Diverticulosis is a disease of the large intestine characterised by protrusions of the mucosa through the muscle wall. These protrusions form pouches which can trap food or waste and become inflamed, resulting in the condition diverticulitis. This can progress to an abscess,  fistula, or perforation. Perforation of an individual pouch will lead to peritonitis.

Diverticulosis is a common condition affecting adults, particularly in the developed world, the incidence increasing with age. It is therefore a disease of aging; although, genetics, diet, and lifestyle have a significant role to play.

Most people are asymptomatic, with about one quarter developing symptoms. Pouches usually form in the sigmoid colon, resulting in symptoms such as pain in the lower left hand side of the abdomen, constant or intermittent, bloating, nausea, vomiting, bleeding, and altered bowel habit. Lower right quadrant pain, not to be confused with appendicitis, is more common in Asia. Fever is an indication of perforation and requires prompt treatment. Bleeding is more characteristic of irritable bowel syndrome.

There are several aetiological factors in the development of diverticulosis: a decline in the strength of the intestinal wall and surrounding muscles; alterations in motility with increased segmental pressure; colonic microbial imbalance (dysbiosis); and inflammation. While inflammation is only evident in a percentage of people who develop  diverticulosis, it contributes to recurrence of diverticulitis.¹

Conventional treatment involves painkillers, antibiotics, bowel rest, and a liquid diet. Surgery is necessary for abscess, fistula or perforation. Surgery may involve bowel resection. Chronic use of non-steroidal anti-inflammatory drugs is a risk factor for poor intestinal wall integrity and ulceration.

Treatment

General

Smoking, high alcohol consumption, and a low fibre diet are risk factors. Diverticulosis runs in families, indicating a genetic susceptibility for poor connective tissue integrity, or early decline in strength. Iridology will aid in an assessment of bowel structure and function.

A CDSA will provide information as to general bowel health, pathogens, parasites and inflammation (faecal calprotectin). Check for food sensitivities, which cause chronic inflammation, with an eliminate-and-challenge diet or IgG test (gluten, dairy). A blood type diet will help to align the diet with constitution, a factor which is increasingly important as we age and lose tolerance for incompatible foods. Salivary cortisol can give an indication of chronic stress which severely affects the gut.

Diet

The modern urban diet is considered a major factor due to low-fibre levels which cause constipation and stagnation. Regular straining, a dry stool, and stasis increase pressure on the intestinal walls. The reabsorption of wastes due to prolonged contact with the bowel wall harms the tissues and leads to autointoxication. Vegetarians living on a high-fibre diet are less likely to get diverticular disease than heavy meat eaters.

Consume plenty of vegetables and fruit. Drink water regularly instead of sweetened beverages or bottles juices. Nuts and seeds are no longer considered a problem, but should be chewed well. Oats, figs, prunes, psyllium, bran, pectin, and flax seed provide plenty of fibre to keep the bowel active and prevent stagnation.

In acute cases a simple diet of porridge, fruit juices, whey shakes, boiled vegetables, and broths is recommended. Supplement with vitamin C, vitamin A, fibre, glutamine, bromelain, fish oil, and probiotics. Magnesium will help with constipation

Herbs

The bowel can be protected with slippery elm gruel, combined with liquorice powder or turmeric. Marshmallow is also protective. Echinacea, garlic, and golden seal will treat inflammation and infection, while burdock is for bowel cleansing. Chamomile and aloe vera juice are calming and anti-inflammatory. Comfrey or plantain are used for building tissue integrity, or treating ulceration and abscesses. Bitter herbs such as gentian or wormwood will help stimulate protective secretions, while hops, chamomile, ginger, cramp bark, angelica root, wild yam, and liquorice will calm colic. Fenugreek tea made from the simmered seeds is calming and soothing.

Tissue Salts

Silica is for tissue integrity or abscess. Calc fluor is for tissue integrity. Ferrum phos is for acute inflammation. Mag phos is for treating stress and relieving cramps.

Homeopathy

Aloe—loose stool in diverticulitis with urgency soon after eating; bearing down feeling, pain, bloating, rumbling, gas.

Ars-alb—burning abdominal pain with anxiety and restlessness, worse after midnight;  better for warmth; fatigue, nausea and vomiting, loose stool; desire to sip water.

Bryonia—constipation, dry hard stool, much straining; very thirsty; colic better being still or lying right side; abdomen sensitive; vomits bitter liquid.

China—pain, bloating , excessive gas; colic better by bending double.

Colocynthis—violent cutting, griping, pains come in waves; better doubling up or hard pressure; worse least food or drink;  loose stool and gas.

Mag phos—abdominal pain relieved by warmth and pressure; cramping and gas.

Nit-ac—diverticulitis is with blood in stool; constipation alternates with loose stool; prolonged pain after stool, rectum feels torn.

Nux-vom—bruised soreness worse coughing or stepping; flatulent colic; constipation, never feels done, strains hard; irritable; jaundice.

Disclaimer: this article is intended for the purpose of general education only, and is not a substitute for diagnosis, treatment advice, or a prescription that is given in a consultation with a qualified physician.

References:

1.         Tursi A, Elisei W. Role of Inflammation in the Pathogenesis of Diverticular Disease. Mediators Inflamm 2019;2019:8328490.