From the Guidelines
The treatment for colonic diverticulosis with moderate stool burden on CT typically involves a combination of dietary modifications, stool softeners, and possibly laxatives to reduce constipation and prevent complications. Patients should increase dietary fiber intake gradually to 25-30 grams daily through fruits, vegetables, and whole grains, while maintaining adequate hydration with at least 2 liters of water daily 1. A fiber supplement such as psyllium (Metamucil) 1 teaspoon mixed in water 1-2 times daily or methylcellulose (Citrucel) can be added if dietary changes are insufficient. For the moderate stool burden specifically, docusate sodium 100 mg twice daily can help soften stool, and polyethylene glycol (MiraLAX) 17 grams daily in water may be needed to establish regular bowel movements 1. Physical activity should be encouraged to promote bowel motility. This regimen addresses the underlying constipation that can exacerbate diverticulosis by reducing pressure within the colon, which otherwise could lead to inflammation, infection (diverticulitis), or other complications. Regular bowel movements with softer stool consistency help prevent stool from becoming trapped in diverticula and causing inflammation or infection. It is also important to note that CT imaging is useful in diagnosing and managing acute left-sided colonic diverticulitis, and can help identify complications such as abscesses or perforation 1. However, the use of antibiotics and other treatments should be individualized based on the patient's specific condition and medical history 1.
From the Research
Treatment for Colonic Diverticulosis with Moderate Stool Burden on CT
- The treatment for colonic diverticulosis with a moderate stool burden on computed tomography (CT) may involve dietary changes, pharmacological treatments, and bowel preparation techniques 2.
- Dietary fibre is often recommended as a first-line treatment for diverticulosis, as it can help to soften stool and reduce symptoms 2.
- Pharmacological treatments such as antibiotics (rifaximin), anti-inflammatory drugs (mesalazine), and probiotics may also be used to manage symptoms and prevent complications 2.
- Bowel preparation techniques, such as the use of polyethylene glycol (PEG), may be used to cleanse the colon and prepare it for diagnostic procedures such as CT colonography 3, 4, 5.
- PEG has been shown to enhance colonic barrier function and reduce mucosal damage and inflammation in experimental colitis models 3.
- Reduced-volume PEG bowel preparations have been compared to magnesium citrate preparations for CT colonography, with PEG demonstrating better tagging and shorter interpretation times 4.
- The use of PEG as an oral contrast agent has also been shown to improve contrast medium transit to the colon, even in patients with intraabdominal inflammation 5.
Bowel Preparation Techniques
- Polyethylene glycol (PEG) is a commonly used bowel preparation agent that can help to cleanse the colon and prepare it for diagnostic procedures 3, 4, 5.
- PEG can be used in reduced volumes, such as 1-2 L, to minimize side effects and improve patient tolerance 4.
- The use of PEG as an oral contrast agent can help to improve contrast medium transit to the colon and enhance the diagnostic accuracy of CT colonography 5.