Diverticulitis

Did you know that a low intake of fiber in your diet could lead to development of a silent disease condition within your bowel? This condition termed as diverticular disease or development of small pouches in your large bowel may not cause symptoms in the initial stages. But nevertheless, it places you at an increased risk of sudden complications such as bowel obstruction, bowel rupture, pus collection in the abdomen, and acute bleeding episodes from the rectum.

So, why not increase your awareness about the condition as simple measures of increasing fiber intake, avoiding constipation, and exercising could go a long way to not only prevent development of new diverticula but also its progression and associated complications.

Risk factors

Your risk of developing diverticular disease increases with

  • Advancing age
  • Obesity
  • Family history
  • Chronic constipation
  • Lack of exercise
  • Frequent use of laxatives

It is very unlikely that you will get the disease before the age of 40. It is most common after the age of 60. Both men and women are equally affected.

Diagnosis

Your doctor may diagnose diverticular disease by performing one or more of the following tests. A barium enema (X-ray test performed with injection of liquid material into the colon through the rectum) will help in visualizing the anatomy of the colon, and identify if diverticula, polyps or growths are present.Your doctor may visualize the inside of your colon by colonoscopy by aid of a thin, flexible tube with a light and camera and look for diverticula as well as polyps and other growths.

A CT scan (X ray test that takes multiple section pictures of the body) can help to identify diverticula but is generally not performed to make a diagnosis of diverticular disease.

Prevention

It is not known if you can really prevent diverticular disease. Having a diet rich in fiber (minimum of 15 to 30 grams in a day), restriction of foods with indigestible particles such as popcorns, nuts, and fruits with small seeds, drinking plenty of fluids, and exercising regularly are a few measures in the prevention of diverticular disease.

While diverticulosis may be asymptomatic in many patients, development of complications such as infection, pus formation, bleeding or obstruction of the colon may mandate hospitalization, and effective medical and surgical management. Once a diverticulum develops it does not go away. So why not try to prevent it in the first place. Increasing fiber intake in the diet, preventing constipation, exercising regularly, drinking plenty of fluids, and avoiding excessive laxatives can help in protecting your large bowel from the disease condition.

Diverticulitis treatment depends on how serious the problem is and whether you are suffering from diverticulosis or diverticulitis. But it is better to be aware that once a diverticulum has formed in your colon, it will not go away. If you do not have symptoms of diverticulitis, then you may try to increase the fiber in your diet to soften and bulk the stool, drink more fluids, and exercise regularly to prevent the development of more diverticula or associated complications.

High fiber foods include beans and legumes, bran, whole wheat bread, whole grain cereals, fruits (apples, bananas, and pears), vegetables such as broccoli, carrots, corn and squash, brown rice and whole wheat pasta. Laxatives in consultation with your doctor may help in avoiding constipation.

Treatment of complications

Mild cases of diverticulitis may be managed with oral antibiotics, dietary restrictions, and stool softeners. More severe cases require hospitalization with intravenous antibiotics and dietary restraints. If there is pus collection around your colon, then your doctor may need to drain it by a catheter passed into your abdomen through the skin and guided by radiologic support.

Acute bleeding due to diverticulosis requires in-hospital management with intravenous fluids, blood transfusions, and diagnostic procedures to identify the site of bleed. If you do not respond to medical management, have recurrent episodes of diverticulitis, obstruction of the colon, or severe bleeding from the diverticulum, diverticulitis surgery may be necessary to remove the involved area of the colon. Or else a temporary opening for your colon may need to be done on the abdominal wall.

Diverticular disease affects the colon that is the part of your large intestine. It stores and eliminates waste material from your body. In this condition, there is formation of small pouches or sacs in the lining of your bowel particularly the large intestine. The bulging sac or pouch is called a diverticulum. More than one diverticulum is called as diverticula. These sacs are seen to occur more commonly near the lower end of the left colon (sigmoid colon). Condition of having these diverticula in the colon is termed as sigmoid diverticulosis.

While it is not certain as to why diverticulosis develops, there are a few theories that have been suggested. With advancing age, the muscular wall of your colon goes thicker, although there is no clear understanding on the cause for this thickening. The resultant abnormal contraction and spasm can cause intermittent high pressure in the colon. This increased pressure within the colon causes bulging pockets of tissue or sacs that push out from weak spots in the colon wall.

Another theory suggests the role of low fiber diets or diets that are low in roughage in the development of diverticula. Without fiber the stools are small and dry, and are difficult to pass. Intestinal muscles need to contract with greater pressure to force the stools along. This allows for segments of the colon to close off from the rest of the colon when the colonic muscle in the segment contracts. The pressure within the closed off segments becomes high as the increased pressure cannot dissipate to the rest of the colon. Over a period of time, high pressures in the colon can push the inner intestinal lining outward through weak areas in the muscular walls forming pouches. The other factors implicated are chronic constipation and lack of exercise.

Types : Common types of diverticular disease are diverticulosis, diverticulitis, and diverticular bleeding.
Diverticulosis : Diverticulosis is the term for the presence of more than one diverticulum in the large bowel. Infection may develop when bacteria or stool gets caught in the diverticula. This can result in rupture of the colon, and infection or collection of pus in the tissues that surround the colon. This condition is termed as diverticulitis. Diverticular bleeding  : Diverticular bleeding is when the wall of the colon bleed due to the development of a diverticula on the colon.

Majority of the patients with diverticulosis may have few or no symptoms. It may be chance finding during an endoscopic or X ray examination. Few of the diverticulitis symptoms are:

  • Pain and discomfort in the left lower abdomen
  • Bloating, or change in bowel habits (constipation/ diarrhea)
  • Severe and constant pain over the left lower abdomen
  • High temperature
  • Vomiting
  • Abdominal tenderness
  • Constipation/diarrhea

There is acute bleeding from the rectum in cases with diverticular bleeding. This may be associated with shock like symptoms and dizziness depending on the amount of blood loss.

The complications of diverticulosis are diverticulitis, bleeding into the colon, and colon obstruction. A diverticulum can also rupture and bacteria within the colon can spread to the tissues surrounding the colon. The collection of pus around the inflamed diverticulum can lead to formation of what is called an abscess.