Medical therapy of colonic diverticular disease.

Treatment of asymptomatic diverticulosis is geared to the prevention of constipation, with vigilance for possible signs of complications. A bulky stool decreases colonic intraluminal pressures, probably lessening pain and the chance of development of new diverticula. Increased stool weight may be achieved by the addition of vegetables, fruits, and cereals (bran) to the diet. Foods with undigestible residues should be avoided. When dietary manipulations are not well tolerated, hydrophilic bulk laxatives are a useful alternative. Treatment of acute attacks consists of bowel rest and administration of intravenous fluids and antibiotics. Side effects of anticholinergics may outweigh their questionable usefulness. Nonabsorable oral sulfonamides have little or no place in the treatment of the acute attack (peridiverticulitis).