Results from a phase II dose ranging trial presented recently suggest that the investigational drug alosetron hydrochloride provides adequate relief of pain and discomfort for females with twisted bowel. The results, presented by Allen Mangel, M.D., clinical research director, Glaxo Wellcome Inc., during Digestive Disease Week, showed that twisted bowel more causes_risk_factors in female patients.

Occasionally cystoscopy, to demonstrate colovesical fistula, or angiography and technetium red cell scanning, to demonstrate a source of colonic blood loss, may be required.

Patients with a change in bowel habit, blood per rectum or recurrent abdominal pain will require outpatient investigation to determine the cause of their symptoms. Rigid sigmoidoscopy and barium enema or total colonoscopy are the mainstays of investigation. Asymptomatic diverticulae are present in at least one in three of those aged over 65 and therefore diverticulitis can only be safely diagnosed when the clinical picture is compatible and there is no other identifiable pathology, especially malignancy.

Provided the patient has no systemic upset, patients with acute diverticulitis do not always require admission to hospital and can be treated effectively at home with oral antibiotics (amoxycillin with clavulanic acid, and metronidazole for five days), oral fluids, analgesia and bed rest. If pain either does not settle within a few days, worsens or becomes more generalised, or if the patient develops systemic signs (that is, a rising pulse rate or temperature), emergency referral to hospital is required. Patients who present with generalised abdominal pain and/or signs of peritonitis require emergency referral to hospital.

Uncomplicated disease may be treated with dietary manipulation. A high fibre diet and/or pharmacological bulking agents such as ispaghula husk are recommended and patients should be advised to drink plenty of fluid. Pain due to smooth muscular spasm may be adequately relieved with antispasmodics such as mebeverine. The role of surgical resection in uncomplicated disease is controversial and should not be undertaken lightly.

Laparotomy and myotomy (division) of the hypertrophied sigmoid smooth muscle has rightly been condemned to the history books. Elective surgery Complications such as fistulae or strictures will require surgical resection of the diverticular segment of colon and primary anastomosis. Patients presenting with recurrent episodes of diverticulitis may be offered resection when they are medically fit and any other pathology has been excluded.

One-third of patients admitted with an episode of diverticulitis can be expected to be readmitted within five years with similar problems. Elective surgery is associated with much lower morbidity and mortality; resection and primary anastomosis is usually achieved, though occasionally a diverting stoma may be required. Emergency surgery Patients with generalised peritonitis requires effective resuscitation with intravenous fluids and antibiotics prior to surgery.

Large bowel perforation is a serious condition and nearly half of all patients presenting with faecal peritonitis will die from their condition. Purulent peritonitis resulting from the rupture of a diverticular abscess results in lower, but still significant mortality rates. Patients with acute diverticulitis who do not respond to conservative therapy may also require surgery. In such cases the inflamed diverticular segment or phlegmon can be resected and a primary anastomosis is usually possible.

Where there is excessive faecal or purulent contamination of the peritoneal cavity, resection of the affected segment is required, but primary anastomosis may not be appropriate. In such situations the rectal stump is closed and the proximal colon is delivered as an end colostomy. This is termed Hartmann’s procedure. The colostomy can be safely closed for most patients following Hartmann’s procedure, and many units report reversal rates in excess of 80 per cent.

Using Schulze’s Intestinal Formula 1 and Formula 2 and researching diverticulitis foods to avoid, you’ll have a handle on your bowel concerns.  Although some experience the usual cleansing symptoms such as cramping and gas, that just means there is impaction that needs to be moved out and the quicker the better.

Though diverticulosis may sound serious, it seldom is. This disorder of the large bowel occurs when small pouches, usually about the size of a pea, form in the intestinal wall. According to the National Institutes of Health, one in ten people over 40 and half those over 60 have diverticulitis symptoms. The condition occurs most frequently in industrialized societies, where fiber intake tends to be low.

But though the condition is common, most people who have it experience no symptoms and thus never know. Diverticulosis is associated, however, with irritable bowel syndrome, which may cause such symptoms as gas, bloating, and diarrhea. And if your diverticulosis turns into diverticulitis, you will definitely have symptoms. This happens when one or more of the pouches become infected from bacteria in the digestive tract, usually because a particle of undigested food gets trapped in the pouch.

A mild infection can produce bloating, gas, and nausea-symptoms for which most people don’t immediately see a doctor, especially if they improve. (Pain is usually on the left side of the abdomen, unlike appendicitis, which affects the right side.) But sometimes symptoms–abdominal pain and/or rectal bleeding–are severe and shouldn’t be ignored. They can be signs of complications. An abscess may develop and the intestinal wall may become perforated, causing surrounding tissues in the abdominal cavity to become infected. These cases, fortunately rare, can be life-threatening and call for immediate hospitalization and, possibly, surgery.

Perhaps because fiber is sometimes called “roughage,” the idea used to be common that a high-fiber diet–fruits, grains, and vegetables–was somehow rough on the bowels and that a person with symptoms of diverticulitis should immediately go on a low-fiber or even liquid diverticulosis foods. It’s now thought that this is about the worst thing you can do. Indeed such a diet can even cause the large intestine to go into spasm.

Fiber, on the other hand, provides bulk in the intestine, which enables food and waste to pass more easily and efficiently. Waste moves rapidly along–an advantage for the internal economy. Of course, if you have an acute case of diverticulitis requiring hospitalization, you may have to follow a liquid diet and take antibiotics until your colon has begun to heal. Soon after, though, you will be advised to increase your fiber intake for the standard stay at home diverticulitis treatment.

Eat a lot of fruits, whole grains, and vegetables to boost your fiber intake. (If you aren’t used to a high-fiber diet, start gradually.) Choose whole-wheat bread over white, brown rice over white. Add a little bran to baked goods. Eat whole-grain cereals for breakfast. Eat fruits and vegetables unpeeled when you can. Raw produce is good, but cooking does not destroy fiber. Drink plenty of fluids–at least eight 8-ounce glasses of fluids daily, including juices and soups.

Fruits and vegetables also contain a high percentage of water, which is another plus. Get regular exercise. There’s some evidence that active people are less prone to diverticulitis and that exercise may help prevent constipation. If you’re occasionally constipated, try eating a few prunes. These can really help. They not only are a good source of fiber, but also contain a natural laxative. Don’t rely on stimulant laxatives.