Digestive Disorders / Gastroenterology Expert Forum
Diverticulitis
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Diverticulitis

1.  Can you have diverticulitis without a fever?  I have had, for about 3 weeks, lower left abdominal pain and nausea exactly like the symptoms for which I was hospitalized in July 07, with the exception of no fever and no diarreah (diarrhea).  
2.  When I have this pain and nausea, should I go back to clear liquids or continue with high fiber.  I am trying to intake mostly soluble fiber.
3.  FYI:  The Ct scan in July indicated diverticulitis with resultant IV antiiotics and clear liquids.  I had to return in August for what I thought was the same problem.  CT scan and colonoscopy in August indicated diverticulosis, but not diverticulitis.  The GI and internist continue to say it is irritable bowel and not diverticulitis, even though they decline to see me.
4.  I am concerned that it could be diverticulitis, and it may rupture.
5.  I am really confused regarding the diet.  The diet for irritable bowel makes me more constipated, which I understand is more likely to cause diverticulitis.  The medicine they prescribed (Bentyl) also makes me more constipated.  I have told them this, but they said I have no other options since I am taking valium for an inner ear disorder that affects my balance.  Are there medicines for irritable bowel, other than Librax or the one that was recalled?
Tags: Colon
Related Discussions
233190_tn?1278553401
Yes, it is possible to have diverticulitis without a fever.

A negative CT scan and colonoscopy would make diverticulitis less likely however.  You can consider malabsorption, which can cause pain in the same area.  A stool test can be done to exclude this possibility.

Regarding treatment for IBS, there are small studies suggesting tricyclic antidepressants and the antibiotic Rifaximin may help in select cases.

These options can be discussed with your personal physician.

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 patients education only. Please see your personal physician for further evaluation of your individual case.

Kevin, M.D.
www.kevinmd.com
11 Comments
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Avatar_n_tn
Hello,
I too sufffer from diverticular disease in the lower left abdomin (abdomen) and it's strange that like you when it first started for me it was accompanied with fever. It has been a few years now but I remember the excruciating pain when it first presented. At the hospital the first doctor I saw diagnosed this right off the bat with no tests or anything. Well I was sent home with antibiotics ect.. Weeks later when it flared up again I spent a couple days in the hospital with numerous tests and they finally they told me what the first doctor knew just from experience - diverticulitis.
Just like you it came with fever but since those first episodes when I have a flareup it usually is not with fever.
As far as diet it is a must for me to take psylium ( Metamucil) daily and roughage. Also I find that certain foods irritate my colon more than others and if I stay away from these foods I am usually ok. Eggs,  salty cold cuts, spicy hot foods ect... are a big no no. It took at a lot of trial and error to pin these down, but above all the Metamucil is a must. If I get lazy and forget for a couple of days - pain and suffering! The doctor kinda of thought I should have surgery to remove the bad area but I am a real chicken when it come to the anesthesia ( bad experience waking up in a past apendix surgery) so I do anything to avoid flareups. My niece is a surgical nurse and she thinks I am crazy risking a rupture  but I know other people who have had colon resection and for some it is not all peaches and cream with the same symptoms as before.
Anyway I don't know what will work for you as everybody is different but I would definantly keep a close eye on the foods you eat to see what irritates. I do find it kinda of strange that with a definate diagnosis of diverticula ( I mean they can and have seen this by way of the tests) that the chose not to treat this as the primary cause of your symptoms. I am no doctor but I would think that irritable bowel and its ensuing symptoms could be caused by diverticular disease and  to treat that first would be the way to go. I could be wrong but I believe that " irritable bowel disease" is one of those catch all diagnosis's they give when lower GI symptoms present with negative results from the tests such as colonoscopy and CT scans.
micpenn
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Avatar_n_tn
Thanks for your reply.  I'm sorry to hear that anyone else is in this cycle of pain, and "What do eat?" and most of all "Will it rupture?"  I bought the book "Eating for IBS", but it seemed that she recommends things I can't eat.  I can't tolerate spices either, citrus, red meat and the list goes on.  Friends and neighbors said lettuce was the worst thing, and they have had to be hospitalized for eating any kind of lettuce. I have tried the acacia fiber that the IBS book recommended, but it seemed like it was too rough and caused a lot of gas and pain. Metamucil does the same for me-glad it works for you.  It seems like Citrucel works best for me, even though the citric acid doesn't help upper tract.  Benefiber seems to actually make the constipation worse. One Dr. said to avoid seeds, nuts, and hard fiber (which I have avoided like the plague) and the GI doc said it doesn't make any difference, but I'm trying to find a new GI doc since he said I could not have diverticulitus without a fever and that I had IBS.  His last arrogant comment was "What do you want me to do?"  I was flabbergasted to say the least!  I would like to know what he wants me to do!  
I'm certainly not wanting a surgery, as I react to a lot of anethesia and meds, and take forever to recoup.  But I don't want the rupture either.  That sounds awfully dangerous.  The Gi doc doesn't think I need surgery, but the internist mentioned it several times.
Do you go back to clear liquids to get over a flare up, or do you continue to take the fiber?  I can't seem to get the food right.  I get really weak on the liquid diet and it still hurts.
Well, above all I hope for your good health and thanks for listening.  Sounds like great minds think alike! LOL
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Avatar_n_tn
Thank you for your reply. Should I go back to clear liquids and bed rest, or continue to take fiber and eat what little I can?  I'm trying to find a new GI doc in the St. Louis area.  Any suggestions would be appreciated-very much.
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Avatar_n_tn
Hello again,
When I saw your comment on how your doctor asked you  "what do you want me to do?" it brought to mind a similar incident that happened  to me, this was earlier when my diverticulitis flareups still were accoumpanied by fever, and I went to my doctor and the secretary/nurse asked me what I was there for and I explained that I had a flareup of my diverticulitis with lower ab. pain and  fever and she asked me in a condesending manner "so what do you want us to do?" I was so struck to  even be asked this question that for a minute I didn't say anything then I retorted "well seeing that there is fever it usually means that there is an infection so antibiotics might be the first course of treatment" she replied with an "oh" and asked me to sit down!  I should have said that if the law would allow me to write a prescription for antibiotics I would,  and not be here to bother you! Till this day I still remember the humiliation I felt.
Anyway I see where some of the fiber treatments aren't for you but one thing I forgot to mention was some good advice I was given by one doctor when he stated " lots and lots of water!" and that does help especially when taking any of the fiber supplements. Without enough water they will do the opposite of their intended effect, and I know that if I take the metamucil without enough water I will get the stomac pains also. The funny thing is that it is almost universal that anyone with diverticular disease is advised to stay away from anything with seeds or nuts as they could get stuck in the pouches and cause trouble, I am sure that this is good advice for most but as for me they never even came close to being on my list of things that bother me. Nor is lettuce in any way a problem but then maybe they were talking about IBS and not diverticular disease.
As far as rupturing goes I too am a bit concerned about it, as a ruptured colon is a major medical emergency,  but luckily not all that common so I was told, but you know how it goes: I only worry about when I am suffering a flareup and when I am fine I forget about it! Human nature I guess.
My flareups are usually caused by either two things: something I ate that I should not have or not taking in enough fiber, water etc.. So what I have to do is avoid the offending foods and eat sparingly and gradually increase my fiber and water intake for a few days until I get over it. The other unsettling thing I noticed lately is that any time I have constipation I will almost always get the diverticular pain but along with it comes the most horrible spasms or what I call contractions of the colon. These can leave me holding my abdomin (abdomen) and almost breathless until it passes - these are the times I think my colon is going to rupture!
Anyway I hope that you find a more sympathetic doctor, and ways to manage your symptoms ( without going insane in the process! ).
Micpenn
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Avatar_n_tn
Sorry, I haven't been able to get to the computer and I don't have a laptop.  Since the Gi doc never returned calls, I was able to see my internist and he put me on antibiotic (Avelox) and bed rest.  He said it was either "smoldering diverticulitis" or the IBS.  Still no fever, but horrible nausea.  The liquid diet makes me very weak.  I do drink a lot of water, but I need to be reminded.  I am 6 days into the antibiotic and still lots of pain, so I don't know if it is diverticulitis, since he thought if it were diverticulitis the pain would be gone in a few days.
Thanks for you r insight.  I appreciate yur reassurance on the rupturing.  When I felt ok for a about  a month, I was sure it was IBS and I didn't worry about a rupture.  It is really a help to know others feel the way I do, only I certainly don't wish it for anyone. Everyone I know has one or the other Dx, but not both.  
Yes, I am still trying to sort out the offending foods.  In my case, I tried beans to get in more fiber and wow, I started with the most awful heartburn I had ever had in my life and then the constipation and pain.  Yes, constipation really does make things worse, and I was trying more and more fiber, to keep things soft and continued to tell myself it was only the IBS, but the diet recomended for that seemed to cause more constipation.
Thanks again for the insight and the reassurance.  It seems like you have sorted out the food triggers for you and you are still sane!
I'm obviously new to this board, and I suppose I shouldn't have asked the Dr. two questions on this board.  I was in so much pain the brain doesn't always work right either. LOL
Yes, the quote of the day is the medical profession saying, "What do you want me to do?"  There is a commercial on tv that shows a man at a table with a knife and the Dr. apparently on the phone instructing him to operate on himself.  The man looks around
and says in a puzzled tone, "Shouldn't you be doing this?"  It is an insurance commercial, if I remember correctly, but reminded me of the medical arrogance and indifference.
Thanks for answering.  This chair is getting hard and that causes pain too, have you noticed that, too?  I apoligize for being too personal, I'm just trying to gain information to sort this out.
ggw60
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Avatar_f_tn
Hello,
first off  your colon can rupture,,I had many episodes of diverticulitis, which I would be put on flagil and ciptro..I never experienced any fever with these attacks,,my colon did rupture,  I went to  2 hospitals with pain, which I told them i believed it was diverticulitis,,both hospitals sent me home..my colon ruptured 9 hours later at home sitting on the toliet,I had a covaginal fistula,,which means my body was trying to find a escape route for the infection and found the weakest part of my lower which was from a hysterectomy which when it ruptured it came out my vagina,,usually it ruptures to your bladder..I was very lucky as most of the infection came out,,one thing thats scary about it rupturing is there is no pain the pain is gone,,which if it would of ruptured else where I would of possibly died as the infection would of been inside of me,,so please be carefull with diverticulitis I was never once told it could rupture. Also  i have had to small bowel blockages  which the syptoms (symptoms) are just like diverticulitis, with diverticlitis i was never sick to my stomache,just severe pain,,with the small bowel severe pain and throwing up..both are very serious  why drs  do not take this serious  is beyond me,,my understanding  is now if yu have 5 attacks of diverticulitis your colon should be resectioned..I had 21/2 feet of colon removed.
hope you get your problemed resloved youwill not believe how sick you were untill you have te surgery and how much better you feel!!
Annie
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Avatar_f_tn
Hello,
Have had this pain off and on for like 2 yrs now..Its in my upper right just below my breast bone goes to my back,,and the weirdest part it travels to my right ear and up on the right side of my head,,I had gallbadder removal about 30 yrs ago so it can't be that  any ideas??..what concerns me is it traveling to my head ..the pain is quite severe, I can get it to relieve its self by sticking my finger down my throat and and maken me throw  up..it seems to be always in the morning on a empty stomache.
Thank you in advance,
Annie
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Avatar_f_tn
During an attack of diverticulitis..you are to remain on a low fiber diet,,  clear liquids, bed rest,,Drs  say that certain foods like seeds and nuts do not cause the flairups but for me they did..if I ate tomatoes  peanuts  popcorn,,it would be like a week later when i would get diverticulites,,  I believe cause it gets caught in the dverticulas and takes awhile for the infection to start up..If you get started immediatley on antibiotic when you first get the signs,,I was on flagil and ciptro It would stop the attack. I feel so bad for anyone that goes through this as it rules your life, like I said before you really don't realize till you have the surgery and how great your life is after the surgery and how sick you really were.
ANNIE
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432633_tn?1204061768
I had my surgery a little over a month ago (sigmoid coloctemy and resection). I am currently having some complications but was wondering if you ever get back to feeling "normal" after the resection. My entire digestive system just feels different. i no longer feel the urge to have a bowel movement like I did before surgery, thank you for the insight.
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Avatar_f_tn
Hi T,
your just over a month from surgery..Believe me it will get better takes time for the colon to heal,,within 3months i can almost guarnatee you will be feeling great..just take it easy  don't eat large meals  stay towards softer foods like mashed potatoes mac and cheese..soups  if u eat meat have ground up hamburg and rice,make a gravy eat it over mashed potatoes or bread....hope u get to feelen better soon.
ANNIE
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433485_tn?1321816990
A related discussion, colon resection- diverticulitis was started.
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Avatar_f_tn
A related discussion, Recovery after a sigmoid colectomy for diverticulitis was started.
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