Shhhhhh. My colon is resting.
July 20, 2014 6:59 AM   Subscribe

I ended up in the ER on Thursday night with horrible stomach pain, lower left quadrant. After being scanned inside and out and subjected to other personal indignities I won't describe in detail (promise), I was diagnosed with acute diverticulitis. What happens now?

Hi, Mefites. I know you're not my doctors, and any advice you give will not be medical advice.

Me: 44, very overweight, female. I have no history of high blood pressure or diabetes. I'm extremely, extremely gluten sensitive. I recently lost a ton of weight on the paleo diet, and gained about a quarter of it back over the past six months or so, mainly due to the existence of potato chips and gluten free pizza. I know all the wrongs I've done myself, so there's no need to point that out, thanks.

My pain was very, very, very bad, and I have a lot of health anxiety, to put it mildly. I'd had diarrhea and constipation off and on for a few weeks, then about a week of steadily increasing pain. My GP diagnosed me with a UTI and put me on nitrofurantoin, which I took for a couple of days. When I told her the pain was getting worse instead of better, she said to keep on with it, and wait it out. Unfortunately -- or fortunately, I guess -- I'm just not that tough.

My ER PA was awesome and very calming, my nurse was great, A++ emergency room experience, especially since I didn't turn out to have tumors anywhere (which is what I was mostly afraid of). But they were very harried and busy, and when I left I was in a post-morphine-and-not-terrible-news haze, so I didn't get a very clear picture of what I could expect to happen next. I know I need to follow up with my GP (I'm not looking forward to that conversation - sorry, I didn't trust you so I went to the ER, and it turned out you were wrong...sorry!?!). I know I need to follow up with a gastroenterologist. I know I need to NOT be googling things.

However, I have been googling things. I just wanted to know what one could expect after diverticulitis. As it turns out, the only people who really talk about diverticulitis on the internet have had forty perforations and three bowel resections and live lives of misery, pain and fear. I'm sincerely hoping that's the 3% of diverticulitis patients who have very bad cases, and not a glimpse into my future.

What I'm looking for:

1) Anecdotes/experiences with mild diverticulitis. What was recovery like? How long did it take? What do you do differently now to prevent it coming back? ...did it come back?

2) Is all diverticulitis chronic? The internet seems to differentiate between acute and chronic, but I can't tell if they're describing acute phases of a chronic disease, or if it's really possible to just have one bout of it and not get it again (assuming you don't repeat previous mistakes).

3) Opinions - can people who have had diverticulitis really never eat corn or nuts again? No pistachios again EVER? I know that's a weird thing to stick on, but I REALLY like pistachios. They're my go-to salty-crunchy when I'm not off the paleo wagon. The internet seems split on this topic as well.

4) Any tips on surviving a forced 5-day fast/cleanse?

YANMD, I am not asking for medical advice! Throwaway email address:
posted by anonymous to Health & Fitness (15 answers total) 4 users marked this as a favorite
Mom has it, and she gets flare-ups once in awhile, for which she gets heavy-duty antibiotics and sometimes some heavy-duty pain meds. There seems to be some sort of controversy over whether she should eat anything with seeds or not. One of her doctors says absolutely not, the other says it's not really as big a deal as you'd think.

She has had flare-ups after eating nuts the night before, but that's totally anecdotal.
posted by xingcat at 7:35 AM on July 20, 2014

Diverticulosis - the existence of pockets in the sides of your intestines - is a chronic condition, but diverticulitis doesn't have to be. It can be chronic (symptoms/infections subside but are never truly gone), recurrent (separate bouts over and over again - though some people may call this chronic), or a one time thing. A high fiber, well hydrated diet may help this be a one time thing for you, though diet is by no means the only factor in how your condition behaves. Plenty of people with diverticulosis never have diverticulitis.

"No nuts and seeds ever again" is not the current advice for patients with diverticular disease. I mean, yes, definitely avoid them (and anything high in fiber) during a bout of diverticulitis, but once the inflammation subsides, feel free to continue eating them as long as they don't cause you problems. They research just doesn't support cutting them out for all diverticulosis patients. Being an extra vigilant chewer certainly won't hurt, though.
posted by obfuscation at 7:39 AM on July 20, 2014 [3 favorites]

My dad has this and the last flair up was because he decided to eat 5 ears of corn in one sitting. Before that he decided to eat a giant bag of pistachios. Anyway, he now sticks to 1 ear ear of corn & a handful of pistachios instead of gorging on them. Hasn't had a flair up in a long time.
If I remember correctly, he was in the hospital for about 3 days and he would have been out sooner but they wouldn't let him out until he had a bowel movement.
posted by govtdrone at 8:14 AM on July 20, 2014 [1 favorite]

Here is a page from the National Institutes of Health (US) that has a lot of information:

This disease is kind of like your body has an extra appendix (or, maybe a lot of them) that can get inflamed and worse. Just the way not everyone has appendix problems, not everyone gets diverticula problems, but occasionally the situation can become life-threatening. It sent my mom to the ICU more than once.

The main prevention measure for not getting diverticulosis, as well as not making it worse, is NOT STRAINING. Seriously, have some fruits, have some yogurt, have some veggies. Take a magazine. Take up knitting to pass the time. Bowel movements should not involve straining or pain. (And actually, if you have a varied diet with enough fiber you won't need to take up a passtime.)
posted by zennie at 8:24 AM on July 20, 2014 [1 favorite]

4) Any tips on surviving a forced 5-day fast/cleanse?

Were these really your discharge instructions? It's not safe to fast for five days unless you're under medical supervision. Do you have more details about your aftercare instructions you can share? I have been NPO (nil per os, nothing by mouth) for five days before but only while I was an inpatient.
posted by telegraph at 9:42 AM on July 20, 2014

I'm the OP, in a sock account. Thanks very much for the answers so far.

telegraph - When I went in to the ER on Thursday, I'd had nothing solid since about 9:30 am. I was in the ER until just after midnight. At that time, they told me to stay on a clear liquid diet "for a few days, until you start to feel better" and to follow up with my GP. I have yet to start feeling appreciably better, so I haven't dared try anything solid.

Friday, I went to work (possibly not my best idea ever; I felt mostly fine when I woke up, mostly fine at work, but was really wiped out and achy by the time I got home). All I had Friday was some cranberry juice and black coffee in the morning. The rest of the day, water.

Saturday, mostly water until around 6pm, then I had some salted broth and some apple juice.

Today I've had apple juice and water. Not really very much of either. I've got some jello slowly becoming jello in the fridge, and I was thinking I might try some white rice cooked in chicken broth later.

So, I'm not water fasting and I'm not cleansing. I'm just on liquids. Basically liquids and antibiotics at the moment.

I probably won't be able to see my GP until Tuesday. I called the nurse advice line at my insurance plan (a pretty good plan) and it was fairly useless - she was reading from a database and seemed never to have heard much about diverticulitis. So I'm kind of floundering right now on what to do with myself. I have a call in to my GP's on-call service but haven't heard back.

There's a lot I'm not sure about right now - for instance, do I need to be on bed rest? I wasn't told that at the ER but the internet seems to think I should. Is it okay to sleep on my left side, or will I burst something? (That's how I sleep! Basically the only way I sleep.) Is it okay to go back to work tomorrow? I have some pain, but I'm not by incapacitated. My job is sitting at a desk all day. I can do that. These are all things I plan to ask the on-call doc when I hear back, so I'm not expecting any medical advice here; just stuff I'm wishing I'd thought to ask at the ER.
posted by antimony_hayes at 11:13 AM on July 20, 2014

20 years ago, my mother was diagnosed with diverticulitis. She constantly talks about being worried about what she can/cannot eat but she seems to eat what everyone else is eating (she's a bit of a hypocondriac).

A good friend of mine was experiencing frequent and intense bouts of inflamation from diverticulitis even though she was very careful to avoid seeds and nuts. Last year she needed to have a bowel resection. The surgery and recovery were pretty intense, but she hasn't experienced any flare-ups since.

I don't have diverticulitis, but I thought I did - I was sure it was either that or IBS. I had lots of intestinal pain and fluctuated between constipation and diarrhea. I toughed it out for a few years and tried to control it by diet, but nothing worked. My doctor referred me to a gastroenterologist and I had my first colonoscopy. It was colon cancer. Chemo, radiation, resection, 12 years and several colonoscopies later, and I'm fine. My point is, follow up with a gastroenterologist. I don't want to freak you out or suggest that the ER doctor was wrong in saying you don't have any tumors, but without a colonoscopy, I don't think cancer can be ruled out.

On preview, there is no need for bed rest, but you probably won't have the energy level you're used to due to the lack of nutrients. Sitting all day is not the best thing when you're having trouble with your bowels, so if you do go in to work, be sure to get up regularly and walk around. Please, don't panic over this - stress only makes intestinal problems worse. Colon cancer is unlikely and it's not a fast moving type of cancer. Diverticulitis is painful, but it's my understanding that bursts are not common. IANAD.
posted by kbar1 at 11:52 AM on July 20, 2014 [1 favorite]

OK I do not understand this bowel rest protocol. Five days without nutrition is a long time. In hospital if they put you on bowel rest they support you with tube feeding.

Do you understand why you were put on precisely five days of bowel rest? Cause if not, you should call the hospital. Did they provide phone numbers for dietitian support or specialists in your discharge papers? Call those numbers if you have them.

Otherwise, yeah clear fluids is the start. Clear fluids includes broth, which you should eat for the sodium, and also sports drinks which you might take for the potassium. The progression after this is to full fluids. Start with milk and juice but progress to a diet supplement such as Boost or Ensure. After that, you should have received a food recommendation cause I don't know diverticulitis and if it's a low residue, low fibre, low fat, or just general low flavour diet you try before attempting full diet.

Start calling through the hospital directory and get a number for Monday to contact the dietitian if you don't already have it. Otherwise, get the broth and Gatorade and hope for the best.
posted by crazycanuck at 1:08 PM on July 20, 2014

Sorry OP I missed your sock puppet follow up.

I listened to a diverticulitis discharge once and spent a lot of time in GI ward, but I am not a doctor. I would say that if the doctor let you walk out of the hospital you don't need bed rest. They would have mentioned that.

You don't have a precise time line for resting from food, good. Chicken and rice should be fine but get the Boost anyway cause if you can tolerate it you will resume a full calorie diet faster.

You can sleep however you want, if there was a restriction like that they would have mentioned it.

You could theoretically go to work tomorrow but if it is practical I would suggest staying home and getting some rest because you will feel like shit without proper nutrition.

Good luck with the GP, don't leave without referral to gastroenterologist and dietitian.
posted by crazycanuck at 1:18 PM on July 20, 2014

I'm a doctor but not your doctor, this is not medical advice. I often tell people who are having trouble with nausea, vomiting, and diarrhea that they should try a diet of "clears" or BRAT-type diet for a while, but it's not a set time period, it's just to help them feel better - especially because a lot of folks don't seem to realize that eating a double cheeseburger or a bucket of hot fried chicken wings is rough on your digestive tract. The phrase is "advance as tolerated", meaning you can eat real food whenever you feel like it.

People with diverticulitis are not normally required to be on bed rest. Bed rest is not a good idea for most medical conditions - it actually puts you at risk for other problems like blood clots and makes you more deconditioned. Do not go on bed rest if you have not been advised to by your doctor.

I tell my patients with diverticulitis to go to work only if you feel up to it. I would tell them it doesn't matter what side you sleep on (I've never heard of the side-sleeping thing you mention).

Diverticulitis is a very common problem because we don't have enough fiber in our diets, for the most part. It does not mean you are more likely to have cancer. I'm not sure what the answerer above was implying when they said cancer could not be ruled out, but diverticulitis is not caused by cancer, it is caused by diverticulosis. Some people do get recurrence of diverticulitis and need surgery, and some (a lot) don't. You're definitely seeing a subset of the worst cases in your web searches.

Here is what eMedicine, my favorite online medical reference, says about diet after diverticulitis:
"In mild episodes, a clear liquid diet is advised. Clinical improvement should occur within 2-3 days, and the diet can then be advanced as tolerated...

Studies imply a high-fiber diet will prevent progression of diverticulosis. However, after patients have become symptomatic, the benefit of fiber supplementation is less clear. Recommending to patients to avoid seeds and nuts is currently less common, since it is now thought that seeds and nuts may not play a significant role in the development of diverticulitis, as believed in the past.
Long-term management probably includes a high-fiber, low-fat diet."
posted by treehorn+bunny at 4:40 PM on July 20, 2014 [3 favorites]

I don't have experience on this, but I do have some experience on having a few days of just liquids, and you are going to feel wiped out regardless of the diverticulitis if you're consuming that little in the way of calories all day. Broth, sports drinks, whatever, you probably should not be having plain water unless you really cannot possibly stomach anything else or else you're really sure you've taken in enough sustenance already. This is really, really not medical advice, but while I don't drink much soda ordinarily, when necessary I sometimes switch back to Coke because I find it more appealing to drink. Spread it throughout the day, too, because it won't stick with you the way that solid food does. I have no idea what your diet should really be like at this stage, I'm just saying, if you're going to do fluids only, you have to be a bit careful or you won't be taking in enough to give your body the sugars and electrolytes it needs to run even in the short term.
posted by Sequence at 5:14 PM on July 20, 2014 [1 favorite]

OP here - Again, thanks to everyone for the thoughtful answers. I'll advance the diet a little now, because I'm tired and hungry, and see how I feel. I still have some pain, but it's not extreme. I feel sort of like I've strained my left side. Earlier I had a banana; now I'm going to try some rice.

To follow up, other things I forgot to mention - I've had a fairly recent colonoscopy (4 years ago). I've had amyopathic dermatomyositis for about 8 years (dating to when I noticed the first gottron's sign on a knuckle). I was positively diagnosed 4 years ago, and at that point I was scanned, x-rayed, ultrasounded, blood-tested, etc. to within an inch of my life. Diverticulae were noted in the colonoscopy at that time, with no -itis however. (A lot of my health anxiety comes from the dermatomyositis diagnosis; I went to the dermatologist thinking I had eczema and left with a lifelong condition. I've been a little hypervigilant ever since. All the blood tests at the ER were negative for scary; I don't have a lot of detail on that, but I imagine my GP will when I see her. Urinalysis was also fine.

treehorn+bunny, I really appreciate the detailed reply, which was not medical advice! I do have one question about the e-medicine quote. My hope was to be able to return to paleo-style eating for health and weight loss after recovering from this -- which can be high fiber with enough fruit and vegetables, but can't really be low fat if it's going to work. Would you say that's a bad idea?
posted by antimony_hayes at 5:29 PM on July 20, 2014

If there is one thing you didn't mention in your post, it's if you have a Gastro doctor or not. The first thing I would do if I was you is get a referral from your General Physician and get to a Gastro doctor. You'll need to to some tests - some suck, but you can get put under for them. I cannot stress enough how much my Gastro doctor has improved my life. For *years* I was just dealing with my GP and an occasional ER visit. But my recent Gastro doc has changed my life for the better.

tl/dr If you are dealing with *any* type of gastrointestinal issues, go to an actual Gastro doc for a correct diagnosis and you'll be in a much better position to deal with this.
posted by punkrockrat at 8:42 PM on July 20, 2014

Hello antimony, this is really a better question for your gastroenterologist (I'm not a gastroenterologist or an internal medicine physician, I'm emergency medicine). I did a little PubMed research on your question, though and unfortunately I did find some evidence to suggest that a lower fat diet, and specifically, avoiding red meat, could contribute to prevention of diverticular disease. Obviously, one could do a paleo diet and avoid red meat, but that would be very restrictive.

The paper I linked there (a free full text article) does qualify the statement about fat intake by saying that a higher fat intake had a greater negative impact if the diet was also low in fiber - which wouldn't apply to a paleo diet, but still doesn't get you off the hook entirely. However, I would also note that there is some strong evidence in the literature for a link with obesity and diverticular disease, so if the paleo diet is the only thing getting you to lose weight, then that should be considered in the risk:benefit equation.
posted by treehorn+bunny at 9:55 PM on July 20, 2014 [2 favorites]

I was hospitalized for diverticulitis several years ago. This tends to be an old person's disease, and I gather it is not that unusual for it to be misdiagnosed in a younger person. I also have complex treatment resistant digestive issues the gastro docs have christened under the almost entirely useless diagnostic umbrella of IBS. So I've done a lot of navigating of these waters.

I don't know what kind of testing and diagnosis they did at the ER - I assume you had a CAT scan? But I can tell you that I was immediately hospitalized for 3 days for my diverticulitis, then spent 2 weeks at home on percocet and crushingly strong doses of two scorched-earth type antibiotics, so I would think your case is not as bad. And I've had no recurrence of the diverticulitis, and my follow up showed no serious physical issues with my colon, so yes - you need not assume the cases you're reading on the internet are descriptive of your future.

Here is a good basic article on diverticulosis. Here is another. As you'll see in the second article, unfortunately the medical facts on this condition aren't all settled or unambiguous. Finally here is the Mayo site article.

My recommendations out of the hospital were to follow a low residue diet (I would add to this that aside from restricting fiber, I found it very helpful to just eat particularly lightly, moderate fat, drink a lot of water and take no caffeine). After complete recovery I worked slowly up to a higher fiber diet. I was recommended to give up caffeine and though I struggled mightily to resist this advice I've come to the conclusion that it does in fact aggravate my issues (though as I noted above mine are complicated and multifactorial).

Please follow up with your GP as soon as you're feeling better enough - you have nothing to feel bad about, the pain got severe and you appropriately went to the ER. Though I guess I will say that given diverticula had been noted in your colon I wonder if this should have been on the radar. I don't know but something for you to think about in terms of how you feel about your GP. But for now, you need a referral to a gastroenterologist and will probably be recommended to have another colonoscopy.
posted by nanojath at 8:29 AM on July 21, 2014 [1 favorite]

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