Diverticulitis is a common digestive condition affecting the large intestine, particularly as individuals age. It involves the inflammation or infection of small, bulging pouches called diverticula that can form in the colon wall. While many people with these pouches (a condition known as diverticulosis) may not experience symptoms, constipation often becomes a frequent and challenging issue for those with diverticulitis.
Diverticulitis and Constipation Connection
When diverticulitis is present, constipation can arise as a symptom. The inflammation associated with diverticulitis can narrow the passage within the colon, making it difficult for stool to pass through smoothly. This inflammation may also affect the muscles in the colon, leading to decreased motility and impaired contractions, which slows down the movement of stool. While older theories suggested that straining from constipation might cause diverticula to form, current research indicates that low-grade inflammation or even frequent bowel movements could be more significant factors. Constipation, however, can increase pressure inside the colon, potentially worsening diverticulitis or triggering flare-ups.
Laxative Types and Their Use
Using laxatives with diverticulitis requires careful consideration. It is always advisable to consult a healthcare provider before starting any new regimen. Not all laxative types have been extensively studied in the context of diverticulitis, especially during acute flare-ups. A healthcare provider should rule out complications such as bowel obstruction before recommending laxative use.
Bulk-forming laxatives, such as psyllium or methylcellulose, work by absorbing water in the intestine to create a larger, softer stool, making it easier to pass. These are generally recommended after a diverticulitis flare-up has resolved to help manage constipation and increase fiber intake. It is important to introduce them gradually to minimize potential gas and bloating.
Stool softeners, like docusate, function by allowing more water to be absorbed into the stool, making it softer and easier to pass. They may be considered for mild cases of diverticulitis or for constipation prevention, but long-term use should be discussed with a doctor.
Osmotic laxatives, including polyethylene glycol or milk of magnesia, draw water into the colon to soften the stool and stimulate bowel movements. These can be useful for short-term constipation relief.
In contrast, stimulant laxatives, such as senna, work by causing the intestines to contract to promote stool passage. These are typically stronger, can be habit-forming, and may irritate the gut lining, making them generally less recommended, especially during active inflammation.
Non-Laxative Approaches to Constipation
Managing constipation with diverticulitis often begins with non-pharmacological strategies focusing on diet and lifestyle. Dietary modifications are a primary approach to promoting regular bowel movements and reducing strain.
A high-fiber diet, typically aiming for 25 to 35 grams daily, is generally recommended for the long-term management of diverticular disease. This increased fiber intake helps soften stool, adds bulk, and can reduce pressure within the colon. Good sources of fiber include whole grains, fruits like prunes and pears, vegetables, beans, and legumes. When increasing fiber, it is important to do so gradually to avoid gas and bloating.
During an acute diverticulitis flare-up, however, a low-fiber or clear liquid diet may be advised to allow the colon to rest, with fiber reintroduced gradually as symptoms improve.
Adequate hydration is another important factor in preventing and alleviating constipation. Drinking plenty of fluids, typically at least eight 8-ounce glasses of water daily, helps to soften stool, making it easier to pass.
Regular physical activity also plays a supportive role in maintaining bowel regularity. Exercise helps to tone the intestinal muscles, which encourages more consistent bowel movements.
Additionally, natural options like prunes or prune juice can serve as gentle alternatives for promoting bowel activity. It is also beneficial to respond promptly to the urge to have a bowel movement rather than delaying it.
When to Consult a Doctor
Seeking professional medical advice is important for individuals managing constipation in the context of diverticulitis. A doctor should be consulted if constipation persists despite home treatments or if symptoms worsen. Specific scenarios that warrant medical attention include severe abdominal pain, particularly if it is constant or located in the lower left side of the abdomen.
Other concerning symptoms that necessitate a doctor’s visit include the development of a fever or chills, nausea, and vomiting. The presence of rectal bleeding, blood in the stool, or mucus in the stool also requires immediate medical evaluation. If there is an inability to pass gas or stool, it could indicate a potential bowel obstruction, which is a serious complication requiring urgent care.