticular segment of colon and primary anastomosis. Patients presenting with recurrent episodes of diverticulitis may be offered resection when they are medically fit and any other pathology has been excluded. One-third of patients admitted with an episode of diverticulitis can be expected to be readmitted within five years with similar problems. Elective surgery is associated with much lower morbidity and mortality; resection and primary anastomosis is usually achieved, though occasionally a diverting stoma may be required. Emergency surgery Patients with generalised peritonitis requires effective resuscitation with intravenous fluids and antibiotics prior to surgery. Large bowel perforation is a serious condition and nearly half of all patients presenting with faecal peritonitis will die from their condition. Purulent peritonitis resulting from the rupture of a diverticular abscess results in lower, but still significant mortality rates. Patients with acute diverticulitis who do not respond to conservative therapy may also require surgery. In such cases the inflamed diverticular segment or phlegmon can be resected and a primary anastomosis is usually possible. Where there is excessive faecal or purulent contamination of the peritoneal cavity, resection of the affected segment is required, but primary anastomosis may not be appropriate. In such situations the rectal stump is closed and the proximal colon is delivered as an end colostomy. This is termed Hartmann's procedure. The colostomy can be safely closed for most patients following Hartmann's procedure, and many units report reversal rates in excess of 80 per cent. Schulze's Intestinal Formula 1 and Formula 2 have helped thousands with their bowel concerns. Although some experience the usual cleansing symptoms such as cramping and gas, that just means there is impaction that needs to be moved out and the quicker the better.
| 