Complications can develop from bout of diverticulitis

DEAR DR. ROACH >> I am an 84-yearold woman in relatively good health, with a concern about diverticulitis. I had my first attack 10 years ago. The second attack was two months ago, and I had a CT scan that showed an apparent infection. I took one course of antibiotics, but the pain persisted, followed by a second attack and more antibiotics. Since then, I have had intermittent stabbing pain at the same site. I know that taking unneeded antibiotics is bad, but what about when you have a lingering infection? If a diverticulitis infection is not cleared completely, what are the dangers? Festering, incurable infection? Sepsis? — R.W.

DEAR READER >> Diverticula are small pouches in the wall of the colon. They can appear anywhere in the colon, but are most common in the sigmoid colon, the section just above the rectum. The condition of having diverticula is called diverticulosis. But diverticula can cause trouble, either by bleeding or becoming infected, in which case it is called diverticulitis. The usual treatment is oral antibiotics.

Most of the time, this works well, but occasionally the infection is more serious. Some people need to be admitted to the hospital for intravenous antibiotics. Without prompt and effective treatment, serious complications can include an abscess — a large, walled-off area of infection requiring drainage, either through a tube or through surgery. The diverticula can perforate, creating a connection between the inside of the colon and the abdominal cavity, called the peritoneum. Large perforations require emergency surgery. Diverticulitis also can lead to a blockage of the colon, or to a fistula, an abnormal connection between the colon and other structures, such as the bladder.

So, a bout of diverticulitis that doesn’t get better raises concerns about serious conditions. Most of these can be suspected based on a careful physical exam, but often a CT scan is needed for definitive evaluation.

Recurrent diverticulitis often is treated surgically. Once the infection has resolved, the diseased portion of the colon can be removed to prevent further attacks; however, a surgeon would need to carefully consider doing so in an 84-year-old woman with only one recurrence in 10 years.

DEAR DR. ROACH >> I read your recent newspaper publication on UTIs and the possible causes, especially in post-menopausal women. The one thing not mentioned by you, and neither by my internist nor my gynecologist, was bathroom hygiene.

Several years ago I was having UTIs every six weeks. When I saw the urine culture results, I figured out the cause myself. The bacteria was E. coli. Wiping from back to front was not the thing to do. With that basic change, I have not had a UTI since.

It was a simple fix to an ongoing problem. Please be sure to mention that in future communications. — M.E.A.

DEAR READER >> I thank you for taking the time to write. I did forget to mention it. It’s an important point that many of us take for granted but shouldn’t. Other general advice that may help: Get enough fluids to avoid being dehydrated or volume-depleted; urinate after sexual activity; take showers rather than baths; wear breathable cotton underwear; and eat yogurt or take probiotics. One or more of these may help prevent urine infections in the future.