AF and Diverticular : Hello everyone, I am... - AF Association

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AF and Diverticular

Bekiebexs
Bekiebexs

Hello everyone, I am new here and would really appreciate your help. I have AF (which seems to come about 6months intervals) Have been very anxious about taking anticoagulant, mainly because I suffer with Diverticular and really concerned would bring about a bleed from stomach.Does any one else suffer with this and takes anticoagulants ? I have dilated cardiomyopathy and take 2.5mg bisoporol, perindopril,furosemide and thyroxine ( had my thyroid removed due to cancer several years ago)

Any advise would be greatly appreciated.

54 Replies
Hidden
Hidden

My understanding is that anticoagulants (ACs) do not cause bleeding. They slow down normal clotting of the blood, in response to bleeding.

If you have a problem which does cause bleeding, then the bleeding will continue longer because of the AC.

For example, if you have an episode of acute diverticulitis, the inflammation may cause bleeding and your AC may prolong the bleeding.

Some anticoagulants have reversing agents.

Bekiebexs
Bekiebexs in reply to Hidden

Thank you so much for replying . I do have have flare ups sometimes and stomach does get tender and swollen and was worried that taking AC I would get a bleed which I have only had twice and was diagnosed many many moons ago . Because of this I have been very anxious about starting on AC.

Hidden
Hidden in reply to Bekiebexs

According to NICE (June 2020) there are now antidotes to Apixaban and Rivaroxaban as well as Dabigatran and Warfarin. Your GP should be able to reassure you about the best choice of AC.

Bekiebexs
Bekiebexs in reply to Hidden

That is so helpful. I will ask my GP for advise about the best choice .

Thank you again for your help by replying.

Lacarno
Lacarno in reply to Hidden

That the benefits from thisWell l have AFib and Diverticular Disease and had to bad flare ups which brought the AFib on both times the pain with Diverticular was worse than any labour pain and didn’t know what it was when l had my first bout l really thought l was dying, l got the AFib afterwards then the same again the next time I’m on anticoagulant also and l believe that they haven’t got a coagulant for it yet but their is others on Rivaroxaban on here and l gather the benefits out way the risks but however l am going to have a word with the Doc when l get to actually see him, have been working hard on diet for my weight and bowels have a large dish of fruit every day which keeps me regular prunes figs apricots cherries melon kiwi every day and has helped me so much and feel better for it .

Most literature says there is risk, but severe complications are rare. Patient has to be on top of any symptoms that appear to be gastrointestinal bleeding, so it can be attended to immediately. The sooner . . . the better.

I have diverticular condition too and have had no problems taking apixoban. As previous replies have said the anticoagulants don’t initiate bleeding they just slow clotting. And the little pockets in your gut wall that are divirticular condition should not be bleeding .if the condition is under control, as I am sure yours will be.

Being blunt it is so much better to reduce the risk of stroke.

Hi Bekiebexs, I have Diverticular and take Apixaban and have no problems, I have just had a recent flare up of it (not nice and no bleeding) and was placed on Antibiotics, much better now.

I have been taking rivaroxaban since June 2019 and also have diverticular problems. I had the same worries and spoke to my GP about this, but he wasn't overly concerned. Keep in mind that many people have diverticulosis and aren't aware of it. We are the unlucky ones with symptoms - tell me about them!

Steve

Auriculaire
Auriculaire in reply to Ppiman

In 2018 I had 26 cm of my colon removed due to diverticulitis. I had had a few episodes since the first in 2014 when I was hospitalised on a drip for several days. I was able to control them with rest and a liquid then low fibre diet. In Jan 2018 I had another bad episode with another spell in the clinic and my gastroenterologist said I needed a colectomy. I was very reluctant but eventually agreed. She sent the surgeon to see me that evening ( I think in case I changed my mind!) and when I left to go home I had an appointment to see him a fortnight later. A pre op colonoscopy had to be abandoned as my gastroenterologist said it would have been dangerous to continue I had so much scar tissue blocking the sigmoid colon. I had the op in the last week in March . The surgeon said what he removed showed signs of infection (despite the fortnight of antibiotics both iv and oral I had had in January) and that without the op there was no doubt in his mind I would have had a perforation sooner or later. I recovered well from the op and though the post op colonoscopy showed some remaining diverticuli in the transverse colon I do not have to restrict my diet or worry any more about attacks. If you ever get the chance to fix your diverticulitis with this op I would say "go for it".

Ppiman
Ppiman in reply to Auriculaire

Goodness, you did have a serious case of diverticular disease and were lucky, it seems. It's good to read a success story!

Mine is much less severe and - so far - I haven't had an infection of any importance, but plenty of uncomfortable symptoms. Add to the bowel problems a hiatus hernia and reflux issues and you can guess that life can be uncomfortable. What I have found over the years is that it takes a very long time to settle once it "flares up". I was told that bowel surgery isn't to be undertaken lightly owing to the chance of adhesions, also, the surgery itself and anaesthesia aren't without risks.

I've currently had discomfort and nausea under my left rib for a couple of months and don't know whether it's the HH or the DD. My doctor says he's not concerned but I just wish it would go away. Getting older is such fun.

Steve

Auriculaire
Auriculaire in reply to Ppiman

I don't think I did have that serious a case. The difference is in the approach here in France. Elective surgery is considered preferable to continued rounds of antibiotics and worsening fibrosis leading to greater risk of perforation. I read on a diverticulitis forum that in the UK elective surgery has been stopped . They wait for you to perforate. Well that way the surgery is far more difficult with a much greater chance of the patient ending up with a colostomy bag and then having to have another op a few months later to join the ends. Not to mention the risk of peritonitis. As for adhesions part of my problem was that I had bad adhesions from my hysterectomy in 2000 and they were pulling on my colon. The surgeon was able to clean those up a bit at the same time by reopening my hysterectomy scar as well as doing the keyholes. If the discomfort is as high as the rib it might not be diverticules that are causing it. My gastro said I still had one or two in the higher bit of the descending colon and in the transverse but that it was very rare for those to get infected like the ones in the sigmoid.

Ppiman
Ppiman in reply to Auriculaire

That's an interesting post - thank you. Different countries have thier own ways to deal with chronic problems, for sure. British doctors have often seemed to stand a little apart from their continental and American colleagues, and some would say rather too obstinately and proudly. I think, though, that if a colonoscopy or contrast CT showed extensive scarring and such like, a doctor here might well be willing to carry out an elective op, but I can't be sure.

I suspect what I have is related to the hernia as you say, but nausea is a common issue with some DD, too, I have read. The problem with chronic conditions is uncovering their cause and then knowing what to do about it, since there's often nothing exceptional to see.

Time usually soothes digestive problems, I have found but the older we get, the longer it seems to take.

Steve

Auriculaire
Auriculaire in reply to Ppiman

I never had nausea with my attacks but I did get bladder pain. I suspect with the NHS it's lack of money and short termism that has led to the policy of not doing elective ops for diverticulitis. There is also the consideration that they don't work for everybody and diverticuli can come back in the remainder of the colon.

Thank you all so much for taking time to reply to me.

I have been so anxious about this . I had flare up last weekend, and that made me even more concerned as my stomach is swollen and tender and I thought if stomach gets inflamed which I think it must do if I was on AC anticoagulants it would cause a bleed .

Hi Locarno, Diverticular Disease is so painful .

Thankfully have not gone into AF while having flare up as yet .

I really have to watch my diet and find if I have too much fibre it can cause flare up. It’s trying to find the happy medium . Since going on certain medication has caused constipation which has added to problem .

I have read that some AC do bring about stomach problems .

Do hope you get help with this .

The thought of having stroke is scary more so for my daughter so it’s really weighing it all up .

Buffafly
Buffafly in reply to Bekiebexs

I was told to follow IBS diet, no whole meal products (which does make life more difficult re constipation!) and to follow first liquid diet then low fibre until symptoms subside - probably you know all that. I take Apixaban but also careful what I eat to avoid flare ups as I had a bowel abscess and was only saved by huge doses of IV antibiotics as I didn’t have extreme pain so didn’t recognise how ill I was until nearly too late 😱 My anticoagulant wasn’t stopped though.

Bekiebexs
Bekiebexs in reply to Buffafly

Hi Buffafly

Yes I follow liquid diet as long as poss then when start to feel weak I go onto toasted white bread and broth. Seems to work for me. Yes then low fibre till stomach feels better.

So sorry to hear you have suffered like that !

Must of been so awful for you.

Do hope you are settled now and very brave to stay on AC I think I would be anxious.

Auriculaire
Auriculaire in reply to Buffafly

Have you not considered a colectomy? See my reply to ppiman above. I have no regrets about having one . I have since the op what is called an accelerated transit ( ie I go to the loo more often ) but it is worth not having the attacks and being able to eat what I want. I never had extreme pain with the attacks either but the scar tissue was causing narrowing and I used to get bladder pain as well because everything was stuck together.

Buffafly
Buffafly in reply to Auriculaire

No, haven’t been offered one as I only had the one serious flare up and now I am aware I have diverticular disease not IBS 🙄 I am more careful. I changed from Rivaroxaban to Apixaban so that I could follow the liquid diet advice and very pleased I did. Also my friend had it and still has problems and my hysterectomy led to more trouble. And I need a hip op, a cataract op, and a possibly a pacemaker and was told the hospital would have to have an ITU bed available if I had the hip op which is quicker and simpler in comparison so all round, no!

Auriculaire
Auriculaire in reply to Buffafly

My hysterectomy in 2000 left me with a lot of adhesions which were making the diverticulitis worse as everything got stuck together. Twice now they have had to separate my bladder from other bits which hasn't done it much good either! The increasing amount of ops needed as one ages is no joke. I am recovering well from my hip op but still not looking forward to having the other one done.

HiAuriculaire,

Pleased to hear things have improved for you after going through all that.

Unfortunately I am unable to have any kind of op as my Cardiologist said my heart wouldn’t be able to cope.

That is unfortunate. As far as diet is concerned for DD it is better to avoid fibre in it's insoluble form such as too much wholegrain cereals and bread. Soluble fibre in fruit and veg is better.

Lacarno
Lacarno in reply to Buffafly

Well just make sure that abscess has gone completely my Nephew had one caused by an ingrown hair they sent him home after we believed they had removed it , he had sepsis as well and major heart probs he was home for about four days in agony they had not removed it and still had sepsis he came straight home from intensive care forgot to mention that however the ambulance came same men and could not believe he was home and he was much worse he was rushed in but didn’t come out he was50 with small children we are all devastated he didn’t deserve this should not have happened so anyone having abscess in the bowel you make sure it’s gone

Buffafly
Buffafly in reply to Lacarno

That is terribly upsetting, I am very sorry for your family. Thank you for your advice - I was paranoid about the abscess returning for years after but since I have been on diltiazem I have much less bowel trouble so not so anxious now.

Lacarno
Lacarno in reply to Bekiebexs

Well in the book about the diet for Diverticulitis it says to have high fibre which l was pleased about as l have pre diabetes as well but it seems on here the people who have it are on low fibre so which is right?

Bekiebexs
Bekiebexs in reply to Lacarno

Hi Lacarno

There is no right or wrong !

It’s what suits you.

What might bring on a flare up for me might not necessarily cause one for you.

If you look at Fodmap diet like Belle previously suggested it gives you an insight at what foods to have and ones to avoid

For example If i have cauliflower, sprouts,apples , pears, these upset my stomach also too much fibre.

But for you it might not.

Do hope you are able sort out your prediabetes

Cutting out carbs really helps with that eg potatoes,

rice. bread and smaller portions.

You probably know all this.

Hope this helps

Buffafly
Buffafly in reply to Lacarno

I was told high soluble fibre is good but be careful about insoluble fibre as found in whole grains. So no probs with a low carb diet which I am going to try a bit with my husband as he is pre diabetic. Will be an uphill struggle though 🙄

Low fibre is for when you have a flare up as it allows the bowel to ‘rest’.

Hi Bekiebexs

I have A/F and have a PM and suffered from diverticulitis , I was put on Dabigatran but had to come off it as it caused anemia , I ended up having iron infusions but soon as I came off it my bloods went back to normal after a few months .

I had all the test to see where the bleed was coming from but all the tests came back clear .

My cardiologist has told me I will eventually go back on thinners .

Talk to your Gp or cardiologist about your concerns to be on the safe side .

Hope all goes well for you ..

Keep Safe ..

Bekiebexs
Bekiebexs in reply to 274-

Hi 274-

Sorry to hear you went through that, hopefully you will get it sorted .

Has your Cardiologist suggested a different AC ?

I think this is sometimes the problem with Diverticular you might have inflammation which would cause even slight bleed which if on AC would be more.

I will talk to my GP and Cardiologist.

Trouble is I get so anxious about this kind of takes over !

Which isn’t good.

Thank you 274- for replying, I wish you well and take good care .

274-
274- in reply to Bekiebexs

Hi

I think we will have the discussion about a different AC at my next appointment.

Anxiety doesn’t help with our conditions too so talk to your Gp about that’s as well because there is more and better things out there to help with anxiety than there were in my early days .x

Ask your doctor

Hi, I have diverticulitis and I’m on apixaban. How long does your flare up last ? I have been in constant pain with bloating for weeks now and I’m in AF. Feel awful.

Bekiebexs
Bekiebexs in reply to Redders

Hi Redders,

So sorry to hear you are suffering so much 😩

I really do feel for you .

My last flare up last weekend lasted about 5 days other times does vary .

Had one couple years ago where all of my stomach was so bloated tender and sore. It was awful went to Doctors she sent me for scan thought it might be cancer. Thankfully it wasn’t .

I find hot water bottle on stomach helps throughout the day and plenty of rest .

Do you follow special diet ?

How are you coping with the AF ?

Redders
Redders in reply to Bekiebexs

I don’t follow any diet but I thought I may try gluten free. I’m having a telephone conversation with my doctor on Monday re my stomach problems. He prescribed medeverine last week but it has done nothing for me.

My AF is quite bad especially during the night I know it sounds strange but if I dream it makes my heart go haywire. Also I have my stomach ache in the night as well.

I have a appointment for a heart ultrasound scan on the 29th March so hopefully that will be ok and they can change my meds.

Have you had your vaccine yet

Bekiebexs
Bekiebexs in reply to Redders

My AF used to be bad at night but since increasing Bisoporol to 2.5mg ( which took some getting used to ) and taking it before I go to bed it really helped.

Also take BP tablet too at night helps too.

Cardiologist said was fine to do this.

Still have dreams but heart remains calm 😊

I had ultrasound scan last Wednesday as Cardiologist wants to see if my medication needs updating .

Be good if they change your meds being as your suffering like this. I’m sure it will help you.

No I haven’t had vaccine yet !!!

That’s another problem !!!

Have been reading on here how it puts a lot of people into AF and really reluctant as haven’t had AF for six months now .

Do get a fast heart rate moving around and doing things but not into AF thankfully.

Have you had vaccine yet ?

Redders
Redders in reply to Bekiebexs

I had the Oxford vaccine on the 30th January and six days later went into AF. Woke about 4am feeling nauseous so tried to get to the bathroom but fainted. My husband tried to pick me up and on doing so bruised my ribs. He dous’nt do things by half lol.

I’m on 1.25 mg bisoprolol because it sends my blood pressure down if I take a higher dose. A few years ago when I was on a higher dose I fainted and smashed my face on a metal filing cabinet at work. My nose was broken and the bone came out, also my 3 front teeth were knocked out.

I don’t really know if my recent faint was anything to do with the vaccine though. I’m sure you’ll be fine when you have yours. I read the other day that if you have a blood group A you’re higher risk of catching Covid. I’m A negative so glad I had my first jab.

Bekiebexs
Bekiebexs in reply to Redders

Oh my goodnessRedders that must have been awful fainting like that especially breaking your nose and knocking out your teeth .

They once increased my Bisoporol to 3.75mg and I ended up in A&E felt like I was chocking and very unwell and breathless they decreased it .

I don’t know my blood group .

Hi. I had been prescribed Xarelto (Rivaroxiban) because of A Fib and the possibility of stroke. I reminded my cardiologist of my diviticulitis problems and known side effect of GI bleeding with this drug. He said because of your risk of stroke which would you prefer. So i chose to take xarelto.

I suffered severe bleeding and some time in hospital in the following 12 months with blood and iron transfusion.

I chose to have a watchman device implanted and was prescribed again Xarelto plus asprin to prevent thrombus forming on the device after implant.

Again severe GI bleed.

So 12 months later i am doing ok. No anticoagulants, only asprin which is an antiplatelet.

I feel more secure because of the Watchman device but will never again take anticoagulants.

I would suggest you see your gastroenterologist for advice before making your decision.

Bekiebexs
Bekiebexs in reply to tooh

Hi tooh,

Oh my goodness..... poor you that sounds awful what you have been through !

I am unable to have watchman device as my Cardiologist said doesn’t think my heart would be able to cope !

All what you have said as made me very reluctant to take AC.

I will ask my Doctor to refer me to gastroenterologist.

Thank you so much for taking time to reply and for the advise.

Do hope all goes well for you tooh.

Lacarno
Lacarno in reply to tooh

Was there an underlying cause to the bleed or was it solely due to the Rivaroxaban as l have been on it for sometime but am ok

tooh
tooh in reply to Lacarno

Yes recurrent bouts of severe diviticulitis. All electrophysiologist, cardiologist and gastrologist together agreed that Rivoroxiban caused the bleed. Keep in mind only a percentage have this reaction and i was one of them. Now that i am no longer on it i am so much better.

I have been on Apixaban for about 2 years with no issues. I've had Diverticular Disease most of my adult life. I'm 77 now. I suffer from SVT events, now reduced by 66% with dietary changes. I won't make any dietary suggestions for you though because everybody is so different.

All the best.

Roy

Thank you Roy, pleased to hear you have no issues .

Hope all continues to go well for you .

Thank you for replying.

All the best to you too .

I have diverticular disease of the bowel, not sure how this would result in a stomach bleed. Are you sure you have Diverticular?

Bekiebexs
Bekiebexs in reply to RichMert

Hi RichMert,

I was diagnosed in hospital with Diverticular Disease many moons ago.

I have had two colonoscopys in the past

Also have had two bleeds with it, last one about nine years ago .

Since then have flare ups every so often .

Hi BekieBex, I have diverticular disease too. I take rivaroxaban, and it hasn't caused me any gut bleeding. I make sure I take it with food.

I used to need antibiotics for attacks once or twice a year, but for the last few years, I've found a way of eating that suits my gut and keeps attacks at bay - I've had no attacks in the 2 years since I was diagnosed with AF.

Bekiebexs
Bekiebexs in reply to Belle11

Hi Belle11,

Thank you for replying.

Everyone has been so helpful on here so glad I joined .

Does help to put your mind at rest knowing your not alone with your health problems.

Can you please give examples on your way of eating to keep attacks at bay ?

Belle11
Belle11 in reply to Bekiebexs

Hi Bekiebex

Yes, it's very helpful to have this group. Here's what works for me, in case there's anything here that's helpful for you:-

There seem to be some dietary things that are generally helpful in managing diverticular disease, and others that are probably more individual triggers. Apologies if I'm telling you things you already know.

While a low fibre diet can help during an attack of diverticulitis, plenty of fibre seems to be key in avoiding attacks. I find psyllium husks are a really helpful gentle fibre, 2-4tsps a day - I buy it from a wholefood shop. It's also called ispaghula husk, and GPs prescribe it as Fybogel, which has added artificial sweetener, which I prefer not to have.

Lots of veg are good.

A US doctor, Dr Axe has a section a long way down this webpage about "Natural Treatment for Diverticulitis Symptoms" draxe.com/health/diverticul... where he recommends more anti-inflammatory foods and probiotics, among other things, but less alcohol and possibly red meat (all helpful with AF too). Sugar's another inflammatory food.

Some of the foods Dr Axe recommends actually make me worse though.

Oats and oat bran are recommended, and seem to suit a lot of people. They don't suit my gut - too harsh, and I can't tolerate wheat bran at all, so I stick to gluten free grains like brown rice, buckwheat, quinoa, corn.

Nuts and seeds are supposed to be good, and not associated with diverticulitis, but my experience has been that I've only ever had attacks when I've eaten foods containing hard pieces of nuts and seeds. I'm best even avoiding some ground nuts and seeds and I've come across other people on forums who find the same thing. Very smooth nut butters work for me, and tahini. I don't know how unusual I am in that, but it's perhaps worth noticing how you react. It's since I've strictly avoided them that I've had no more attacks. I've just found this article which comments that anecdotally some people do find they are a trigger and suggests avoiding certainly seeds. dietvsdisease.org/diverticu...

He also recommends a vitamin D supplement, and suggests that a low FODMAP diet may help - he has a suggested menu for several days to try (in my case I'd not have the nuts he includes.) He does comment that each person’s experience is different so that you may find certain foods worsen your symptoms and are best avoided. Yours may well be different from mine.

Sorry for the essay! I hope you find what works for you to keep free from attacks.

Bekiebexs
Bekiebexs in reply to Belle11

Hi Belle11,

Thank you so much for taking time to send this detailed dietary explanation.

I have found it very helpful and will definitely be looking to buy the Psyllium husks as I need a gentle fibre. Since being put on a new medication it has caused constipation and caused a flare up.

I know my Doctor would prescribe Fybogel but like you say want to avoid artificial sweeteners.

I will go onto Dr Axe webpage and have a read.

I have found a lot of my triggers are caused by too much veg also whole meal bread.

Like you say we are all different .

Thank you again for your help. It is much appreciated.

Hope all goes well for you 😊

Belle11
Belle11 in reply to Bekiebexs

Sympathy for the effects of your medication - constipation is a real trigger for diverticulitis. The second link I shared gives more of the things that work for me. A friend who also suffers has found a huge difference since following the FODMAP diet, which involves cutting out certain foods including some veg - eg

Wheat,

Onions and garlic

Certain fruits, such as apples, peaches and pears,

Certain vegetables, such as asparagus, Brussels sprouts and cauliflower,

Dairy foods

Legumes

Details are at the end of this article by an Australian dietician/nutritionist dietvsdisease.org/diverticu...

Onwards and upwards!

Bekiebexs
Bekiebexs in reply to Belle11

Yes certain veg that I really enjoy I find not good for me.

Cauliflower which I like

Sprouts

With fruit it’s apples and pears

Definitely going to try the Fodmap

Also have read of the links you have kindly sent

Thank you again for this really helpful information

Wishing you all the best 😊

Belle11
Belle11 in reply to Bekiebexs

You're very welcome.

They do sound like Fodmap foods that affect you! Good luck in sorting it all out.

If you don’t take anticoagulant you are high risk of a massive stroke or massive heart attack are you prepared to risk that my Dad had a massive stroke and l wouldn’t wish it on my worst enemy, you must take with food there is anticoagulant if you have a bleed l was worried but the good points out weigh the bad

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