Colon 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, diverticulum perforation, peritonitis, abscess, fistulas, increasing intestinal obstruction and suspicion of cancer.

The choice of conservative treatment is due to the peculiarities of the clinical course, the severity of the inflammatory process, motor disorders of the colon, the presence and nature of dysbiosis, complications and concomitant diseases.

Treatment of uncomplicated diverticular disease involves the elimination of symptoms and the prevention of inflammation. Assign a diet enriched with dietary fiber, which increases stool volume, reduces intestinal pressure, promotes bowel emptying, which is important for patients with a tendency to constipation. The diet includes at least 200 g of fruits and vegetables, salads, wholemeal bread. If necessary, add wheat bran, the dose of which is recommended to slowly increase from 2-5 to 20-25 g per day, since bran initially can cause flatulence. A few weeks later meteorism spontaneously disappears. The lack of bran is a bad taste. A possible side effect is an increased loss with feces of calcium, phosphorus, magnesium, zinc, and possibly iron.

From food exclude products that cause swelling of the intestines (legumes, lentils, grapes, etc.) and constipation (blueberries, white rice, etc.). You should also exclude sunflower seeds, fruit grains and very coarse fiber (radish, turnip, radish, persimmon, pineapple). Only with diarrhea are limited, if necessary, even temporarily exclude foods that increase peristalsis and secretion in the intestines, followed by a gradual expansion of the diet as the stool is normalized. Products containing fiber, first, and if poorly tolerated and later, subjected to processing (grinding, cooking) and assigned in fractional portions.

In most cases dietary interventions, exercise therapy, hydro- and psychotherapy can achieve regular stool and eliminate pain in uncomplicated diverticular disease.

Medicinal treatment of diverticulums is recommended only at preservation of clinical symptoms, despite the above-stated actions. In these cases, a minimum effective dosage of drugs is necessary. Laxatives are contraindicated in patients with diverticula, because they cause spasmodic contractions of the intestine and an increase in intraluminal pressure, and with prolonged administration, constipation may be strengthened and side effects, such as hypokalemia, may develop. To eliminate constipation, medicinal substances that absorb water, increasing in volume and causing irritation of the receptors of the colon, are effective. Such is the mechanism of action of sea cabbage, flaxseed, psyllium, mucophage, spiculia, methylcellulose. The dose is selected individually. Taking the medicine, the patient should wash it down with 1.2-1.5 liters of fluid per day, since the already easy "gluing" of the contents of the gut can give the opposite effect.

To eliminate diarrhea (in most cases it alternates with constipation), you should temporarily limit the use of fiber, and if necessary, assign funds with an astringent, absorbing property (white clay, calcium carbonate, carboline, bismuth preparations, smect). A good antidiarrheal effect in Smukta is a means of natural origin. The drug is a stabilizer of the mucosa of the digestive tract, protecting it from the effects of various aggressive factors, including intestinal microorganisms, their toxins. A possible side effect is the appearance of constipation. Absorbent properties of the drug may affect the absorption of other drugs, so other medications should be taken at least 40 minutes - 1 hour before or after - after taking smectic and other adsorbents.

It is important to eliminate meteorism - one of the causes of increased intestinal pressure. Since the causes of meteorism are diverse, then its treatment is different. Exclude gas-producing vegetables, and with intolerance to whole milk it is bred. With achlorhydria and meteorism, preparations of the gastric juice type are shown, with exocrine pancreatic insufficiency - enzyme preparations. At a dysbacteriosis the normalization of an intestinal microflora is necessary. In addition, adsorbents are administered. To speed up the transport of gases and to enhance their diffusion, therapeutic exercise is appropriate.

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

Patients with severe movement disorders of the large intestine (with hypermotorics predominate in diverticulosis) and pain, prescribe treatment with spasmolytic (no-sppa, papaverine, baralgin), cholinolytic agents (platyphylline, atropine, metacin, etc.) for 1-2 weeks. Longer-term use of these drugs can aggravate constipation. A good effect gives metoclopramide.

[1], [2], [3], [4], [5], [6], [7]