Living with diverticulitis: Get the full scope of symptoms, treatment, and prevention | Digestive

Javier Salgado Pogacnik, M.D.

Section Chief of Colorectal Surgery

Surgery

While the cause of diverticular diseases is unknown, several studies associate the conditions with low fiber intake, excessive alcohol use, anti-inflammatory medications, steroids, obesity, and smoking.

Constipation. Diarrhea. Abdominal cramps. People expect gastrointestinal disorders to manifest with unpleasant, easily recognizable symptoms. But most patients with diverticulosis, one of the most common gastrointestinal conditions, don’t even know they have it.

Diverticulosis occurs when small, bulging pouches (diverticula) form inside weak areas of the colon, with the majority of cases occurring in the sigmoid colon – the lower part of the large intestine. In the U.S., 35% of adults age 50 or younger and 58% of adults age 60 or older have diverticulosis.

People with diverticulosis might not experience symptoms or complications that require treatment. Patients can learn they have the condition when they get a colonoscopy, X-ray, or CT scan for an unrelated gastrointestinal issue.

But in fewer than 5% of patients with diverticulosis, the diverticula become inflamed or infected, causing diverticulitis – a condition that does typically cause symptoms such as:

• Pain in the lower left abdomen
• Fever
• Nausea and vomiting
• Diarrhea
• Lack of appetite

Many people who experience these symptoms delay seeking care because they’re embarrassed, or they fear that gastrointestinal surgery with a colostomy bag will be their only treatment option. However, most patients with diverticulitis can manage their symptoms with antibiotics and lifestyle changes. By learning how we diagnose and treat this disease, you can feel more comfortable asking for help sooner.

Diagnosing diverticular diseases

An abdominal CT scan is the best way to diagnose diverticulitis, as it shows the severity of the inflammation and helps us determine the right treatment plan. Severe or untreated diverticulitis can result in life-threatening complications, such as a(n):

• Abscess: a painful, pus-filled fluid collection
• Fistula: an abnormal tunnel that forms between the colon and another organ/muscle, such as the bladder or vagina
• Perforation: a tear in the colon that allows its contents to leak into the abdomen
• Stricture: a narrowing of the colon created by scar tissue that can prevent stool from exiting the colon, possibly leading to obstruction or perforation

If you haven’t had a colonoscopy within a year of experiencing symptoms, we’ll order one for eight weeks from the day your symptoms began in order to rule out the possibility of colorectal cancer, among other issues. While the risk of cancer is low, it’s 40 times higher in patients with uncomplicated diverticulitis than in the general population. It is important to time the colonoscopy for eight weeks after symptoms to reduce the swelling of the bowel, therefore reducing the risk of bowel perforation during the procedure.

Related reading: Colonoscopy and alternative screenings for colon cancer just got easier

While the cause of diverticular diseases is unknown, several studies have associated the conditions with low fiber intake, excessive alcohol use, anti-inflammatory medications, steroids, obesity, lack of exercise, and smoking.

One disproved theory is that eating nuts, seeds, and popcorn increases your chances of developing diverticulitis. The reality is these foods can actually decrease your chances of a diverticulitis flare-up by softening your stool, which puts less pressure on your colon.

Treatment options for uncomplicated diverticulitis

Antibiotics

If you are among the 80% of people with mild symptoms (uncomplicated diverticulitis), your treatment plan likely will focus on short-term symptom relief and creating a long-term plan to prevent flare-ups. Your provider might prescribe a few days of rest and possibly 10 days of oral antibiotics, such as Ciprofloxacin or Flagyl (metronidazole), to help reduce inflammation.

Lifestyle changes

Eating a high-fiber diet, rich in foods such as bran, whole-wheat pasta, apples, pears, raspberries, beans, sweet potatoes, avocados, and vegetables, can help prevent regular flare-ups.

To help prevent recurring flare-ups, which happen in one-third of patients with uncomplicated diverticulitis, we recommend:

• A high-fiber diet rich in foods such as bran, whole-wheat pasta, apples, pears, raspberries, beans, sweet potatoes, avocados, and vegetables
• Regular cardiovascular activity
• Weight loss, if appropriate

Increase your fiber intake slowly to reduce gas and bloating and be sure to drink plenty of water – at least 64 ounces a day. Fiber without 64 ounces of water per day will constipate you. Patients who need to limit their water intake can instead take fiber supplements such as sugar-free fiber gummies. Otherwise, we find the powder form of Metamucil (two spoons of powder in a glass of water daily) is the most helpful.

Second or severe flare-ups

Patients typically start feeling better within weeks. A second flare-up can occur, but the timing is different for every patient. If suspicion of a recurrent diverticulitis flare-up is present, we’ll confirm diverticulitis with a CT scan before prescribing the above recommendations.

If your flare-up presents severe symptoms, you might need to stay in the hospital to get IV fluids and antibiotics. Your care team will likely recommend a clear, liquid diet for several days before slowly reintroducing bland foods.

Surgery for recurring and complicated diverticulitis

For some patients, colorectal surgery is the most appropriate treatment to significantly reduce diverticulitis flare-ups. You may need surgery if your:

• Recurrences continue despite antibiotics or lifestyle changes
• Symptoms are severe, including formation of a fistula, an abscess, or a perforation
• Bowel is obstructed

You have about five feet of colon, and most patients can live a normal, healthy life without the sigmoid section, which is about one foot long. Sigmoidectomy, sometimes called a sigmoid or bowel resection, is a minimally invasive procedure to remove the sigmoid colon and make a new connection between the intestines on each side of it – called anastomosis. This surgery is almost always laparoscopic, which uses several tiny abdominal incisions, rather than open surgery, which uses a comparatively large single incision that cuts through the abdominal muscle and wall. In rare cases, laparoscopic surgery would be converted to an open surgery. This might be due to something unsafe found during the operation, such as dense scar tissue or adhesions.

A sigmoidectomy ends recurring flare-ups for more than 95% of patients. If another flare-up occurs, we can treat it with antibiotics such as Augmentin or a combination approach of Ciprofloxacin and Flagyl.

What to expect during sigmoidectomy recovery

Many patients worry that they’ll need a colostomy bag after a sigmoidectomy. However, less than 1% of patients require a bag, which collects fecal matter if the intestines leak after surgery (anastomotic leak) or if the colon cannot be reconnected safely during surgery. In these cases, most patients receive a temporary bag that can be removed within three to six months. Your surgeon will discuss these risks with you prior to surgery.

Following surgery, you’ll stay in the hospital for a few days until you:

• Can pass gas regularly
• Can defecate and urinate by yourself
• Show no signs of infection, such as a fever or warmth, redness, pus-like discharge, or tenderness in your abdominal incisions
• Can walk independently with little to no discomfort (or at baseline before surgery)

After you go home, you may have diarrhea on and off during the first month. It takes about three months for the bowels to learn their “new normal.” You’ll need to avoid heavy lifting for six to eight weeks to prevent a hernia. Within two weeks after surgery, you’ll visit your surgeon or advanced practice provider to discuss your progress and determine when you can go back to work and other normal activities. It is case by case, but the average time off work is six to eight weeks.

Gastrointestinal symptoms can be difficult or uncomfortable to discuss, but that’s what we’re here for! There’s nothing we haven’t seen or heard. And the sooner you seek treatment when experiencing diverticulitis symptoms, the sooner we can help you start feeling better.

To visit with a diverticulitis expert, call 214-645-8300 or request an appointment online.

Diverticulitis: Signs, Symptoms, and Diagnosis

Diverticulitis is an inflammatory disease of the colon that occurs as a result of genetics, lifestyle, and other factors, including diet. Specifically, a diet that is low in fiber and high in animal fat can put you at risk of developing this potentially serious condition, according to the Mayo Clinic. A sedentary lifestyle, smoking, alcohol, and excessive caffeine consumption can also contribute to diverticulitis. The incidence of diverticulitis increases with age, and the condition has been linked with obesity.

Nonsteroidal anti-inflammatory drugs (NSAIDs) have been associated with increased risk of diverticulitis. But that observation isn’t definitive: One study found that NSAIDs as a class of drugs more than tripled the risk of diverticulitis, but that aspirin, also an NSAID, did not increase risk.

Diverticulitis develops from a condition called diverticulosis, in which small, saclike pouches called diverticula form on the wall of the digestive tract, per the Cleveland Clinic. By themselves, these pouches are not dangerous, but when they become ruptured, diverticulitis occurs.

Once that happens, it’s important to seek medical attention. Caught early and with mild symptoms, diverticulitis can be treated with bowel rest, a liquid diet, and an over-the-counter pain medicine like acetaminophen (Tylenol). In the past, doctors prescribed antibiotics to treat uncomplicated diverticulitis, but guidance published in March 2022 from the American College of Physicians states that most cases can be treated without this medication.

“For uncomplicated diverticulitis, we no longer routinely treat with antibiotics,” says Rabia De Latour, MD, a gastroenterologist at NYU Langone Health. “The data that we have on routine antibiotic use for uncomplicated diverticulitis did not show a clear benefit, and thus regularly administering them for uncomplicated cases has fallen out of favor.”

However, if left unchecked, diverticulitis may require surgery to remove infected portions of the colon.

Why It’s Important to Know the Signs of Diverticulitis

Because prompt treatment is needed to ward off diverticulitis complications, it’s important to be aware of all the common and more surprising signs of diverticulitis so you can alert your doctor if you think you may have the condition. The most common symptom is also the easiest to recognize: acute pain in the abdomen. Research shows that for people of European descent in Western countries, this pain usually occurs in the left lower abdomen, where the sigmoid colon is found, but people of Asian descent tend to experience the pain on their right side. This can sometimes be confused with appendicitis. The pain may be constant, lasting for days or until the condition can be treated.

“The acute onset of abdominal pain should always be evaluated by a professional to help identify if the cause of the pain is potentially life-threatening,” says Donald Tsynman, MD, a gastroenterologist at Gastroenterology East, P.A. & Endoscopy Center in Greeneville, North Carolina. “It’s definitely not something you should ever ignore.”

With that in mind, it’s key to be able to recognize the signs and symptoms of diverticulitis.

What Does Diverticulitis Pain Feel Like?

“Classically, the pain from diverticulitis is a sharp, progressive pain in the left lower quadrant of the abdomen,” Dr. Tsynman says. “But everyone experiences pain differently, and diseases certainly don’t read textbooks to learn how they should show up, so any sharp, consistent pain in the abdomen should be taken very seriously, especially if accompanied by other symptoms.”

The pain might also be accompanied by a tender feeling, which could indicate the presence of an abscess, or pocket of pus that can form in a ruptured diverticulum, says Johnny Altawil, MD, a gastroenterologist at Gastrointestinal Associates in Knoxville, Tennessee. “That’s a really bad complication, requiring either drainage or surgery.”

RELATED: What Is Abdominal Pain?

Dr. Altawil adds that if the diverticulitis has progressed to the point that there are complications, the pain may also be accompanied by the feeling of a palpable mass in the abdomen. “It can feel like there’s something big just sitting in your gut,” he says.

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• Directory of Diseases

October 10, 2022

Diverticulitis is an inflammation of diverticula, benign intestinal growths. Diverticula are protrusions of the intestinal mucosa at structurally weak points, such as the vascular lumen of the intestinal wall. They are considered harmless on their own, but if they become inflamed, they can cause serious symptoms.

Source:

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Solitary diverticula usually do not make themselves felt and are found only during endoscopic or other examinations. With diverticulosis, numerous outward protrusions of the intestinal wall are formed. If they become inflamed, doctors speak of diverticulitis. The process usually causes severe abdominal pain and fever, and can lead to symptoms such as blood in the stool.

Inflamed lesions sometimes heal without treatment with a light diet and adequate fluid intake. More severe cases require antibiotics and sometimes hospitalization. If this does not help, or complications such as bowel perforation or severe bleeding occur, surgery may be required. The doctor removes the part of the intestine where the diverticula lie. If the inflammation continues to return and this causes, for example, a narrowing of the bowel, another operation may also be recommended.

Protrusions of the intestinal mucosa, diverticula, are common, especially in the elderly. They usually form through the gaps in the intestinal wall, which are intended for the passage of intestinal vessels. In the presence of a large number of such intestinal elements, doctors speak of diverticulosis. While they do not cause any symptoms, and this is more than 80% of cases, this is an asymptomatic process. This condition is not dangerous and does not require treatment. However, when symptoms appear, the so-called diverticular disease occurs. The bulges can become inflamed and cause severe discomfort and complications. This is diverticulitis. In rare cases, mucosal outgrowths can lead to profuse bleeding into the intestines even without inflammation.

Strictly speaking, diverticulosis is formed by “false” or “pseudo-diverticula”. So doctors call the condition when not the entire intestinal wall protrudes through the vascular lumens, but only the mucous membrane. The so-called “true” elements are usually congenital protrusions of the intestinal wall in the right sections of the large or small intestine. False and so-called Meckel’s diverticula, located in the small intestine, are harmless on their own, but can become inflamed and cause appendicitis-like symptoms.

In about three percent of all appendix surgeries, doctors accidentally discover Meckel’s diverticulum. More than 90% of formations occur in the penultimate section of the colon (sigma, sigmoid colon) on the left. Inflammation of these areas (sigma diverticulitis) is expressed, respectively, by severe pain in the lower abdomen on the left, which can also spread to the entire abdomen. Unlike colon lesions, small bowel diverticula are rare and usually cause no symptoms.

Causes

In developed countries, 50 to 60 percent of people over 70 have diverticulosis. This age distribution is associated, among other things, with the increasing weakness of the connective tissue in old age, which contributes to the “sagging” of the intestinal wall. Approximately 10 to 20 percent of people develop symptoms associated with inflammatory diverticular disease (diverticulitis).

Risk factors that contribute to the development of the disease are also permanently increased pressure in the intestines – mainly caused by chronic constipation. A diet low in fiber can lead to this pathology. Unlike Asian and African countries, where diverticula are much less common (less than ten percent), in our country, on average, too little fruit, vegetables, and whole grains are eaten. Excess red meat on the menu, as well as lack of physical activity, genetic factors, and being overweight can also be causes of diverticulitis.

Symptoms of diverticulitis

In more than 80% of cases, intestinal diverticula cause no symptoms. However, if they become inflamed, symptoms such as:

• Abdominal pain in the sigmoid colon is usually localized in the left lower abdomen.

• In case of damage to the cecum or inflammation of the Meckel’s diverticulum in the right middle or lower abdomen.

• Abdominal pain is often better after a bowel movement or after the passage of air.

• Digestive disorders such as constipation, diarrhea or severe flatulence.

• Elastic compaction (“roll”) in the abdominal cavity, usually on the left with sigmoid diverticulitis. It is sometimes also referred to as “left-sided appendicitis”.

• Possible fever, general malaise.

Possible complications and risks

If you have any symptoms, you should consult a doctor, as the pathology can lead to serious and even life-threatening complications:

• Intestinal rupture (perforation).

• Inflammation of the peritoneum (peritonitis).

• Abscess formation.

• Narrowing of the intestine up to intestinal obstruction.

• Bleeding in the intestines.

• Connecting passages between different sections of the intestine or intestines and neighboring organs (fistulas).

Diagnosis

The typical symptoms and history give the doctor the first indication that this may be diverticulitis. During the physical examination, bowel sounds are assessed and the abdomen is palpated. The doctor can localize the patient’s pain and possibly feel a lump in the lower abdomen. In addition, he measures body temperature and gently feels the rectum. A blood test usually reveals signs of inflammation – an increased number of white blood cells, an increased value of CRP, or accelerated blood sedimentation.

Abdominal ultrasonography (abdominal echography) or computed tomography (CT) can help localize inflammation and determine the stage of inflammation. X-ray examination can also be useful, as in this way it can be relatively quickly determined whether intestinal perforation has already occurred.

With an open rupture, air is outside the intestinal loops into the abdominal cavity, which is clearly visible on the pictures. If such intestinal perforation has occurred, the operation must be carried out immediately! Colonoscopy should not be performed if diverticulitis is suspected due to the increased risk of bowel perforation in the acute stage. However, four to six weeks after the inflammation subsides, a colonoscopy is highly recommended to rule out other causes (eg, tumors, chronic inflammatory bowel disease).

How to treat diverticulitis

Diverticula that do not cause symptoms do not require treatment. Therapy depends on the stage of inflammation and the presence of complications. In the case of a mild course, if there is no fever or additional risk factors such as immunodeficiency, an attempt is made to find out whether the body itself is able to contain inflammation in the abdominal cavity. However, this is possible only if patients drink and eat enough light or liquid food. Careful medical supervision is required. Antibiotics are needed only in case of severe inflammation. Treatment can be done on an outpatient basis.

If symptoms improve, a light, low-waste diet is possible. Sufficient fluid intake is very important, and after two to four days, the affected person can usually eat normally (high in fiber) again. On the other hand, severe complicated diverticulitis requires inpatient treatment. Patients receive antibiotics and possibly fluids by vein. If an abscess has formed, it is emptied and flushed through the skin with a tube.

Physicians monitor closely to see if the patient’s condition has changed. Inflammatory constrictions in the intestines usually widen again with antibiotic therapy. Even heavy bleeding stops on its own in more than 80% of cases. However, in case of massive bleeding, ligation of the bleeding vessel may also be required. The operation is also necessary in the presence of complications such as perforation, severe narrowing of the intestine or connecting passages (fistulas) in other organs.

During the procedure, the surgeon removes (resects) the part of the intestine containing the inflamed diverticula, and then sews the intestine back together. Avoid emergency surgery whenever possible. If this is still necessary, a “one-stage operation is performed. However, there are situations where a two-stage approach is needed. During the first intervention, the surgeon removes the corresponding section of the intestine and creates an artificial anus (anus praeter) to unload the suture site of the intestine. The artificial anus is then closed again some time later during the second operation.

Attention!

The information on this site is not a guide to self-medication. All materials are for reference only and do not replace a visit to the doctor. If any symptoms appear, you should contact a specialist.

Literature:

1. Ivashkin V. T., Shelygin Yu. colon disease // Russian Journal of Gastroenterology, Hepatology, Coloproctology. – 2016. – No. 1. – S. 65-80.

2. Leitlinien der Deutschen Gesellschaft für Gastroenterologie, Verdauungs- und Stoffwechselkrankheiten und der Deutschen Gesellschaft für Allgemein- und Viszeralchirurgie (DGAV): S2k Leitlinie Divertikelkrankheit / Divertikulitis, Online: http://www . awmf.org/uploads/tx_szleitlinien/ 021-020l_S3_Divertikelkrankheit_Divertikulus_2014-05.pdf

3. Lock JF, Germer CT: Erste deutsche Leitlinie zur Divertikelkrankheit. In: Bayerisches Ärzteblatt 2017, 12: 640-646. Online: http://www.bayerisches-aerzteblatt.de/fileadmin/aerzteblatt/ausgaben/2017/12/einzelpdf/BAB_12_2017_640_646.pdf

4. Ardatskaya MD Diverticular disease of the colon. Resolved and unresolved issues // MS. 2017. No. 15. URL: https://cyberleninka.ru/article/n/divertikulyarnaya-bolezn-tolstoy-kishki-reshennye-i-nereshennye-voprosy

species, indications for stoma

A stoma is an opening through which the contents of the intestine are expelled. But this difficult stage is over, and it’s time to close the stoma: how does it happen and what are the risks? Answered by Konstantin Eduardovich Rzhebaev, surgeon, head of the surgical department No. 1 of the City Clinical Hospital No. 15 named after. O.M. Filatov.

There is a belief among the people: if a person has an intestinal stoma removed, it is for life.

How about really?

In most cases, an intestinal stoma is a temporary measure. Our main contingent is oncological patients who underwent bowel resection. They remove the stoma, because the intestine cannot be urgently stitched, especially in conditions of its obstruction or peritonitis (inflammatory lesions of the peritoneum – ed.). The second group – patients with diverticulitis: inflammation of hernial protrusions of the intestinal wall. With this disease, it is also necessary to remove part of the intestine and temporarily make a stoma. Well, the third group – patients with intestinal ruptures as a result of trauma or any other pathological conditions. In this case, a stoma is removed to a person and thereby saves a life – and then they restore the normal course of the intestine. Of course, there are life-long ostomies, but this is a much rarer situation.

There are two types of stoma. The colostomy is removed from the rectum, the ileostomy – from the small intestine.

How long can a person live with an ostomy?

Ileostomies (holes in the small intestine) can be closed at the earliest after one month. Colostomy (in the colon) – at least after three months, and preferably after six. There is no deadline: you can live with a stoma for at least ten years. The most important thing is not to rush. The removal of the stoma is an operation, which means the source of the inflammatory process in the body. It is necessary to wait until the tissues are completely healed, the inflammatory reaction will pass, because it is irrational to perform surgical interventions against this background, because it will be technically difficult to operate, and it will be worse to heal physiologically.

There are situations: a person wants to get rid of the stoma, takes a certificate from the oncologist, comes to the surgeon, closes the stoma – and six months later he has a recurrence of cancer. Perhaps it was the reconstruction of the stoma that provoked it.

It is also necessary to take into account the disease that causes the stoma to be removed. If it is oncology, then after resection of the intestine and removal of the stoma, they usually undergo chemotherapy or radiation therapy. This is at least six months of treatment and several months of recovery. Only then can the stoma be closed, and then on condition that there is no recurrence of the oncological disease. There are situations: a person wants to get rid of the stoma, takes a certificate from the oncologist, comes to the surgeon, closes the stoma – and six months later he has a recurrence of cancer. Perhaps it was the stoma reconstruction that provoked it, because the operation means stress for the body and a decrease in immunity.

On the one hand, we understand that a stoma is uncomfortable. On the other hand, a stoma is life and safety. So, it is necessary to approach the issue of restoring the intestinal lumen, reconstructing the stoma very reasonably – both for the patient and the surgeon.

How is the stoma closure operation performed?

It depends on the type of stoma.

• With a single-barrel stoma , only one end of the intestine is brought out, and the second, blind, is in the abdomen. The operation to reconstruct such a stoma is technically more complicated: it is necessary to open the abdominal cavity, find the blind end, then cut off the intestine that is connected to the stoma and sew it with the blind end.
• In double-barreled stoma , both ends of the intestine – efferent and adductor – are brought into the wound. Such an ostomy can be more difficult to make, but then it is easier to close. This does not even require a major operation: a small incision is made in the stoma area, two parts of the intestine are connected, the excess is cut off and the sewn intestine is removed into the abdominal cavity.

The image shows a single-barrel stoma: only one trunk of the intestine will be brought out through the hole in the anterior abdominal wall, and the blind end is left in the abdominal cavity.

How well is healing after stoma reconstruction?

The main risk is the failure of the sutures at the junction of the two ends of the intestine. The large intestine grows together worse than the small intestine: the blood supply is worse, the flora is “angrier”, the wall is thinner. We have to start all over again: resect this failed anastomosis (junction), bring the ends of the intestine out and re-reconstruct the stoma in 3-6 months. It is clear that the more operations in the past, the more technically difficult it is to make a new operation.

To understand the risk of non-union of the intestine, I give conditional figures to patients: the small intestine does not grow together in one out of a hundred cases, the large intestine – in one out of ten. In my personal practice for 15 years of fairly active work in this area, there was not a single case of non-union of the small intestine, and about 10-15 cases of non-union of the large intestine.

Usually, patients stay in the hospital until 7-8 days after the operation, so that we can make sure that the person has a stool, no fever, pain, or intestinal obstruction.

Whether the intestine has grown together becomes clear on the 3-7th day. If the anastomosis “falls apart” on the first or second day, most likely, some technical omissions were made during the operation. If later, the reason is most likely a violation of the blood supply or poor functioning of the immune system. Therefore, patients usually stay in the hospital until 7-8 days after the operation, so that we can make sure that the person has a stool, no fever, pain, intestinal obstruction – that is, everything works as it should. If nothing happened before discharge, then, as a rule, then it happens extremely rarely.

Can I eat and go to the toilet on my own after the operation?

There are different surgical approaches. Previously, the patient was not allowed to eat for a long time after an operation on the intestines. But modern recommendations allow the use of special therapeutic nutrition, starting from the second (and sometimes from the first) day after the operation. Contrary to myths, the anastomosis “falls apart” not from food, but because of poor blood supply to the sutured intestine and defects in the patient’s immune system. With proper and early nutrition, the patient receives with food the necessary “building” substances – proteins necessary for the effective fusion of the cross-linked part of the intestine. The chair is restored in the first days after the operation.

How does the work of the intestine change, which has been inactive for many months?

First, I will explain what happens in the lower, non-functioning part of the intestine while a person lives with a stool bag on his side.

• Firstly, there is a certain amount of feces left in the intestine, which was there even before the operation to remove the stoma (after all, such operations are usually done urgently).
• Secondly, even in the blind end of the intestine, mucus is constantly produced. Many doctors miss this moment after the operation to remove the stoma. A week, a month passes, mucus accumulates – but is not displayed. What should be done in this case? Be sure to put microclysters with warm water every 2-3 days, and then hold this water for several minutes. This allows you to flush the intestines and keep the sphincter working. Thus, the person, as it were, prepares them for the operation to close the stoma.

If the lower part of the bowel becomes clogged with stool, it can already be harmful during the stoma reconstruction surgery. The fact is that anastomoses are now most often superimposed using a device that is inserted through the anus and through the intestines reaches the place where the stoma is removed. There he joins with the second part of the apparatus and stitches the intestine. So, if the apparatus goes through the feces, this is bad: the risks of anastomosis failure increase. Of course, before the operation, we do enemas and control the cleansing of the intestines – but this takes time, the person is delayed in the hospital. It is much better if the patient himself systematically cleanses the intestines and prepares for reconstruction.

Can the sphincter atrophy during its “non-use”?

This is a highly contrived thing. In my years of practice, I have never seen such a complication. The sphincter can be destroyed as a result of illness, injury – but not atrophied. These are not the risks that the patient needs to worry about. His task is to listen to the surgeon, eat sensibly, and quickly become active. The faster a person begins to move after surgery, the greater the likelihood of a favorable outcome and a quick recovery.