10/3/2012 10:17:00 AM Dr. K for Oct. 3, 2012 Dietary fiber reduces risk of recurring diverticulitis
DEAR DOCTOR K: I went to the doctor complaining about pain in my abdomen, and he diagnosed me with diverticulitis. I don't know the first thing about this condition.
DEAR READER: Diverticulitis is a disease that affects your colon, or large intestine. This long, muscular tube constitutes the final portion of your intestinal tract. Diverticula are sac-like pouches that protrude from the colon.
Many people develop diverticula as they grow older, but most of the time you never know you have them because they don't cause symptoms. Sometimes, diverticula can cause bleeding. There may be no pain, just blood that starts to appear in the bowel movement. Whenever that happens, it's time to call your doctor -- even if it turns out that the bleeding is caused not by diverticula but by something simple like hemorrhoids.
Now and then the diverticula become inflamed. The inflammation is caused by the bacteria that are packed into feces. It's not clear why some diverticula become infected and inflamed while others do not.
Inflamed diverticula may or may not bleed. But as you know, they can sure cause pain. The pain is usually most pronounced in the lower left part of the abdomen. Fever is also common. Other symptoms may include urinary urgency or frequency, nausea, loss of appetite and fatigue. Some patients have constipation, others diarrhea.
If the infection in the diverticula spreads into the blood, you can get a lot sicker. Your blood pressure can drop, you can get very lightheaded, you can start shaking uncontrollably -- and you can even die. I nearly lost a relative this way. So pain in the abdomen, particularly if is accompanied by the other symptoms of diverticulitis, should never be ignored.
Since bacteria are responsible for the inflammation, antibiotics are the cornerstone of treatment. Resting your intestines can also help. That means sticking to a diet of clear liquids for a few days. Then you can gradually add soft solids and resume a more normal diet over a week or two. If your diverticulitis is severe, or you're at risk for complications, you may need surgery.
Diverticulitis tends to recur. That's why prevention is a key part of treatment. A high-fiber diet sharply reduces the risk of developing diverticula. Even after the pouches form, dietary fiber reduces the risk of inflammation.
The recommendation is 38 grams of fiber a day for men age 50 and under and 30 grams a day for older men. For women, the recommended amount is 30 grams a day for those age 50 and under and 21 grams a day thereafter.
Good sources of fiber include nuts, seeds, legumes, oat cereals, whole grains, wheat and corn, bran, popcorn, broccoli, cabbage, root vegetables, onions, green leafy vegetables, and fruit and vegetable skins.
Many people experience constipation or increased intestinal gas when they increase their fiber intake. The best way to avoid that is to start with low doses and add fiber to your diet gradually. It will reduce your risk of recurrent attacks of diverticulitis.
(Dr. Komaroff is a physician and professor at Harvard Medical School. To send questions, go to AskDoctorK.com, or write: Ask Doctor K, 10 Shattuck St., Second Floor, Boston, MA 02115.)