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Gastroenterology (Expert Forum)
35 YO with Recurring Diverticulitis or IBS?
Answered by
Kevin Pho, MD - Internal Medicine
Kevin Pho, MD
Boston - MA
This forum is for questions regarding Gastroenterology issues such as Acid Reflux (GERD), Barretts Esophagus, Colitis, Colon/Bowel Disorders, Crohn's Disease, Diverticulitis/ Diverticulosis, Digestive Disorders, IBS, Stomach Pain.
35 YO with Recurring Diverticulitis or IBS?
by weasel1, Sep 13, 2005 12:00AM
35 year old male. History so Far:
COLONSCOPY: Had Colonoscopy about 3 years ago which showed diverticulosis. Was trying to rule out GERD/GI problems at time.
FIRST DIVERTICULITS 2 YEARS AGO: Had first Diverticulitis attack (diagnosed by pain location and presence of diverticulosis from previous Colonoscopy, but no CT) about 2 years ago and resolved in 2 weeks with antibiotics.
SECOND DIVERTICULTIS IN MAY 2005: May of this year had a Diverticulitis attack that took a month to resolve. Not admitted to hospital, but probably should have been due to pain level (which was much worse, deep in the middle, lower left and for some reason the area just above my groin). CT scan was taken and showed inflammation consistent with Diverticulitis (but no other complications). Problem resolved after about 4 weeks on antibiotics and time off from work.
THIRD? DIVERTICULTIS IN AUG 2005: In mid-August I had what was believed to be another attack and did another 2 week course of antibiotics and problem seemed to resolve. Pain slighlty less but doctors didn't feel CT was warranted.
FOURTH? DIVERTICULITS IN SEPT 2005: Now in September, I've had localized pain (a distinct pain I associate with diverticulitis and had never felt before attackes) again in the middle, lower left and just above groin. Currently about to start antibiotics again.
PAST LAB TESTS: Have had tests that, according to my Dr., have ruled out giardia, liver problems, wheat allergies/issues, general food allergies and have not symptoms of an immune issue. One previous test suggested a higher than normal fecal fat level.
PENDING TESTS: Have a naturpathic test pending regarding stool bacteria (which is seems there is some questions over reliability on) and another stool fecal fat test.
OTHER SYMPTOMS: Had previously slower than normal elimination of a larger BM every 2-3 days. BM's were often dark in color (no blood noted), floated and tended to have a very foul odor (above and beyond normal scents and hence checks for gluten intolerance). Currently do feel increasing pain that lessens upon BM elimination. Pain is worse when I bend over or move around to much. Less when laying prone. Pain generally worsens as day goes on (not sure if that's just drowsiness in morning)
THE QUESTIONS: I am seeing a GI specialist next week and want to make sure I touch all the bases and ask all the questions having been in pain for the last 3-4 months or so. Is there anything else I should be asking for other than a CT or colonscopy to nail things down? Concerned I may get the dreaded "hands up in the air" IBS diagnosis. What is prognosis for coexisting IBS and diverticulosis? Can IBS irritate the Diverticulosis due to improper movement of stools? If surgery needed does IBS complicate recovery in a colon surgery for diverticulosis?
COLONSCOPY: Had Colonoscopy about 3 years ago which showed diverticulosis. Was trying to rule out GERD/GI problems at time.
FIRST DIVERTICULITS 2 YEARS AGO: Had first Diverticulitis attack (diagnosed by pain location and presence of diverticulosis from previous Colonoscopy, but no CT) about 2 years ago and resolved in 2 weeks with antibiotics.
SECOND DIVERTICULTIS IN MAY 2005: May of this year had a Diverticulitis attack that took a month to resolve. Not admitted to hospital, but probably should have been due to pain level (which was much worse, deep in the middle, lower left and for some reason the area just above my groin). CT scan was taken and showed inflammation consistent with Diverticulitis (but no other complications). Problem resolved after about 4 weeks on antibiotics and time off from work.
THIRD? DIVERTICULTIS IN AUG 2005: In mid-August I had what was believed to be another attack and did another 2 week course of antibiotics and problem seemed to resolve. Pain slighlty less but doctors didn't feel CT was warranted.
FOURTH? DIVERTICULITS IN SEPT 2005: Now in September, I've had localized pain (a distinct pain I associate with diverticulitis and had never felt before attackes) again in the middle, lower left and just above groin. Currently about to start antibiotics again.
PAST LAB TESTS: Have had tests that, according to my Dr., have ruled out giardia, liver problems, wheat allergies/issues, general food allergies and have not symptoms of an immune issue. One previous test suggested a higher than normal fecal fat level.
PENDING TESTS: Have a naturpathic test pending regarding stool bacteria (which is seems there is some questions over reliability on) and another stool fecal fat test.
OTHER SYMPTOMS: Had previously slower than normal elimination of a larger BM every 2-3 days. BM's were often dark in color (no blood noted), floated and tended to have a very foul odor (above and beyond normal scents and hence checks for gluten intolerance). Currently do feel increasing pain that lessens upon BM elimination. Pain is worse when I bend over or move around to much. Less when laying prone. Pain generally worsens as day goes on (not sure if that's just drowsiness in morning)
THE QUESTIONS: I am seeing a GI specialist next week and want to make sure I touch all the bases and ask all the questions having been in pain for the last 3-4 months or so. Is there anything else I should be asking for other than a CT or colonscopy to nail things down? Concerned I may get the dreaded "hands up in the air" IBS diagnosis. What is prognosis for coexisting IBS and diverticulosis? Can IBS irritate the Diverticulosis due to improper movement of stools? If surgery needed does IBS complicate recovery in a colon surgery for diverticulosis?
Doctor's Answer
by Kevin Pho, MD, Sep 14, 2005 12:00AM
, Sep 14, 2005 12:00AM
To answer your questions:
1) Repeating the CT scan can be done to cement the diagnosis. However, diverticulitis is a "clinical" diagnosis - meaning that it can be made without the help of imaging studies. Given the recurrent episodes, a referral to a surgeon may be needed to consider resecting the bowel area in question.
2) Coexisting IBS and diverticulosis can be managed with medications - such as antispasmodic agents, or with Zelnorm if there is constipation-predominance. However, if there is recurrent episodes of diverticulitis, a surgical referral may be necessary.
3) It is possible that there is a relation between the symptoms IBS and diverticulitis.
4) I am not aware of IBS complicating the recovery of surgery. It is possible that it may make the post-op course more symtommatic, but this can vary from patient to patient.
Followup with your personal physician is essential.
This answer is not intended as and does not substitute for medical advice - the information presented is for patient education only. Please see your personal physician for further evaluation of your individual case.
Kevin, M.D.
http://www.straightfromthedoc.com
1) Repeating the CT scan can be done to cement the diagnosis. However, diverticulitis is a "clinical" diagnosis - meaning that it can be made without the help of imaging studies. Given the recurrent episodes, a referral to a surgeon may be needed to consider resecting the bowel area in question.
2) Coexisting IBS and diverticulosis can be managed with medications - such as antispasmodic agents, or with Zelnorm if there is constipation-predominance. However, if there is recurrent episodes of diverticulitis, a surgical referral may be necessary.
3) It is possible that there is a relation between the symptoms IBS and diverticulitis.
4) I am not aware of IBS complicating the recovery of surgery. It is possible that it may make the post-op course more symtommatic, but this can vary from patient to patient.
Followup with your personal physician is essential.
This answer is not intended as and does not substitute for medical advice - the information presented is for patient education only. Please see your personal physician for further evaluation of your individual case.
Kevin, M.D.
http://www.straightfromthedoc.com
I though that I had the flu or just a bad case of spastic colon, colitis.
I was in so much pain that the I finaly consented to seeing my family dr. He imediatly sent me for a ct, blood work, was sure I had divertic. He was correct, it was so bad that it had abcessed and walled it self off to my bladder.
I had an immidiate resection surgery.
Starting in December i began to have pain again, my pcp gave me rx for antibiotics. I was better in 2 weeks. Then in Febuary and again in august, the same attack. I was then hospitalized and given iv anitiotics. I was better in a few days.
I saw My surgon again today, as that the CT showed divertiuitis again. He said that I was the first case of recuring diverticulits he has seen after a resection. Is that possible? I dont understand why I have this again. And why the Dr has not seen this reoccur in any of his post resect patients, how could I be the first he has seen?