DIVERTICULOSIS/DIVERTICULITIS By: Drew Nystrom L.Ac., CMT

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1 DIVERTICULOSIS/DIVERTICULITIS By: Drew Nystrom L.Ac., CMT Diverticulosis is a condition that involves Diverticula which are bulges of Intestinal wall which creates a pocket that can get infected when food/stool gets stuck inside the pocket which is known as Diverticulitis. Click here for an image. There is not a 100% consensus about the cause of Diverticulosis but lack of enough fiber is definitely a factor. Lack of fiber in a persons diet leads to harder stools which lead to the need to strain while defecating. This increases the pressure within the bowels putting strain on an already weak intestinal wall leading to these pouches. Diverticulosis is very common. In America half the people above the age of 60 have it. Symptoms: 1. Diverticulosis: A person may not show any signs or symptoms. Some cramping and or bloating of the lower abdomen might occur and rarely any blood will be present in their stool. 2. Diverticulitis: Symptoms are more severe and sudden which may become worse over a course of a few days. Tenderness/pain, usually in the left lower side of the abdomen Bloating or gas Fever and Chills Nausea and Vomiting Loss of appetite Blood in Stool (less common) Tests: Blood work to see if there is any infection. CT scan Ultrasound Barium Xray Risk Factors: Aging (over age of 40) Limited Fiber Not enough Exercise Obesity Smoking Treatments: Depending on the severity you might have to be admitted to the hospital but most of the time this can be treated at home. Bed rest with a heating pad on the abdomen. Pain medication Only liquid diet for 1-2 days with the slow transition to solid foods Antibiotics After the episode increase fiber intake and eliminate certain foods like seeds, nuts and corn {12062 Valley View St. Suite 225A Garden Grove CA 92845} 1

2 from your diet. However, research has shown no increased risk associated with these foods and Diverticulitis., Diverticulosis is something that will never go away but one can limit Diverticulitis by diet. Serious Complications: Some more serious complications might occur that require surgery. Fistula (a tunnel that connects one loop of bowel to another or bowel to bladder, vagina or skin) Abscess (pocket filled with pus) Perforation [a hole in the bowel leading to inflammation of the abdominal cavity peritoneum (aka: peritonitis)] Stricture (a section of tightened bowel) Types of Surgery: 1. Primary Bowel Resection: The diseased part of the bowel is surgically removed and the healthy parts are reconnected together to allow for normal bowel movements (aka:anastomosis). 2. Bowel Resection with Colostomy: After removal of the diseased section of bowel the inflammation of the bowel might be too severe to connect the bowel to the rectum. In which case a hole through the abdominal wall (aka: stoma) will be made. The unaffected bowel will be connected to the stoma where a Colostomy bag will capture the waste. Months later if the inflammation has gone down a second surgery will be done to connect the bowel to the rectum and close the stoma. When to Call your Healthcare Provider?: Blood in stools Fever of F that doesn't subside Nausea Vomiting or Chills Sudden Abdomen or Back pain that increases and/or is severe Diverticulosis/itis from a Chinese Medicine perspective: Internal Heat: Yang Ming Heat & Damp Heat: Abdominal pain, fullness and distension that's worse with pressure. Painful area is warm to touch. Usually a tidal fever but may also be constant and high. Patient complains of dry mouth, thirst restlessness, irritability, sweating, either whole body or hands and feet and concentrated urine. Tongue: Red or with Red Spots and a Greasy or Dry Brown or Yellow Coat Pulse: Strong, Bounding, Rapid, Slippery or Deep and Strong Treatment Principles: Clear Heat, Stop Pain via purgation Liver Qi Stagnation: Abdominal or epigastric distension and pain that is related to the patients emotional state. Intermittent pain that varies in intensity and moves around but tends to be the lateral and lower abdomen which gets better with relaxation and passing of gas. Pain is non focal to where patient uses entire hand to designate the site. Other signs and symptoms are sluggish stools or alternating diarrhea and constipation, flatulence and/or belching that relieve pain, chest tightness with difficulty breathing, cold fingers and toes, mood swings, depression, irritability, anxiety, and tension. {12062 Valley View St. Suite 225A Garden Grove CA 92845} 2

3 Tongue: Normal or Dark with Red edges Pulse: Wiry Blood Stagnation : Chronic Diarrhea with a feeling of incomplete evacuation or tenesmus. The stools may be purple or black, sticky or tarry. The diarrhea may alternate with constipation. Fixed and localized, sharp or stabbing abdominal pain (usually in the lower left quadrant) which is worse with pressure. Other symptoms include: Dark complexion, dark rings around the eyes and purple nails, Spider naevi or vascular abnormalities over the abdomen, face and legs (particularly the inner knee and ankle). Tongue : purple or with brown or purple stasis spots; sublingual veins dark and distended. Pulse : wiry, choppy or thready. Treatment Principle : Transform and eliminate stagnant Blood from the Intestines Qi and Blood Stagnation Stage: Acute intermittent, spasmodic, lower abdominal pain, usually in the left or right iliac fossa. The pain may be quite severe and is worse with pressure. In some cases there is rebound tenderness (pain increases when pressure is suddenly released). The abdominal muscles over the site of pain may or may not feel tight. The pain may have begun over the navel. If qi stagnation predominates, the pain may be un-localized; with Blood stagnation, the pain is focal. As well as, abdominal distension, belching, loss of appetite, nausea, maybe vomiting, normal stools or constipation, the person may or may not have a mild fever or fever and chills Tongue: unremarkable with a thin, white or thin, yellow coat Pulse: Wiry or Tight Treatment Principle: Open the bowels to purge the accumulating pathogen, Move qi and eliminate Blood stasis while clearing Heat. Toxic Heat Patterns: The development of Toxic Heat constitutes a medical emergency, as the patient is very ill at this stage. The abscess has suppurated and may have ruptured. Clinical features are severe localized pain or pain that is spreading to involve the entire abdomen; abdominal rigidity and guarding; patient cannot bear to be touched. Epigastric and abdominal hardness and distension along with constipation inability to pass gas, high fever with or without rigors, thirst, dryness of the mouth, lips and throat, red complexion and eyes, malaise, headache, nausea, vomiting, halitosis and concentrated urine are all symptoms. Tongue: Deep red or Scarlet with a greasy or dry, yellow coat Pulse: Flooding and rapid Treatment Principles: Clear Toxic Heat. Invigorate Blood and break up Blood Stagnation. Dissipate accumulation and resolve the abscess. Chronic Abscess with Cold or Blood Stagnation and/or Deficiency: Patient has a localized lower abdominal mass with or without lower abdominal discomfort and focal tenderness. The mass may feel soft, rubbery and well defined, or firmer and more irregular. Pain may be intermittent, absent, mild or sever, depending on the pathology. Alternatively, pain may only be evident upon palpation. The abdomen may feel taut initially, but with increased palpation and pressure, the tone is lost and the abdomen feels soft or boggy/puffy. The skin tends to be dry and coarse. No fever or chills and bowel movements may be normal, loose or sluggish. {12062 Valley View St. Suite 225A Garden Grove CA 92845} 3

4 Cold Damp Predominates: Little to no pain meaning the mass would most likely be discovered upon routine palpation. The tissue/skin around the mass may feel colder than the surrounding tissues. Toungue: white and greasy especially on the root. Pulse: Deep and slow Blood Stagnation Predominates: Quite focused pain that's sharp or piercing that's worse with palpation. A firm and tender mass. Patient displays Spider naevi or broken vessels on lower extremities. Tongue: Dark or purplish body or brown or purple spots and distended sublingual veins. Pulse: Wiry or Choppy. Qi and Blood Deficiency Predominates: Mild discomfort, soft abdomen, tendency to loose stools, fatigue and weakness with a pale/sallow complexion. Tongue: Pale and Swollen. Pulse: Weak and Thready *Disclaimer: The information offered in this paper is not intended to diagnose but rather to inform the public about Diverticulosis and Diverticulitis and give a brief look at how Chinese Medicine looks at and treats them. {12062 Valley View St. Suite 225A Garden Grove CA 92845} 4

5 References: Fox JM, Stollman NH. Diverticular disease of the colon. In: Feldman M, Friedman LS, Brandt LJ, eds. Sleisenger and Fordtran's Gastrointestinal and Liver Disease. 9th ed. Philadelphia, Pa: Saunders Elsevier;2010:chap Will Maclean and Jane Lyttleton, (2003), Clinical Handbook of Internal Medicine The Treatment Of Disease with Traditional Chinese Medicine Volume 2 Spleen and Stomach, University of Western Sydney (pgs 68-74, 75-80, , , , , , ) {12062 Valley View St. Suite 225A Garden Grove CA 92845} 5