It’s common for people older than age 50 to have small, bulging pouches (diverticula) in their digestive tracts—a condition known as diverticulosis. Although diverticula can form anywhere, including in your esophagus, stomach and small intestine, most occur in your large intestines. Because these pouches seldom cause any problems, you may never know you have them. When the pouches become infected or inflamed, the condition is called diverticulitis. This happens in 10 to 25 percent of people with diverticulosis. Diverticulosis and diverticulitis are also called diverticular disease.
What Causes Diverticular Disease?
Although not proven, the dominant theory is that a low-fiber diet is the main cause of diverticular disease. The disease was first noticed in the United States in the early 1900s. At about the same time, processed foods were introduced into the American diet. Many processed foods contain refined, low-fiber flour. Unlike whole-wheat flour, refined flour has no wheat bran.
Diverticular disease 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 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.
Constipation makes the muscles strain to move stool that is too hard. It is the main cause of increased pressure in the colon. This excess pressure might cause the weak spot in the colon to bulge out and become diverticula.
Diverticulitis occurs when diverticula become infected or inflamed. Doctors are not certain what causes the infection. It may begin when stool or bacteria are caught in the diverticula. An attack of diverticulitis can develop suddenly and without warning.
What Are The Symptoms?
Diverticulosis:
Most people with diverticulosis do not have any discomfort or symptoms. However, symptoms may include mild cramps, bloating, and constipation. Other diseases such as irritable bowl syndrome (IBS) and stomach ulcers cause similar problems, so these symptoms do not always mean a person has diverticulosis.
Diverticulitis:
The most common symptom of diverticulitis is abdominal pain. The most common sigh is tenderness around the left side of the lower abdomen. If infection is the cause, fever, nausea, vomiting, chills, cramping, and constipation may occur as well. The severity of symptoms depends on the extent of the infection and complications.
What Are The Complications?
Diverticulitis can lead to bleeding, infections, perforations or tears, or blockages. These complications always require treatment to prevent them from progressing and causing serious illness.
Bleeding:
Bleeding from diverticula is a rare complication. When; diverticula bleed, blood may appear in the toilet or in your stool. Bleeding can be severe, but it may stop by itself and not require treatment. Doctors believe bleeding diverticula are caused by a small blood vessel in a diverticulum that weakens and finally bursts. If you have bleeding from the rectum, you should see your doctor. If the bleeding does not stop, surgery may be necessary.
Abscess, Perforation, and Peritonitis :
The infection causing diverticulitis often clears up after a few days of treatment with antibiotics. If the condition gets worse, an abscess may form in the colon. An abscess is an infected area with pus that may cause swelling and destroy tissue. Sometimes the infected diverticula may develop small holes, called perforations. These perforations allow pus to lead out of the colon into the abdominal area. If the abscess is small and remains in the colon, it may clear up after treatment with antibiotics. If the abscess does not clear up with antibiotics, the doctor may need to drain it. To drain the abscess, the doctor uses a needle and a small tube called a catheter. The doctor inserts the needle through the skin while having a CT scan and drains the fluid through the catheter. These procedure is called percutaneous catheter drainage. Sometimes surgery is needed to clean the abscess and, if necessary, remove part of the colon. A large abscess can become a serious problem if the infection leaks out and contaminates areas outside the colon. Infection that spreads into the abdominal cavity is called peritonitis. Peritonitis requires immediate surgery to clean the abdominal cavity and remove the damaged part of the colon. Without surgery, peritonitis can be fatal.
Fistula:
A fistula is an abnormal connection of tissue between two organs or between an organ and the skin. When damaged tissues come into contact with each other during infection, they sometimes stick together. If they heal that way, a fistula forms. When diverticulitis related infection spreads outside the colon, the colon’s tissue may stick to nearby tissues. The organs usually involved are the bladder, small intestine, and skin. The most common type of fistula occurs between the bladder and the colon. It affects men more than women. This type of fistula can result in a severe, long-lasting infection of the urinary tract. The problem can be corrected with surgery to remove the fistula and the affected part of the colon.
Intestinal Obstruction:
The scarring caused by infection may cause partial or total blockage of the large intestine. When this happens, the colon is unable to move bowel contents normally. When the obstruction totally blocks the intestine, emergency surgery is necessary. Partial blockage is not an emergency, so the surgery to correct it can be planned.
Diagnosis
Because diverticula by themselves usually don’t cause problems, most people learn they have diverticulosis during routine screening examinations for colorectal cancer or during tests that check for other intestinal problems. Diverticulitis, on the other hand, is usually diagnosed during an acute attack. Your doctor is likely to examine your abdomen for tenderness. You may also have a blood test to check your white blood cell count and an imaging test such as a CT scan to help visualize the colon segment that is inflamed or infected. A CT scan uses a series of computer-directed images that provide a comprehensive view of your internal organs. Diverticulitis can range from minor inflammation to a massive infection.
Treatment
Diverticulosis:
Increasing the amount of fiver in the diet may reduce symptoms of diverticulosis and prevent complications such as diverticulitis. Fiber keeps stool soft and lowers pressure inside the colon so that bowel contents can move through easily. The American Dietetic Association recommends 20-35 grams of fiber each day.
Diverticulitis:
In general, treatment depends on the severity of you symptoms and whether this is your first attack of diverticulitis. If your symptoms are mild, a liquid or low fiber diet and antibiotics may be all you need. But if you’re at risk of complications or have recurrent attacks of diverticulitis, you may need surgery.
Home Care:
If your condition calls for home treatment, expect to remain quiet for a few days. You’ll also temporarily need to avoid all whole grains, fruits and vegetables so that your colon can rest and heal. Once your symptoms improve-often in two to four days- you can gradually start increasing the amount of high-fiber foods in your diet.
In addition you likely will need to take antibiotics to help kill the bacteria causing your infection. If you have moderate or severe pain, you may need to take pain medication.
Hospitalization:
About half the people with diverticulitis require hospitalization and may need intravenous antibiotics. You’re more likely to be hospitalized if you have vomiting, a fever above 100F, a high white blood cell count or are at risk of complications such as bowel obstruction or peritonitis.
Surgery:
If you have recurring diverticulitis, you may need surgery to remove the diseased part of your colon. There are two types of surgery;
Primary bowel resection : This is the standard surgery for people with diverticulitis. Your surgeon removes the diseased part of your intestine and then reconnects the healthy segments of your colon (anastomosis). This allows you to have normal bowel movements. This is usually done for patients who have chronic recurring episode of diverticulitis. Also patients with complications of bleeding, fistulas and partial obstructions can have a primary resection and anastomosis. This is usually done when there is no infection present in the bowl.
Bowel Resection with colostomy : This surgery may be necessary if you have so much inflammation in you colon that it’s not possible to rejoin your colon and rectum together safely at that time. This occurs with sever infections that do not respond to IV antibiotics, large abscesses, perforation, peritonitis, or continued bleeding. This surgery usually involves two operations. The first surgery will clear the infected abdominal cavity and remove part of the colon. Because of infection and sometimes obstruction, it is not safe to rejoin the colon during the first operation. Instead, the surgeon creates a temporary hole, or stoma, in the abdomen. The end of the colon is connected to the hole, a procedure called a colostomy, to allow normal eating and bowel movements. The stool goes into a bag attached to the opening in the abdomen. In the second operation—done two the three months later—the surgeon rejoins the ends of the colon.
Prevention
Eat more fiber : High-fiber foods, such as fresh fruits and vegetables and whole grains, soften waste material and help it pass more quickly through your colon. This reduces pressure inside your digestive tract. Aim for 25-30 grams of fiber each day. Try to substitute fruits, vegetables, and grain products for foods high in fat. If you have a hard time consuming 25-30 grams of fiber every day, consider using a fiber supplement such as psyllium (Metamucil) or methylcellulose (Citrucel).
Drink plenty of fluids . Fiber works by absorbing water and increasing the soft, bulky waste in your colon. But if you don’t drink enough liquid to replace what’s absorbed, fiber can be constipating.
Respond to bowel urges . When you need to use the bathroom, don’t delay. Delaying bowel movements leads to harder stools that require more force to pass and increased pressure within your colon.
Exercise regularly . Exercise promotes normal bowel function and reduces pressure inside your colon. Try to exercise at least 30 minutes per day.
