Q: My husband has had problems with his health recently. He had to be hospitalized in November for severe abdominal pain. He was told that his problem was diverticulitis. Now he is afraid to eat many different things. I don't think that he should be so strict with his food. Can you explain what he needs to do to avoid another flare-up? Thank you. — Naomi

A: Diverticular disease affects many people over 60. Let me first explain about the diverticula. The colon (large intestine) is a long, tube-like structure that stores and then eliminates waste material. Sometimes increased pressure inside the large intestine makes little pouches stick out. One way to visualize it is to inflate a rubber glove. The fingers will stick out after certain pressure is applied. The same happens with our body. Pouches are created due to the elevated pressure inside our gut. This happens because of our diet. Lack of fiber, or "roughage," causes muscles around the intestine to strain in order to move its contents along. Diverticular disease (the existence of the pouches) is common in developed or industrialized countries — particularly the United States, England, and Australia — where low-fiber diets are common. The disease is rare in countries of Asia and Africa, where people eat high-fiber vegetable diets. Fiber is the part of fruits, vegetables, and grains that the body cannot digest. Some fiber dissolves easily in water (soluble fiber). It takes on a soft, jelly-like texture in the

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intestines. Some fiber passes almost unchanged through the intestines (insoluble fiber). Both kinds of fiber help make stools soft and easy to pass. Fiber also prevents constipation. About half of people over 60 have the pouches (doctors call them diverticula and a single one diverticulum). This is called diverticulosis or diverticular disease. Once formed, diverticula are permanent. Most of the time the pouches cause no problems at all. Sometimes, however, in about 10 to 25 percent of people with the pouches, bacteria get inside the pouch, causing symptoms. Pain in the lower left side of the abdomen is the most common problem, but fever, nausea, vomiting, chills, cramping and constipation may occur as well. Diverticular disease can be diagnosed with X-rays or with a colonoscopy. At times bleeding may happen if the pouch breaks. This is what has happened to your husband and it may be serious at times. Infection is treated with antibiotics. If the bleeding is severe enough, it may require a blood transfusion. The bowel is rested (no food) and pain medications are given. If attacks are severe or frequent, the doctor may advise surgery.

For most people with diverticulosis, however, eating a high-fiber diet is the only treatment needed. You can increase your fiber intake by eating whole-grain breads and cereals; fruit like apples and peaches; vegetables like broccoli, cabbage, spinach, carrots, asparagus and squash; and starchy vegetables like kidney beans and lima beans. Some doctors recommend avoiding nuts, corn, and seeds, which can plug the pouches and cause inflammation and infection. Whether avoidance of such foods is beneficial is unclear. Your husband should not restrict his diet, but he needs to have enough fiber and water to avoid constipation. His doctor probably did it already, but make sure that all of the medications he takes are checked, since some medications can cause constipation, including nonprescription over-the-counter and alternative drugs. Losing some weight may be beneficial, as you suggested. Regular physical activity will also help. People who exercise regularly rarely suffer from constipation. I sincerely hope that your husbands "pouches" will never again land him in the hospital. Dr. Beata Skudlarska is a Bridgeport geriatrician. Send questions to Bridgeport Hospital Center for Geriatrics, 95 Armory Road, Stratford CT 06614 or geriatricmd@aol.com.