Today my first patient was my own co-worker. He was walking gingerly toward me holding his abdomen and wincing. “Could you check out my abdomen, I was up most of the night with pain.”

As I pressed around his abdomen, the left lower quadrant was obviously the tender spot. A few more questions and labs showed no diarrhea, but nausea, a high white blood count and a fever. Judging from the marked pain in his abdomen from even light pressure, it was soon obvious my co-worker was going to be heading home and downing some antibiotics.

So, what did his symptoms indicate? Diverticulitis. Let’s look at some terms: diverticulosis refers to having little pockets off of the bowel, most commonly the colon. They are usually the size of a small marble and approximately 10% of Americans over the age of 40 have them. But as we age, the condition becomes even more common so that over half of people older than age 60 have them and by age 80 two-thirds of individuals have diverticulosis. If these pockets aren’t infected or bleeding, people often don’t even know they have them. Occasionally they cause some lower abdominal bloating, bleeding, constipation, or, less often, diarrhea.

In developed countries such as the United States the typical diet is low in fiber and high in highly processed carbohydrates. This diet causes harder stool and slower transit time through the colon, which in term increases the pressure inside the colon. The current theory is that over time this results in out-pouchings along the colon. So, in countries with this kind of low fiber diet, diverticulosis is common.

If someone has these little pockets (diverticulosis) and they get infected, it’s then called diverticulitis. Now this patient can have all the symptoms we’ve mentioned, with left lower abdominal pain being the hallmark. In fact, diverticulitis is sometimes called “left-sided appendicitis” because it hurts like appendicitis but usually occurs on the left side of the abdomen instead of on the right side where appendicitis would occur. However, diverticulitis can sometimes affect the right side of the colon as well.

If you happen to know you have diverticulosis, usually due to having had a colonoscopy (but also visible on other tests such as a barium enema or sigmoidoscopy), what can you do to avoid attacks of diverticulitis? A high fiber diet seems to be key. The average American gets 15 grams of fiber daily, but the recommendation is for 25 grams daily for females, and a whopping 38 grams for males. This comes from sources such as whole grains, legumes, seeds, nuts, and vegetables.

There used to be a theory (and it is still often repeated) that nuts, seeds, corn, and popcorn increase the likelihood of diverticulitis attacks. But subsequent studies have not borne this out, and a 2008 study actually showed that diets higher in nuts and seeds had a lower incidence of diverticulitis. Besides a higher fiber diet, drinking lots of water, and if you’re prone to constipation, using a daily fiber supplement can be helpful.

If, despite your best efforts, you start feeling lower abdominal pain, especially on the left side, it’s time to have your doc check you out. Blood work, and occasionally some imaging by x-ray or CT if needed, can help diagnose the problem. A combination of antibiotics along with bowel rest (fluids only) for a few days will usually allow the problem to pass. However about 50% of people who have one bout of diverticulitis will get one or more recurrences in the future. Occasionally the frequency and severity of attacks is so great that surgery is recommended to remove the worst section of colon. Another uncommon complication is where a diverticulum ruptures allowing stool into the surrounding abdominal cavity and causing a severe abdominal infection. Severe pain and fever results and hospitalization is needed.

So, when you’re wearing shorts or pants, it’s handy to have pockets; in your colon… not so much. And if those colon pockets start holding on to some nasty, infected stuff, it’s definitely not handy. So like your mama told you, eat your vegetables and drink lots of water, and don’t be afraid to toss in some nuts, seeds and whole grains.

Andrew Smith, MD is board-certified in Family Medicine and practices at 1503 East Lamar Alexander Parkway, Maryville. Contact him at 982-0835