These comments are kindly supplied by email from a doctor friend. I find them very helpful.

Diverticulitis as an infective disorder is real and can be life-threatening. Faecal matter can become trapped in the little pockets and in loops of bowel and ferment which gives you the pain and bloating; but there can also be overgrowth of pathogenic bacteria which give you the fever and lethargy and which can lead to perforation and peritonitis and death.

Possible side effects of antibiotics to me seem somewhat diminished by comparison.

The surgery is horrendous because you are very ill when it is done and the bowel is so fragile it is difficult to cut bits out and reconnect it and you can develop fibrous tissue all over the abdomen as things heal and that gives you pain and if you try to operate again it makes everything worse. It should be rarely needed in this country particularly in metropolitan areas. (Having said that some bugs are very virulent and can overwhelm you quickly)

My own opinion is that you need to use antibiotics in adequate doses to either kill the baddies or stun them enough to allow your body to finish them off. The problem with the anaerobic bacteria is that it is difficult to do the latter and they lurk. Which is why doctors hit you with a heavy load of antibiotics initially.

For some people with recurrent problems they have found out which antibiotic works for them and are happy to have a prescription on hand for flare ups.

The rationale for going on to water when symptoms flare is to avoid adding to the substrate load. If you have to go to hospital you will be put on I/V antibiotics and allowed only water initially with gradual introduction of food over a couple of days.

Traditionally maintenance has been dietary manipulation but there was no basis for this except individual trial and error and which seemed to have contradictory results even in the same person. For some people “fibre” helped for others”fibre” made everything worse and is why you got all the seeds/no seeds cabbage/no cabbage etc etc. The FODMAPS intolerance gives an explanation for this.

[b]A short course of probiotics may help after antibiotics but at this stage it is thought that probiotics dont help as a regular supplement just add to the microbial load and may worsen symptoms by increased fermentation.[/b]

For me the place of slippery elm is for mitigation of symptom flare-ups from dietary “indiscretion” not full blown infection but back in the pre-antibiotic days you used what had some chance of effectiveness.

Irritable Bowel is slightly different. The nerve supply to the bowel to enable peristalsis is very complex and doesn’t always develop properly (in Hirschsprung disease the nerve supply is missing most commonly in the lower part of the bowel which needs to be excised or the baby will die).

It is thought that bits where the nerve supply is suboptimal there is pooling of faecal matter with the usual fermentation pain bloating etc. with a specific pattern depending whereabouts in the bowel this occurs. It can be both small and large intestine with both constipation and diarrhoea. The neurotransmitters in the gut are the same as those in the brain which is why people with IBS often respond to antidepressants. For some women the symptoms cycle with their menstrual cycle and they can benefit from a non-cycling OCP.

Once again I would think that the FODMAPS diet would influence these symptoms although I haven’t read any further. With small intestine disease probiotics may well be helpful.

The site is informative. It’s obviously a commercial site but reliable.

I did run my eyes over your forum and it all seems pretty OK.

Your description of your rebound tenderness was a bit of a worry (the pain when you lifted your hand) and if that persists i think you should go back to your doctor. I probably would be considering an abdominal CT – they can pick up gut pathology these days. Yes yes I know there’s radiation involved but not much and the benefits vastly outweigh any putative risks.