How Can Severe Pain During Defecation Leading To Constipation, Intense Debilitating Cramps And Weight Loss Due To A Second Diverticulitis Flare Up Be Treated?

Posted on Mon, 11 Jun 2018

Medically reviewed by Ask A Doctor - 24x7 Medical Review Team

Mon, 11 Jun 2018 Answered on

Thu, 29 Apr 2021 Last reviewed on

Question : my husband was in the ER tuesday night.this is his second flareup of diverticulitis ,the first was 8 years ago.they sent him home with two antibiotics.he is still in alot of pain and cant really poop.contractions of intense cramps are debilitating him and has lost 10 lbs in the last week.i dont know what else to do. they gave him pain meds but refuses to take them in fear of constipating him even more...what to do..

Answered by Dr. Ramesh Kumar (5 hours later)

Brief Answer:
He needs intravenous therapy.

Detailed Answer:
Hi,
For acute phase of his diverticulitis antibiotic therapy is required but once the acute phase settles down. Severe and drastic life style modificatory changes have to be followed by patient for many months to avoid recurrent attacks.
Firstly antibiotic should be given intravenous for minimum of 3 days if patient is symptomatic which include Metronidazole i.v 100 ml thrice daily and Oflox 100ml i.v twice daily.Parentral antibiotic has 100% bioavailability and would act much faster.
For pain give him a anti inflammatory like ibuprofen with antispasmodic like dicyclomine 10mg thrice.If he constipates add lactulose 15 ml once to twice daily.Give him a lots of isaphghul husk which is a bulk forming natural agent.
However as per me best protocol is to get injectibles for three days with fleet enemas and intramuscular anti inflammatory.
Thanks!

Above answer was peer-reviewed by : Dr. Prasad

Follow up: Dr. Ramesh Kumar (39 minutes later)

Is that something we can ask for ? We currently don’t have insurance for him. I’m trying to find a local gastro Doctor.

Answered by Dr. Ramesh Kumar (15 minutes later)

Brief Answer:
A MD is sufficient to deal with diverticulitis.

Detailed Answer:
Hello again,
Yes you can ask the emergency department doctors to shift him under internal medicine speciality.He needs a ward thats it where intravenous therapy could be given.
This could also be given by a private nurse at home.

Summary is for better and fast relief instead of taking medicines orally we are injecting it directly in blood.
You need not to find a gastro for a normal case of diverticulitis.A MD is sufficient for it.
Even a private nurse can give him three dise of metro and two of oflox with enema.
Thanks!

Above answer was peer-reviewed by : Dr. Prasad

Follow up: Dr. Ramesh Kumar (23 minutes later)

Thank you, what about going to an urgent care? Or how do I find a nurse that would come to the house?

Answered by Dr. Ramesh Kumar (11 minutes later)

Brief Answer:
Call your primary doctor/hospital to provide a skilled nurse for 2 days.

Detailed Answer:
Hi again,
You can ask your urgent care or primary doctor to provide you with a skilled certified nurse or staff.
See once canula is in situ even a child can give drip of antibiotic.
Your urgent care or primary doctor should help you with that.Infact if he gets i.v for 2 days only it would be far better scenario.
If 100 gram of drug is given orally then not more then 25 gram is useful rest is either excreted or first pass metabolised while injectible is 100% bioavailable.
Hope you can understand what i am trying to explain you.

Above answer was peer-reviewed by : Dr. Prasad