Living with diverticulitis: How do I keep it from coming back?

@hopeful33250 I have had 7 flare ups over the past 5 years. This time it has reoccured quickly. I had a flare up in November and now January. I am on my second round of antibiotics. I was told to follow up with surgeon but not sure if Im ready for that and if that is the solution. Looking for suggestions and clarity.

@susanf22 Not a doc, but have had multiple episodes myself. I did have a consult with a surgeon. He’s optimistic about doing robotic surgery and claims a great track record, but then I read stuff here that is far more mixed in terms of results and recovery. I just read here about smoldering diverticulitis which is apparently a low level of inflammation and maybe bad microbes that hangs around without being very symptomatic only to flare up for some reason. Makes sense to me based on my experience of clearing up an episode but still having a lingering pain in lower left quadrant. My problem has been tolerating antibiotics…. I can only go 3-5 days before they create problems related to my liver it seems. This last episode was bad and I got on Augmentin which is amoxicillin with a booster. I could tolerate it okay and did it for all 14 days instead of the usual 7-10 which I could barely do on other antibiotics. Fingers crossed, that may have gotten my system straightened out. Also, I am going to a regular fiber diet, not a HIGH fiber one. Also read about that here. Seems like some people (me?) do better that way and it is consistent with my failures to avoid episodes by trying to be high fiber. Finally, I added prunes to my diet…one a day. I always hated the thought of prunes, but my girlfriend talked me into it. Bingo! It is unbelievable how much easier it makes having a BM. I’m basically regular, but not necessarily every day, but I don’t worry about getting backed up because I will go at some point. If I think it is too long, I either take a magnesium pill or a dose of MiraLAX to make things happen. I am hoping to avoid surgery with this new regime. Good luck to you.

@donbarkman thanks for sharing your story. I feel like I'm at that point also with my decision. Im going to try to revamp my diet and fiber intake and go from there. I really dont want the surgery but I will keep you posted. Good luck to you as well!🥰

@susanf22 Once the "flare ups" are happening more frequently it is best to see a surgeon. The antibiotics and anti-inflammatory med's are difficult to keep taking and every episode is causing more damage and scar tissue in your colon.

@linda82 Thanks for that comment. I did not think of the overall damage that is done from the flare ups. Something to think about for sure!

I was one of those who suffered from smoldering diverticulitis and finally decided I couldn’t live like that anymore. Multiple trips to the ER, a ruined trip because of an infection and antibiotics that made me sick. My surgeon also feared it could burst at some point which would require emergency surgery with whatever surgeon was on duty.
I finally opted for robotic surgery a year ago. I have no regrets. My body is still adjusting to 12” less colon but the issues I have now are tolerable compared to before surgery.
It wasn’t an easy decision but at some point, for me, there was really no choice.

@susanf22 7 in 5 years seems pretty aggressive. Of course details matter and we don't have any details on your flare-ups, tests/scans, treatment and their effectiveness, etc. But if I had it to do over again, knowing then what I know now, I'd have had my Sigmoidectomy after my 5th or 6th, or maybe even 3rd or 4th episodes. I just had it after 11-12 in as many years and I feel a bit lucky to have been able to do a planned surgery vs emergent, using laparoscopic vs open surgery technique, with a surgeon I was able to consult and collaborate with for months vs whatever surgeon is on ER duty if I needed an emergent surgery, and to do so without a colostomy bag. Surgery avoidance is a very natural and powerful reaction. But it concerns me when I see people say things like "I am not ready for that". It is a concern because it usually means they are letting it be a mental decision when it needs to be a physiological decision. Consider, research, and talk to your Doc's about questions like these:

- What are the chances you will stop having diverticulitis episodes (either flare-ups or smoldering)?
- What impact have your previous flare ups already had on your body?
- If you don't stop having episodes, what are the chances of further diverticulitis complications occurring and what risks do those have?
- What is the increased frequency indicating about the progression of your disease?
- What is the antibiotic resistance you're experiencing indicating about the progression of your disease?
- If they don't stop, will the likelihood of the need for planned surgery increase?
If they don't stop, what is the likelihood of the need for a more complicated surgery, recovery, and need for a colostomy bag versus doing it at this point in time?
- If they don't stop, what is the likelihood of the need for an Emergency Surgery?
- If I need and have surgery later, how does my age impact the surgery, its success, and the recovery from it?

Surgery isn't risk free or a promise that you'll never have a gut issue in your life again, so certainly ask about those as well. But the main point I am recommending is - make your decision based on the answers to those types of questions versus "am I mentally ready to make the decision to have surgery?".

@susanf22 Hello Susan, and welcome to Mayo Connect. I see that many members have responded to your post, including @linda82, who has had surgery and is pleased with the results.

One of the main problems in keeping flares at a minimum is following a diet and lifestyle to prevent constipation. How is your diet when you are not having a flare-up? Is constipation a chronic problem for you?

@hopeful33250 my constipation is not consistent. I do take metamul everyday when Im not in a flare up. I try to get fiber through my diet as well.
Everyone who has comment has really given me so much informaton for me to think about. I read each one and appreciate their feedback.

@susanf22 It is something we do not think about, and it is hard to see from CT scans and MRI's
I know for a fact that due to my surgery being so long and because of this scar tissue and damage my Dr. needed to call in another surgeon to help. Mine went from robotic to open.
They worked very hard and thankful every day that I did not have other complications.