Treating chronic diverticular disease

Photo of a woman buying vegetables (PantherMedia / avemario)

If diverticula (pouches in the intestine) constantly cause symptoms, it is referred to as chronic diverticular disease. This condition rarely leads to serious complications. A change in diet and certain medications can sometimes relieve the symptoms. If that’s not effective enough, bowel surgery is an option.

There are two main forms of chronic diverticular disease:

  • Symptomatic uncomplicated diverticular disease (SUDD): This form is characterized by constant (chronic) or recurrent symptoms such as pain, bloating and irregular bowel movements. There are often no signs of inflammation.
  • Recurrent diverticulitis: In this form, the diverticula keep becoming inflamed or infected. Although this doesn’t always lead to complications, abscesses may develop.

It’s not always possible to clearly differentiate between the two forms. Some people have both chronic symptoms and recurrent inflammations. But the treatment options are different.

How is symptomatic uncomplicated diverticular disease treated?

The treatment options for this condition include a change in diet, medication and surgery.

Diet

There is some initial evidence to suggest that a high-fiber diet can reduce digestive problems caused by diverticular disease. This kind of diet mainly consists of a lot of fruit, grains, vegetables and legumes (e.g. beans and peas). It makes the stool (“poop”) softer, increases the volume of stool and stimulates digestion. This helps the stool move through the intestine faster and reduces the pressure on the wall of the intestine. Some people who have bowel problems add linseed and psyllium husk to their diet. These contain soluble fiber that binds to water in the intestine. Because of this, people who eat a lot of fiber are also advised to make sure they drink enough fluids.

The intestine contains different types of bacteria and other microorganisms (gut flora) that play an important role in how well it works and how healthy it is. These include lactic acid bacteria and bifidobacteria. Some people with diverticula have abnormal gut flora. For this reason, it is thought that probiotics containing these bacteria might be able to help. Studies do in fact suggest that probiotics can sometimes reduce digestive problems, as they sometimes do in irritable bowel syndrome (IBS). But it’s not yet clear which products may help in different situations.

Medications

The prescription-only medication mesalamine, also known as mesalazine, has been approved for use in the treatment of the chronic inflammatory bowel diseases known as ulcerative colitis and Crohn’s disease. If it is used in the treatment of diverticular disease, it has to be used “off-label.” Mesalamine is usually taken every day for several months. Studies have suggested that it can relieve the symptoms in some people. Due to a lack of studies, though, it isn’t yet possible to know for sure how effective mesalamine really is.

Surgery

Bowel surgery can sometimes relieve the symptoms. But it is associated with certain risks and there is no guarantee that it will make the symptoms go away.

How is recurrent diverticulitis treated?

Each new episode of diverticulitis is treated like a first acute episode. Antibiotics are important in complicated diverticulitis, but they aren’t always needed in uncomplicated diverticulitis. Complicated diverticulitis – where pus-filled abscesses have formed – has to be treated in a hospital. Surgery is needed if there is an increased risk of serious complications such as peritonitis (inflamed inner lining of the tummy) or blood poisoning (septicemia).

There are various treatments for the prevention of recurrent diverticulitis. These include antibiotics, mesalamine and a high-fiber diet. When tested in studies, though, they weren’t found to effectively prevent inflammations.

People who have diverticulitis shouldn’t take painkillers like ibuprofen or diclofenac (non-steroidal anti-inflammatory drugs, or NSAIDs) because these medications can increase the risk of complications such as intestinal perforation.

It’s important to carefully consider the pros and cons of surgery for recurrent diverticulitis before making a decision. Surgery is quite unlikely to prevent complications of diverticulitis. And operations are always associated with risks. If someone also has chronic symptoms in between acute episodes, surgery might provide relief.