DIVERTICULITIS

Treating diverticular disease and diverticulitis 

Most cases of diverticular disease can be treated at home.
The over-the-counter (OTC) painkiller paracetamol is recommended to help relieve your symptoms.
Painkillers known as non-steroidal anti-inflammatory drugs (NSAIDs), such as aspirin and ibuprofen, are not recommended because they may upset your stomach and increase your risk of internal bleeding.
Eating a high-fibre diet may initially help to control your symptoms. Some people will notice an improvement after a few days, although it can take around a month to fully feel the benefits. Read more advice about using diet to improve the symptoms of diverticular disease.
If you have constipation, you may be given a bulk-forming laxative. These can cause flatulence (wind) and bloating. Drink plenty of fluid to prevent any obstruction in your digestive system.
Heavy or constant rectal bleeding occurs in about one in 20 cases of diverticular disease. This can happen if the blood vessels in your large intestine (colon) are weakened by the diverticula, making them vulnerable to damage. The bleeding is usually painless, but losing too much blood can be potentially serious and may need a blood transfusion.
Signs that you may be experiencing heavy bleeding (aside from the amount of blood) include:

• feeling very dizzy
• mental confusion
• pale clammy skin
• shortness of breath

Diverticulitis

Treatment at home

Mild diverticulitis can often be treated at home. Your GP will prescribe antibiotics for the infection and you should take paracetamol for the pain. It is important that you finish the complete course of antibiotics, even if you are feeling better.
Some types of antibiotics used to treat diverticulitis can cause side effects in some people, including vomitting and diarrhoea. 
Your GP may recommend you stick to a fluid-only diet for a few days until your symptoms improve. This is because trying to digest solid foods may make your symptoms worse. You can gradually introduce solid foods over a two or three day period.

Treatment at hospital

If you have more severe diverticulitis, you may need to go to hospital. Hospital treatment is usually recommended if:

• your pain cannot be controlled using paracetamol
• you are unable to drink enough fluids to keep yourself hydrated
• you are unable to take antibiotics by mouth 
• your general state of health is poor
• you have a weakened immune system
• your GP suspects complications
• your symptoms fail to improve after two days  treatment at home

If you are admitted to hospital for treatment, you are likely to receive injections of antibiotics and be kept hydrated and nourished using an intravenous drip (a tube directly connected to your vein). Most people start to improve within two to three days.

Surgery

In the past, surgery was recommended as a preventative measure for people who had two episodes of diverticulitis as a precuation to prevent complications.
This is no longer the case as studies have found that in most cases risks of serious complications from surgery (estimated to be around one in a 100) usually outweigh the benefits.
However, there are exceptions to this, such as:

• if you have a history of serious complications arising from diverticulitis
• if you have symptoms of diverticular disease from a young age (it is thought the longer you live with diverticular disease, the greater your chances of having a serious complication)
• if you have a weakened immune system or are more vulnerable to infections

If surgery is being considered discuss both benefits and risks carefully with the doctor in charge of your care.

Colectomy

Surgery for diverticulitis involves removing the affected section of your large intestine. This is known as a colectomy. There are two ways this operation can be performed:

• an open colectomy, where the surgeon makes a large incision (cut) in your abdomen and removes a section of your large intestine
• laparoscopic colectomy – a type of ‘keyhole surgery’ where the surgeon makes a number of small incisions in your abdomen and uses special instruments guided by a camera to remove a section of large intestine

Open colectomies and laparoscopic colectomies are thought equally effective in treating diverticulitis, and have a similar risk of complications. Laparoscopic colectomies have the advantage of having a faster recovery time, and cause less post-operative pain.
Laparoscopic colectomies are a relatively new technique and may only be available at specialist surgical centres. There may also be a longer waiting time for this type of surgery.

Stoma surgery

In some cases, the surgeon may decide your large intestine needs to heal before it can be reattached, or that too much of your large intestine has been removed to make reattachment possible.
In such cases, stoma surgery provides a way of removing waste materials from your body without using all of your large intestine.
Stoma surgery involves the surgeon making a small hole in your abdomen known as a stoma. There are two ways this procedure can be carried out. These are explained below.

• An ileostomy, where a stoma is made in the right-hand side of your abdomen (stomach). Your small intestine is separated from your large intestine and connected to the stoma, and the rest of the large intestine is sealed. You will need to wear a pouch connected to the stoma to collect waste material.
• A colostomy, where a stoma is made in your lower abdomen and a section of your large intestine is removed and connected to the stoma. As with an ileostomy, you will need to wear a pouch to collect waste material.

In most cases the stoma will be temporary and can be removed once your large intestine has recovered from the surgery. This will usually take at least nine weeks.
If a large section of your large intestine is affected by diverticulitis and needs to be removed, you may need a permanent ileostomy or colostomy.

Results of surgery

In general terms, surgery is usually successful, although it does not achieve a complete cure in all cases. Following surgery, an estimated one in 12 people will have a recurrence of symptoms of diverticular disease and diverticulitis.

Reference

http://www.nhs.uk/Conditions/Diverticular-disease-and-diverticulitis/Pages/Treatment.aspx