From the Research
To treat diarrhea associated with diverticulitis, focus on a clear liquid diet for 2-3 days during an acute flare-up, gradually transitioning to a low-fiber diet as symptoms improve, and consider antibiotics only if infection is present, as the most recent evidence suggests limited benefit of antibiotics in uncomplicated cases 1.
Treatment Approach
When managing diverticulitis with diarrhea, the following steps can be taken:
- Start with a clear liquid diet for 2-3 days to help manage symptoms and reduce bowel movements.
- Gradually introduce low-fiber foods as symptoms improve, avoiding high-fiber foods, nuts, seeds, and popcorn that can exacerbate symptoms.
- Use over-the-counter medications like loperamide (Imodium) to control diarrhea, taking 2mg after each loose stool, not exceeding 8mg per day.
- Stay well-hydrated with water, clear broths, and electrolyte solutions to prevent dehydration.
- Apply a heating pad to the abdomen to relieve pain and use acetaminophen for discomfort, avoiding NSAIDs.
Antibiotic Use
The use of antibiotics in diverticulitis is a topic of ongoing debate, with recent studies suggesting that they may not be necessary in all cases of uncomplicated diverticulitis 1, 2. However, antibiotics such as ciprofloxacin (500mg twice daily) with metronidazole (500mg three times daily) for 7-10 days may still be prescribed if infection is present or in cases of complicated diverticulitis.
Monitoring and Follow-up
It is essential to monitor symptoms and seek medical attention if severe pain, persistent diarrhea beyond 3 days, bloody stools, fever above 100.4°F, or inability to keep liquids down occur, as these may indicate complications requiring immediate medical attention.
Prevention of Future Flares
Once the acute episode resolves, gradually increase fiber intake to 25-30g daily to prevent future flares, and consider colonoscopy 6 weeks after diagnosis if complicated diverticulitis or suspicious features on CT scan are present 2.