Colonic Diverticula - Treatment

Treatment of diverticular disease of the colon is conservative and surgical. Indications for surgical treatment are severe complications of the disease - massive, life-threatening bleeding, perforation of the diverticulum, peritonitis, abscess, fistulas, increasing intestinal obstruction and suspicion of cancer.

The choice of conservative treatment is determined by the characteristics of the clinical course, the severity of the inflammatory process, motor disorders of the colon, the presence and nature of dysbacteriosis, complications and concomitant diseases.

Treatment of uncomplicated diverticular disease involves eliminating symptoms and preventing inflammation. A diet rich in dietary fiber is prescribed, which increases stool volume, reduces intra-intestinal pressure, and promotes bowel movement, which is important for patients prone to constipation. The diet should include at least 200 g of fruits and vegetables, salads, and wholemeal bread. If necessary, wheat bran is added, the dose of which should be slowly increased from 2-5 to 20-25 g per day, since bran can initially cause flatulence. After a few weeks, flatulence spontaneously disappears. A deficiency of bran is a bad taste. A possible side effect is an increased loss of calcium, phosphorus, magnesium, zinc, and possibly iron with feces.

Exclude from the diet foods that cause intestinal bloating (legumes, lentils, grapes, etc.) and constipation (blueberries, white rice, etc.). Also exclude seeds, fruit grains, and very coarse fiber (radishes, turnips, radishes, persimmons, pineapples). Only in case of diarrhea are foods that increase peristalsis and secretion in the intestines limited, if necessary, even briefly excluded, with subsequent gradual expansion of the diet as the stool normalizes. Foods containing fiber are first, and if poorly tolerated, then further, processed (chopped, boiled) and prescribed in small portions.

In most cases, dietary measures, therapeutic exercise, hydrotherapy and psychotherapy can help achieve regular bowel movements and eliminate pain in uncomplicated diverticular disease.

Drug treatment of diverticula is recommended only if clinical symptoms persist despite the above measures. In these cases, the minimum effective dosage of drugs is necessary. Laxatives are contraindicated for patients with diverticula, because they cause spastic contractions of the intestine and increased intraluminal pressure, and with prolonged use, constipation may increase and side effects may develop, such as hypokalemia. To eliminate constipation, drugs that absorb water, increase in volume and irritate the receptors of the colon are effective. This is the mechanism of action of seaweed, flaxseed, plantain seeds, mucofalk, sterculia, methylcellulose. The dose is selected individually. When taking the medicine, the patient should drink 1.2-1.5 liters of liquid per day, since even slight "gluing" of the intestinal contents can have the opposite effect.

To eliminate diarrhea (in most cases it alternates with constipation), you should temporarily limit the consumption of fiber, and if necessary, prescribe astringent, adsorbent properties (white clay, calcium carbonate, carbolene, bismuth preparations, smecta). Smecta, a natural remedy, has a good antidiarrheal effect. The drug is a stabilizer of the mucous membrane of the digestive tract, protecting it from the effects of various aggressive factors, including intestinal microorganisms and their toxins. A possible side effect is constipation. The adsorbent properties of the drug can affect the absorption of other drugs, so other medications should be taken at least 40 minutes to 1 hour before or after taking smecta and other adsorbents.

It is important to eliminate flatulence, which is one of the causes of increased intestinal pressure. Since the causes of flatulence are varied, its treatment is also different. Gas-forming vegetables are excluded, and in case of intolerance to whole milk, it is diluted. In case of achlorhydria and flatulence, drugs such as gastric juice are indicated, and in case of exocrine pancreatic insufficiency - enzyme preparations. In case of dysbacteriosis, it is necessary to normalize the intestinal microflora. In addition, adsorbents are prescribed. Physical therapy is advisable to accelerate the transport of gases and to enhance their diffusion.

In cases where the appearance of clinical signs is associated with anxiety, depression, negative emotions, sedatives, psychotropic drugs, and psychotherapy are recommended.

Patients with severe motor disorders of the colon (hypermotility predominates in diverticulosis) and pain are prescribed treatment with antispasmodics (no-shpa, papaverine, baralgin), anticholinergics (platifillin, atropine, metacin, etc.) for 1-2 weeks. Longer use of these drugs can worsen constipation. Metoclopramide gives a good effect.

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