Bladder infection and diverticulitis

Q-I am a 41 year old man. I had a series of bladder infections about a year ago, which is unusual in men. As a result, my doctors suggested that I undergo a series of bowel examinations to look for a hole between the bladder and bowel where bacteria

My doctors have recommended that I have about a foot of my descending colon removed. They say that my descending colon is weakened due to all the scanning that I have undergone and that, if I do not have the operation, I risk a ruptured bowel, peritonitis and a colostomy. They have not told me what the risk is or how large a risk I take if I do not have the operation. They have also said that it will take three months to recover, but there will be no side effects. I find this hard to believe as the bowel has to do with water regulation as well as elimination of waste.

I would like to know if there are any alternative treatments worth pursuing and where I can go to find out more about the risks involved in this operation, whether I can discuss this with other people who have had this operation and where I can find out about any research on it.

I think the examinations showed that a section of my bowel had reduced its diameter to 10 cm, but I do not have a copy of the letter and my GP would not give me one or allow me to get a second opinion. JH, Reading........

A-As is so often the case, it sounds as though your doctors are trying to kill a flea with a sledgehammer.

It is true that you may be getting these repeated infections from a hole in your bowel. Sometimes, the colon can form tiny sinuses, or abscesses, through which bacteria and waste from the faeces can leak out. If the bowel rests against the bladder, these bacteria can also cause a little hole in the bladder and drain into it. As your doctors say, these little abscesses can come and go, so it may be difficult to find them in a test or on scans.

It is also possible that your bladder infections are completely unrelated to such a hole and that these many infections are, in fact, just one infection. A common cause of bladder infection for men and women is the bacteria Escherichia coli. However, it is estimated that, in the USA, about 40 per cent of the strains of E. coli are now resistant to trimethoprim sulphamethoxazole, the antibiotic of choice for bladder infections. So, it may be a case of the same infection repeatedly manifesting itself because the E. coli haven't been completely eliminated.

Or you could simply have an irritated bladder. Any one of a number of foods can cause irritation these include all forms of caffeine, such as coffee, tea and carbonated beverages, and any foods containing tomatoes. Artificial sweeteners are also a secret culprit. You might also wish to avoid foods high in the amino acids phenylalanine, tryptophan, tyrosine and tyramine. These would include, in particular, citrus fruits, pineapple, cranberries, avocados, figs, yogurt and chocolate, and all wines other than those which do not undergo malolactic fermentation (Goldberg B, ed, Alternative Medicine, The Definitive Guide, Tiburon, CA: Future Medical Publishing, 1999).

The point is that it may be unusual but not impossible for men to have chronic bladder infection.

According to Dr Larrian Gillespie, an American specialist in cystitis at the Women's Clinic for Interstitial Cystitis in Beverly Hills, California, chronic bladder infection usually has more to do with bacteria being trapped in a bladder and not being able to get out, usually because the bladder isn't efficiently expelling all of its contents during urination. This was aptly illustrated in one study where medical students consented to having faeces was placed in their bladders. By the second time they urinated, no bacteria remained in their bladders.

So the problem may lie with something in your urinary system that is preventing your bladder from voiding completely. As Dr Gillespie says, "If you can move dirt on the pavement with your stream, instead of 'tinkling' drops out, you will not get a bladder infection."

We are surprised that your urologist has not investigated whether the problem lies with any prostate problems. The actual basis for repeated infection may lie in a slightly enlarged prostate, which will impede a fast and efficient flow of urine.

Usually, when doctors start poking and prodding and doing tests, they will unearth something and, in your case, they have come up with diverticulitis, which can be related to the problem of sinus formation and constant bladder infection. Diverticulosis is a condition where the walls of the intestine balloon out like a bubble of chewing gum. Diverticulitis results when these little pockets become infected. Diverticulosis undoubtedly is linked to the Western diet of processed, low fibre food, but it can

sometimes develop in people who have some genetic weakness, just as varicose veins can develop in those predisposed to it.

We spoke to our panel member Harald Gaier, who tells us that, although scar tissue will form because of these sinuses, it will not be large enough to cause such a narrowing of the bowel or diverticulosis, which is a weakness in the bowel, not a narrowing of it.

Even assuming it is, chopping out a huge chunk of your bowel seems a drastic measure. They've warned you that you risk a ruptured bowel, peritonitis and a colostomy without the surgery. But have they warned you that you risk all three with the surgery as well? And nobody, not even the most confident surgeon, can claim that there will be no side effects. There may be, but there may not be. Our mail bag is full of letters from people whose health was wrecked by a doctor who assured them that there were no risks with his procedure.

As you have consulted with a surgeon, he is naturally going to favour surgery. And as your GP is so unforthcoming, it might be prudent to seek a private consultation with a gastroenterologist. Since he does not make his money from surgery, he might be able to suggest alternatives and confirm whether you do need surgery.

In the meantime, there are several alternatives you can try to firm up the diverticular pockets and avoid infection there. Although it's difficult to completely reverse diverticular pockets, Boiron, the French homoeopathic company, produces a suppository called Rectobyl, which has a good track record for firming up these pockets and making sure they don't become larger.

Other homoeopathic remedies like Colosynthis or Belladonna at low potencies have much anecdotal evidence of success.

Besides homoeopathic remedies, you can try certain herbal remedies, which have solid evidence of treating diverticulitis. Dr David Mowrey recommends that you take a combination herbal of goldenseal (Hydrastis canadensis), liquorice root (Glycyrrhiza glabra), gentian root (Gentiana lutea) papaya leaf (Carica papaya), myrrh gum (Commiphora myrrha), Irish moss (Chondrus crispus), fenugreek seeds (Trigonella foenum graecum) and ginger root (Zingiber officinale) (The Scientific Validation of Herbal Medicine, New Canaan, Connecticut: Keats Publishing, 1966). This combination is known to soothe and heal a variety of problems of the gastrointestinal tract, including diverticulitis and ulcers. Any competent herbalist can have such a formula made up for you.

You might also try drinking liquorice tea, which soothes the gut.

Once your bowel has narrowed, the condition is likely to stay with you. However, you can follow a diet that will avoid impacted bulk, which is likely to lead to infection or cause blockages, says Dr Gaier.

This means avoiding foods such as wheat and other gluten containing grains, which cause gas, distention and bulked up stools. You'll also want to cut down on your consumption of meat and dairy products, sugar and refined carbohydrates.

You may also wish to try an elimination diet to determine if you are allergic to any foods or find certain foods difficult to digest. Both types of foods can cause gas and distention or even result in firm, hard stools. Eat plenty of fish, fruits, rice and vegetables, which are easy on digestion. Also, make sure to have enough to drink.

Fibre, those elements of food that remain undigested by the time they reach your large intestine, are vital in getting food to move more efficiently through the intestinal tract. Fibre allows the stool to bind with large amounts of water, which allows easier and more rapid passage through the intestine. Indeed, the problem is that any gastroenterologist is likely to push bran on you to increase fibre. Avoid bran or any gluten containing fibres like the plague. Instead, you can try flaxmeal or psyllium. You should also avoid eating small seeds.