Are you having back pain with any of the following?

  • Severe pain, weakness or tingling in your leg(s).
  • Difficulty stopping urination or loss of control of bladder or bowels.
  • Unexplained fever, nausea or vomiting.
  • A history of cancer or unexplained weight loss.

We understand that you are experiencing one or more of the health issues that might be impacting your back pain.

We recommend that you discuss these health issues with your doctor before proceeding with this program.

Once you are cleared by your doctor to do this program, we hope it helps you find relief from your back pain.

Provider photo for Jeremy Swartzberg

Jeremy Swartzberg, MD

Hospital Medicine

Welcome to My Doctor Online, a web site that my colleagues and I developed to make it easier for you to take care of your healthcare needs. On this site you will find answers to many of your questions about my clinical practice. Also included are several online features that will allow you to e-mail me, check your laboratory results and refill prescriptions. I hope you find its content informative and useful.

My Offices

Oakland Medical Center
Appt/Advice: 510-752-1190

See all office information »

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Overview

Diverticular disease is a very common gastrointestinal problem in older people. It is characterized by 2 conditions in the colon.

Diverticulosis. Small pockets develop in the walls of parts of the colon. These pockets are called diverticula. In most people, they cause no symptoms.

Diverticulitis. Over time more pockets develop. In some people, these pockets can become:

  • Bigger and bulge outwards
  • Plugged with fecal matter
  • Infected

When one or more pockets are inflamed or infected the condition is called diverticulitis. Rarely, the pockets can bleed. This is called diverticular bleeding.  

About half of people over the age of 60 have diverticular disease. Most people over the age of 80 have the condition. We don’t know the exact cause, although a low-fiber diet appears be a risk factor. 

Treatments include:

  • Diet changes
  • Pain medication
  • Antibiotics 
  • Surgery

Symptoms

Diverticulosis

It is rare for uninfected pockets (diverticula) to cause symptoms. A small number of people may develop:  

  • Stomach cramps
  • Discomfort in the lower stomach
  • Bloating 
  • Constipation

Diverticulitis

Diverticulitis means that the abnormal pockets in the colon wall are infected and inflamed. Symptoms are much more likely, including:

  • Stomach cramps 
  • Pain in the lower stomach, usually on the left side, that lasts for hours or days
  • Nausea and bloating
  • Fever
  • Constipation
  • Change in daily bowel habits
  • Diarrhea

In rare cases, blood vessels in the diverticula can hemorrhage. This causes lightheadedness and rectal bleeding. Contact us right away if you experience these symptoms.

Additional References:

Diagnosis

Only about 20 percent of people with diverticular disease have symptoms. We typically diagnose the condition during routine screening for colorectal cancer.  When you come in for an appointment, we will:

  • Discuss your medical history 
  • Examine you
  • Order blood tests
  • Schedule a procedure to examine the inside of your colon. 

If you have serious complications, we may recommend additional tests such as:

  • A contrast enema X-ray 
  • A CT (computed tomography) scan 

Causes and Risk Factors

We don’t know the exact cause of diverticular disease. We do know that you are more likely to develop it if you don’t eat enough fiber. Fiber is found in fruits, vegetables, legumes, nuts, seeds, and whole grains. A low-fiber diet can cause hard stools and constipation. Fiber: 

  • Stays in the colon
  • Absorbs water 
  • Makes bowel movements easier

Other risk factors include:

  • Aging
  • Eating a diet high in meat and fat
  • Family history of diverticulosis
  • Obesity 
  • Living in a Western country
  • Connective tissue diseases, such as Marfan syndrome or scleroderma.

Factors associated with diverticulitis flare-ups include:

  • Use of nonsteroidal anti-inflammatory drugs, such as ibuprofen or naproxen
  • Previous attacks
  • Suppressed immune system
Additional References:

Prevention

It is not clear whether diverticular disease is preventable. However, we do know that:

  • People who eat a high-fiber diet are less likely to develop it. Taking fiber supplements may be helpful.  
  • Vegetarians have a lower risk of developing the disease. This is probably because they eat plenty of fruits and vegetables. They also avoid animal fats.
  • Gender, history of alcohol use or smoking, and history of colorectal cancer do not affect your risk.  
  • Nuts, seeds, and popcorn may be protective. We used to think that these foods could block diverticula and cause infection. A recent study disproved this theory. 
Additional References:

Dietary Changes

Changing your diet is one of the most effective things you can do.  Eating well can treat, or prevent, symptoms. 

Diet changes during a flare-up

We may recommend a low-residue diet for a short period of time. A low-residue diet involves eating less fiber. Eating this way:

  • Slows down bowel movements
  • Decreases the amount of stool in the intestines
  • Reduces blockages 

Diet changes to prevent flare-ups 

We may recommend that you eat more fiber if:

  • You have no symptoms 
  • You’ve had 1 or more flare-ups that have healed

Choose foods with fiber such as:

  • Fruits: Apples, oranges, peaches, nectarines 
  • Vegetables: Broccoli, cabbage, Brussels sprouts, spinach, carrots, squash, or others 
  • Starchy vegetables: Peas, beans, potatoes
  • Grains: Whole-wheat bread, high-fiber cereals, brown rice, oatmeal
Additional References:

Treatment

Medications

There is no cure for diverticular disease. However, most people don’t develop symptoms. If symptoms occur they are usually mild and get better with minimal treatment. If dietary changes don’t help we may prescribe medications. These include:

Antispasmodics are pain killers that help control mild symptoms such as:

  • Colon muscle spasms 
  • Stomach pain or cramping

Antibiotics help:

  • Destroy bacteria
  • Clear infection
  • Relieve moderate to severe symptoms such as pain on the left side of your stomach or fever

Surgery

Most people don’t require surgery. However, the following conditions may require surgical treatment: 

  • Diverticula hemorrhage 
  • Perforations that enable colon contents to leak out
  • Abscesses that don't respond to medications
  • Obstructions in the colon

Possible Complications

Diverticular disease can lead to serious complications. They include:

  • Abscesses. These can develop when diverticula swell and fill with pus. Antibiotics usually clear this up. Minor surgery may be needed to drain the infection. 
  • Perforations in infected diverticula. They can leak pus into the abdomen.
  • Peritonitis. This can develop when pus leaks into the abdomen. Immediate surgery is required to clean infection out of the abdominal cavity and remove damaged parts of the colon.
  • Fistulas. These are abnormal openings between adjacent organs. They are caused by inflamed tissue sticking together. The most common type develops between the bladder and the colon. 
  • Intestinal blockages. These can happen as a result of swelling and scar tissue. Symptoms include stomach pain and vomiting. Medication can reduce inflammation. Surgery may be necessary if the obstruction is severe.
  • Hemorrhage. This occurs when blood vessels in the diverticula rupture and bleed. Call us right away if you experience serious rectal bleeding.
Additional References:

Surgical Procedures

During surgery we open the stomach wall. We then remove or repair the damaged part of the colon. We usually use a surgical approach called a laparoscopy. This approach uses smaller incisions. People recover more quickly. 

If the colon cannot be repaired, we may recommend a colostomy. During this surgery:

  • We create a small hole in the stomach.
  • The contents of the colon are diverted away from the damaged section of colon to this hole.  
  • The content of the colon then empties from the hole into a bag. 
  • Once the colon has healed, the diversion can be removed. Normal bowel function is restored.

Typically, we don’t perform surgery when diverticulitis symptoms are active. We only perform surgery during an attack if there is a life-threatening complication.

Additional References:

Lifestyle Changes

There are a number of things you can do to manage your symptoms: 

  • Track symptoms to identify triggers. Write down when symptoms occur. Note what you ate and drank before you felt them. Avoid those triggers. 
  • Slowly increase your fiber intake. This will prevent constipation.
  • Take over-the-counter fiber supplements. They can reduce cramping and prevent diarrhea and constipation.  
  • Drink more water. This prevents bloating and constipation. Water is especially important if you use fiber supplements. 
  • Exercise to relieve stress and encourage bowel movements. This prevents bloating, gas, and constipation. 
  • Manage stress. Try deep breathing and meditation. Yoga, exercise, and journaling can also help.
  • Avoid chewing gum, carbonated drinks, and eating too quickly. They all cause gas and discomfort.

Your Care with Me

As your hospital medicine physician, my first contact with you will be either in the Emergency Department or in your hospital room.  Together we will go over your medical history and medications you are currently taking, perform a physical examination, and come up with a treatment plan.

While you are in the hospital

I will work closely with your bedside nurse and patient care coordinator each day of your stay to improve your health and to plan for a safe return home. We will also inform your family members of your care plan. If you are having symptoms that concern you when you are in the hospital, please inform me or one of the hospital staff immediately.

If specialty care is needed during your hospital stay, I may contact one of my specialty colleagues and discuss your care with them.

If I prescribe medications

During your hospital stay, we will work together to monitor and assess how your medications are working and make adjustments over time. Before you leave, we will go over each new medication, how to take it, and when/if to stop the medication. At the time of discharge, all medications can be picked up at the discharge pharmacy. 

After you are discharged from the hospital, you will have a follow up visit with your primary care clinician. You may also receive a follow up phone call from one of the hospital staff to see how you are doing once you are at home.

If you are having symptoms that concern you and you are not currently in the hospital:

  • You may contact your personal physician, who will evaluate your health and symptoms.
  • If you have urgent concerns or issues or need general medical advice, you can call the Appointment and Advice line, available 24 hours a day, 7 days a week. You will be connected with a nurse who can give you immediate advice and make an appointment with your doctor if needed.  
  • If you are experiencing an emergency, call 911 or go to the nearest Emergency Room.

Coordinating Your Care

Having all of our Kaiser Permanente departments located together or nearby, including pharmacy, laboratory, radiology, and health education, makes getting your care easier for you.

Another major benefit is our comprehensive electronic medical record system that allows all of the doctors and clinicians involved in your care to stay connected on your health status and collaborate with each other as appropriate. When every member of the health care team is aware of all aspects of your condition, care is safer and more effective.

This applies especially to your primary care physician, who will be notified electronically when you are hospitalized, and may review the care you are receiving while in the hospital. Upon discharge, your doctor will receive a summary of your care in the hospital, including some tests or imaging results that may still be pending.

Care After Hospital Discharge

If you require further testing and medications, or are having symptoms after leaving the hospital, we recommend that you contact your primary care physician.
You can also call the Appointment and Advice line. Our call centers are open every day of the year around the clock. If you need advice, we will transfer you to one of our skilled advice nurses (RNs). They can help you determine when you need to be seen and in what location. The advice nurse can often start your treatment by telephone depending on the situation and has access to your electronic medical record.

If refills are needed in the future after you leave the hospital, you can:

  • Contact your primary care physician.
  • Order them online or by phone.
  • Order future refills from my home page or your primary care physician’s home page.
  • Order by phone using the pharmacy refill number on your prescription label.
  • Have them delivered to you by mail at no extra cost.
  • Or pick up your medications at the pharmacy. If no refills remain when you place your order, the pharmacy will contact your primary care physician regarding your prescription.
If further lab testing or imaging is needed 

For lab tests that are needed after discharge, I will use our electronic medical record system to send the requisition to the Kaiser Permanente laboratory of your choice. For imaging procedures we will schedule an appointment with the radiology department. Your primary care physician will follow up on these results unless your condition needs immediate attention. In addition, you can view most of your laboratory results online, along with any comments that your primary care physician may have attached to explain them.

If I refer you to another specialty colleague

If we decide together that your condition would also benefit from the care of other types of specialists, I will make an electronic referral to the appropriate department and they will contact you for an appointment.

If Surgery or a Procedure is a Treatment Option

Occasionally, a procedure and/or surgery can be postponed until you are healthier and have recovered from your hospitalization. Then I will refer you to the appropriate service and they will follow up with you once you are discharged from the hospital.

If you are considering a procedure or surgery, please take a moment to go to the “Tools & Classes” tab above and select the “Prepare for Your Procedure - Emmi” link. There you can watch videos about different procedures.

Convenient Resources for You

As your specialist, I have a goal to provide high-quality care and to offer you choices that make your health care convenient. I recommend that you become familiar with the many resources we offer so that you can choose the services that work best for you.

My Doctor Online is available at any time that is most convenient for you. From my home page you can:

Manage your care securely
  • View and compose secure e-mail messages to your primary care physician and specialist.
  • Manage your prescriptions.
  • View your past visits and test results. View your preventive services to see whether you are due for a routine screening or updated immunization.
  • Manage your family’s health by setting up access to act on their behalf. Learn how to coordinate care for the ones you love.
Learn more about your condition
  • Read about causes, symptoms, treatments, and procedures of common conditions we take care of in the hospital.
  • Find interactive health tools, videos, and podcasts to help you manage your condition.
  • View programs to help you decide on or prepare for a surgery or procedure.
Stay healthy
  • Locate Health Education classes and support groups offered at every medical center.
  • Explore interactive programs, videos, and podcasts that focus on helping you stay healthy.
  • View your Preventive Services to see whether you are due for a routine screening or updated immunization.

Related Health Tools:

Videos

See more Health Tools »

If you have an emergency medical condition, call 911 or go to the nearest hospital. An emergency medical condition is any of the following: (1) a medical condition that manifests itself by acute symptoms of sufficient severity (including severe pain) such that you could reasonably expect the absence of immediate medical attention to result in serious jeopardy to your health or body functions or organs; (2) active labor when there isn't enough time for safe transfer to a Plan hospital (or designated hospital) before delivery, or if transfer poses a threat to your (or your unborn child's) health and safety, or (3) a mental disorder that manifests itself by acute symptoms of sufficient severity such that either you are an immediate danger to yourself or others, or you are not immediately able to provide for, or use, food, shelter, or clothing, due to the mental disorder.

This information is not intended to diagnose health problems or to take the place of specific medical advice or care you receive from your physician or other health care professional. If you have persistent health problems, or if you have additional questions, please consult with your doctor. If you have questions or need more information about your medication, please speak to your pharmacist. Kaiser Permanente does not endorse the medications or products mentioned. Any trade names listed are for easy identification only.

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