Managing Diverticulitus

Diverticulosis  is a physical abnormality that usual affects the colon. Once its small pockets form, it will be your unwelcome companion for the rest of your life. About 10 percent of Americans older than 40 have diverticulosis. The condition becomes more common as people age, and about half of all people older than 60 have diverticulosis. I am one of those people. It is possible to have diverticulosis and never have a bout of diverticulitis, but I was not so lucky.

A year after my first crisis episode I took up cycling again after a 25yr hiatus. I had to up my management game to stay healthy, as cycling puts a lot of stress on the body, requiring some special attention. It is helpful to think of managing diverticulitis in three stages. Crisis, Remedial, and Recovery.

Crisis stage can be as minor as a partial or missed bowel movement, or it can be so bad you're curled up on the floor in the fetal position, running a high fever after days or weeks of crippling fatigue.

The crisis phase can also be broken down into threes. Onset, Moderate, and Severe. Making the distinction is important in deciding what remedial action to take, because with diverticulitius, a proportional response dramatically improves the outcome.

Onset conditions are mental red flags that your normal routine is not being observed, or is not working. The key to good management here is monitoring your body to detect trouble before it starts. Did you miss a BM? Did you eat something like beef, pizza, or pasta with very little fiber? Has your stool been dry? Have you felt sluggish and dull the last 18-24 hours? Are you cramping? Do you have gas and burping at the same time?

This checklist, with your own modifications and punctuations, should become an old friend. Keeping track of what you've eaten for the last three days is a bit like counting cards. It's a skill you acquire, and it pays big dividends.

Remedial actions for onset conditions are simple. Drink 30-60 oz of water, eat some oatmeal (raw or cooked), have a bowl of raisin bran, eat a few handfuls of strawberries, eat an apple, drink 8-24 oz of prune juice, go for a walk, do 100 jumping jacks, stay out of the heat. Onset lasts until you have a BM that completely clears your bowels. You aren't sick yet, and you won't be if you can get things flowing along nicely again.

If managed well, recovery can be avoided completely. This is a speed-bump, not a detour. Continue to eat your normal high-fiber diet, and carry on as usual.

Moderate conditions usually occur because peer pressure, personal goals, or unknown factors temp us to cheat on our tried and true routine. Getting up unusually early, anxiety about an event, eating an unusual diet, or getting dehydrated in the heat are typical causes. Eating at a restaurant to celebrate a special occasion, or when traveling, exposes you to unfamiliar foods, and that often causes problems.

With moderate conditions you can be further along in the episode's timeline, have more serious symptoms, or both. You need to act faster, more aggressively, and monitor your progress more closely. Your choice of remedies is more restricted, and somewhat different. Take immediate action, and if in doubt, err slightly on the side of too much, rather than too little.

If you have adequate fiber in your GI tract, large quantities of water, up to a gallon or two, can be very helpful, and may prove remedy enough. More likely this will have to be augmented with something that can "tunnel" through the log-jam and get things moving again. Prune juice has this marvelous property. Fruit, berries, commercial fiber supplements, nuts, and grain fibers generally don't. It is usually prudent to take at least a low dose of laxative as part of this response. Having to take a laxative is a sign your prevention protocols aren't up to snuff, but worry about that later. Right now you need to flush stagnant food, bad bacteria, and budding infections out of your system.

Severe conditions occur because of neglect, unusual, or traumatic conditions. Doing a double century ride a long drive's distance from home in 100+ degree heat, and eating pizza as your recovery food, will certainly get you there. So will a long flight in a bone-dry airline cabin, fiber-free airline food, and collapsing into bed when you finally get home. Strange foods with unpredictable consequences, like a big beef steak, baked potato, beer and no salad, or lots of beefy food in hot weather, will all do you in. Favorite family recipes during holidays can also be mine fields. (Happily, 2-3 tablespoons of dry oatmeal eaten as "dessert" will make almost any food acceptable)

Remedial action should be immediate. Get off the freeway at the first off-ramp, buy a case of bottled water, a good laxative, and maybe some Prune juice. Don't eat ANYTHING solid, and whatever you do, DON'T STRAIN to force a BM. In crisis mode the bacteria in your colon is already growing, and weakening your gut. If you strain, and your gut leaks, you risk a long hospitalization or even death. This was the condition that nearly killed Fidel Castro.

If you haven't had a complete BM within 6-8 hours of your initial response, it's time to nuke yourself with the strongest of chemical laxatives. Kaiser Permanente, and many other health organizations, recommend Fleet phospho-soda and 4-6 liters of 7-Up before rectal exams, and having experienced it first hand, I can tell you it will utterly and completely clean you out! Gatorade type drinks can be helpful in preventing dehydration here. You need to be home for this treatment, as you and your bathroom will become best of friends for the next 4-6 hours. Not the most pleasant experience, but much, much better than a long stay in the hospital, or risky colon surgery.

Severe conditions, because of the attendant GI tract purge, and the devastation this causes to the complex environment that supports proper digestion, require a little more care in the recovery stage. First, go easy. Less is more. You'll feel like you've been kicked by a horse, so eat something soothing, like yogurt or ice cream, but nothing solid. Except for creamy oatmeal, keep the level of fiber in your diet very low. This just isn't the time. Water is good, perhaps with some salty crackers to help restore your electrolyte balance. This is especially helpful if part of the root cause was dehydration.

The Crisis and Remedial phases were covered together because the two must be paired for best results. A weak response allows the condition to worsen quickly, and one that is too strong rocks the boat so hard it makes recovery long and difficult - not to mention, downright unpleasant.

Recovery, once past a severe condition, is generally the same for all levels of severity. Initially, favor foods that are fairly low in fiber, and are easy to digest. How much fiber is a judgment call, and requires some finesse. Let experience be your guide.

Steer clear of any food that might contain pathogens, such as raw meats, fresh fruits, and vegetables. You're not in a position to weather e-coli or salmonella. Stick to well-cooked, long-dead food that's been sitting in a can or a jar for a long time. Yes, I know, this is horrible nutrition, but you've likely been losing 2-3 lbs a day, are dehydrated and hypoglycemic, so job 1 is to get some energy back and then worry about good nutrition. Try some premium blueberry or strawberry preserves on crackers. Think of this as an opportunity to enjoy favorite foods otherwise off-limits!

After 2-3 days go back to your normal high-fiber diet in a gradual way, and keep quantities in check. Monitor for Onset conditions, and adjust accordingly. Over time your GI tract will probably become stronger and more robust, and much less sensitive to the occasional transgression. As your management skills improve you may find months go by without incident.

The high fiber diet needed to manage diverticulosis will lower your cholesterol, help prevent diabetes, and probably lower your triglycerides as well. Throw in a commitment to regular exercise, and your overall health will improve substantially. With good diet, everything moves in a good direction, allowing you to live a normal, active life for years to come.