How to treat constipation if have recurrent diverticulitis?

Question

Hello doctor,

I had diverticulitis five months ago. Symptoms returned last month, so I went to urgent care, took antibiotics, and felt better after four to five days. Symptoms returned a few days ago, and I went to ER as the symptoms were worse; I got more Augmentin on the third day of antibiotics and slightly felt better. Currently I am taking Augmentin and Oxycodone tablets. No tests were performed, but a lab and CT scan confirmed the first diverticulitis incident. The main concern right now is constipation and bloating. I have not passed a stool or much gas for the last three days. I am worried about a possible blockage. My stomach is making gurgling and churning sounds throughout the day and still hurts to move; I am not eating much as I was told to stick with a liquid diet. I had a little yogurt, a few crackers, and a little canned tuna. Would you recommend using Ex-Lax, trying an OTC enema, or using stool softeners and Metamucil? I want to feel better and prevent further issues, but I do not want to make things worse accidentally.

Answer 1

Hello,

Welcome to icliniq.com.

I have reviewed your case history; you had recurrent episodes of diverticulitis as per your clinical presentation and your assessment. A diverticulum is an outpouching of the normal colonic inner surface (mucosa); this is more common in patients with severe, recurrent constipation. Usually, we see this in the elderly population; sometimes, hard stool gets stuck into these pouches, causing surrounding inner lining (mucosal) inflammation, known as diverticulitis in medical terms. However, it is not very common at your age until and unless you have a history of severe chronic constipation.

Now coming back to your current situation, you had a prior history of diverticulitis which was diagnosed on a CT scan. My assessment and suggestions are -

You should review your CT scan again to find the exact site of diverticulitis, like sigmoid diverticulitis, left-sided colonic diverticulitis, or somewhere else.
If you have persistent constipation, it must be treated to prevent recurrent episodes.
Is any lumenal narrowing on the prior CT scan causing problems in your case?
You used Oxycodone (Oxycodone hydrochloride) for the pain; this drug significantly increases the chances of constipation, which must be avoided in your case.
Recurrent use of antibiotics like Augmentin (Amoxicillin and Clavulanate) is not the solution; one must find the exact cause and treat it accordingly.
Do you have any family history of cancer or colon diseases in the family?
Do you have a history of unintentional weight loss?
Are you taking enough water and fiber diet to avoid hard stools?
Are there any drug addictions that cause you this problem again and again?
1. Drink plenty of water.
2. Use glycerine rectal suppositories two to four gently insert them into your rectum, and wait for 15 to 30 minutes, it will soften your hard stools within the rectum, and you will be able to pass stools. Once you give stools, take other laxatives orally and drink plenty of water.
3. You can also use an enema if you are comfortable using it alone; it needs precautions to prevent rectal injury while inserting.
4. If you have a fever, severe abdominal pain, or cannot pass flatus (gas), you should have to revisit ER (emergency room); this acute condition can not be treated at home.
5. For recurrent episodes, consult a gastroenterologist. After that, it may be necessary to go for a colonoscopy after a complete physical examination and reviewing your old CT scan reports.
I hope this helps.

Thank you.

Answer 2

Hello,

Welcome back to icliniq.com.

I have answered all your queries. I hope it helps.

Thank you.