Suggest Treatment For Lower Left Quadrant Discomfort And Nausea While Having Diverticulitis

Posted on Thu, 21 Jan 2016

Question: I’ve come to you because I can’t see my PCP for a week, and I can’t see my gastroenterologist until March. I am a healthy, 58-year-old anglo male with a history of sigmoid diverticulosis with seven instances of uncomplicated diverticulitis since 2003. After my most recent diverticulitis attack, which began December 17 and concluded with the end of my course of antibiotics (Cipro and Flagyl) on December 24, I’m concerned something is not right. Bowel movements are meagerly productive and yield only small amounts of soft, unformed content along with a large amount of air. I do not sense incomplete evacuation, but the input/output ratio is far from normal. My abdomen is soft and non-distended. There is no fresh or old blood in bowel content. I currently have no discomfort in the lower left quadrant. I have not experienced vomiting or nausea. I take two doses/day of polyethylene glycol, drink at least 64 ounces of fluid/day, and eat a high-fiber diet. Yet, my symptoms cause me to be concerned that there may be a partial blockage, such as a diverticular stricture, and that the longer the situation persists, the greater is the probability of an emergent situation. My most recent colonoscopy was 2012 and was unremarkable except for the presence of multiple sigmoid diverticula. which may explain the small-content voidings. May I ask for your evaluation of these symptoms, my concerns, and your counsel about the next steps I should take given the inaccessibility of my primary and specialist providers?

Answered by Dr. Panagiotis Zografakis (24 minutes later)

Brief Answer:
perhaps stopping the drugs for the bowels

Detailed Answer:
Hello,

let me start from the basics. A soft, non-distended and apparently working abdomen is usually not in an urgent condition. Partial or complete obstruction of the intestine usually causes pain, distention, inability to pass gas, vomiting and is generally blatant enough to drive the patient to the emergency room. Of course it may take some time until the patient's abdomen distends that much but it won't be asymptomatic.

Regarding the unformed content, there are various explanations for it. First of all the drugs you're using may cause it, so easing up on them a bit might help. When patients use such drugs, this is the most common cause.
Other causes may include a mild diverticular irritation, tumors of the intestine, food-related (too much undigested fiber), etc. Someone (it would be difficult for you to do that) has to check that your rectus is not full of stool by inserting a digit inside and palpating the area. Sometimes the stool may become dehydrated and hard like little round rocks. Then it's very difficult for the intestine to push it outwards.

If the symptoms persist and reducing the drugs won't help, you've got to visit a doctor and make an appointment for a new colonoscopy. Of course, if the symptoms get worse or you start having symptoms of overt diverticulitis then you'll have to visit the emergency room (or another doctor) for appropriate assessment and treatment.

I hope you find my comments helpful!
You can contact me again, if you'd like any clarification or further information.

Kind Regards!

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Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar