My 31-year-old husband recently had emergency surgery for an abscess related to diverticulitis. Now, he has a ostomy bag that he must wear for four months until he has another surgery to reconnect his colon. Can he work wearing this bag? Also, does this mean no sex until he has a second surgery?

M.

Diverticula, which are small pouches in the wall of the colon, are very common in our society. In fact, more than half of all people over age 70 are thought to have them. The cause of these diverticula is not clear. However, it is thought their formation may be tied to the typical Western diet because this high-fat, low-fiber mode of eating frequently can elevate pressures inside the bowels, leading to extra pressure on the colon wall. Most patients with diverticula have no symptoms and are diagnosed only when they undergo a colonoscopy for another reason. However, in some patients, diverticula can cause potentially serious problems. The most common is bleeding, which may result in passage of significant amounts of blood from the rectum.

Another complication is an inflammatory condition known as diverticulitis. In this situation, a tiny perforation occurs in one of the pouches, leading to an infection in the colon wall and surrounding tissue. Patients with diverticulitis will complain of abdominal pain, fever and a change in their bowel habits. In most cases, the perforation is quickly walled-off. These cases will respond to antibiotics and improve over several days to two weeks.

In some cases, the diverticulitis becomes more complicated. For example, the infection may lead to an accumulation of fluid (abscess) in the abdomen. In some cases, a diverticular abscess may be drained through a small needle placed through the skin. In other more severe cases, such as your husband's, surgical drainage is necessary. Generally, the part of the colon affected by the diverticulitis is also removed in the same operation. Depending on the condition of the bowel and the amount of inflammation present in the abdomen, the surgeon may either reconnect the bowel or may opt to wait until the inflammation subsides and a reconnection can be safely done (usually a few months later). Until the bowel is reconnected, the wastes that normally leave the body via the rectum are emptied through an artificial opening in the abdomen called an ostomy.

As for your concerns about your husband's activities, patients with ostomies can go to work and otherwise function normally. They wear a bag over the ostomy, which needs to be emptied periodically. The bag is inconspicuous underneath clothing. There are also no restrictions regarding sexual intercourse. There are various support groups for patients with ostomies, and your husband's surgeon should be able to provide more information on groups in your area. You should also discuss any issues you have regarding the ostomy with him.