Diverticulosis and Diverticulitis

Diverticulosis

Diverticulosis and diverticulitis are called diverticular disease.

Diverticulosis occurs when small pouches, called diverticula, bulge outward through weak spots in the large intestine (colon).

The pouches form when pressure inside the colon builds, usually because of constipation.

Diverticula are common in the sigmoid colon, which is a common place for increased pressure.

This condition is uncommon before the age of 40 and increases in incidence after that age. Half of all people over the age of 60 have it.

Most people with diverticulosis never have any discomfort or symptoms.

The most likely cause of diverticulosis is a low-fibre diet because it increases constipation and pressure inside the colon.

For most people with diverticulosis, eating a high-fibre diet is the only treatment needed.

Diverticulitis occurs when diverticula become infected or inflamed.

Causes of Diverticulosis

Diverticuli are thought to be caused by increased pressure within the lumen of the colon. Constipation is the most common cause of diverticulosis.

Increased intra-colonic pressure secondary to the constipation leads to weaknesses in the colon walls giving way to diverticula.

Other causes may include a colonic spasm that increases pressure. This may be due to dehydration, low-fibre diets, or constipation.

Risk factors include:

  • Low-fibre/high-fat diet
  • Increasing age
  • Constipating conditions
  • Connective tissue disorders (these may cause weakness in the colon wall e.g. Marfan syndrome).

    Diverticular disease is common in developed countries where low-fibre diets are common. The disease is rare in Asia and Africa where people eat high-fibre vegetable diets.

    Fibre is the part of fruits, vegetables, and grains that the body cannot digest. Some fibre dissolves easily in water. Fibre helps prevent constipation.

    Symptoms of Diverticulosis

    This disorder often has no symptoms. If symptoms occur, the most common are:

  • Bleeding (variable amounts)
  • Bloating,
  • Abdominal pain and cramping (especially after meals and often in the left lower abdomen)
  • Diarrhoea
  • Constipation

    Diseases such as irritable bowel syndrome (IBS) and stomach ulcers cause similar problems. These symptoms therefore do not always mean a person has diverticulosis and its better to check with your physician.

    First time bleeding from the rectum should be followed up with a physician, especially if over age 40 because the possibility of colon cancer.

    Symptoms of anaemia such as fatigue, light-headedness, or shortness of breath may be present.

    Diverticulosis Diagnosis

    Colonoscopy is the most used test for diagnosis. This is important for treatment and investigation of other diseases.

    The doctor may also ask about medical history and do a physical exam. Diverticulosis is often found through tests ordered for another ailment because most people do not have symptoms.

    Other tests in include abdominal X-ray, barium enema, CT, or MRI.

    Likely Diverticulosis Complications

    Infection of a diverticulum can result in diverticulitis. This occurs in 10-25% of persons with diverticulosis.

    Tears in the colon leading to bleeding or perforations may occur, intestinal obstruction may occur (constipation or diarrhoea does not rule this possibility out), peritonitis, abscess formation, retroperitoneal fibrosis, sepsis, and fistula formation.

    Emergency surgery is necessary when the obstruction totally blocks the intestine but partial blockage is not an emergency.

    Infection of a diverticulum may result from complications.

    Diverticulosis Treatment

    Often no treatment is needed. Increases in hydration, increasing fibre content in the diet or removing factors resulting in constipation help decrease the incidence of new diverticuli or possibly keep them from bursting or becoming inflamed.

    Fibre supplements may aid if diet is inadequate.

    If the diverticuli are unusually large, infected or exhibit uncontrollable bleeding, surgery can be performed to decrease relapse and other complications.

    If cramps, bloating, and constipation are a problem, the doctor may prescribe a short course of pain medication. However, many medications affect emptying of the colon. This is an undesirable side effect for people with diverticulosis.

    Diverticulosis Diet

    Foods such as nuts, popcorn hulls, sunflower seeds, pumpkin seeds, caraway seeds, and sesame seeds should be avoided because they may irritate diverticuli.

    The seeds in tomatoes, zucchini, cucumbers, strawberries, raspberries, and poppy seeds, are not considered harmful.

    The doctor may recommend taking a fibre product such as Citrucel or Metamucil once a day.

    You can increase your fibre intake by eating these foods: whole grain breads and cereals; fruit like apples and peaches; vegetables like broccoli, cabbage, spinach, carrots, asparagus, and squash; and starchy vegetables like kidney beans and lima beans.

    Some treatments like some colon cleansers that cause constipation and straining are not recommended.

    Diverticulitis

    Diverticulitis is a common disease of the bowel affecting particularly the large intestine.

    Diverticulitis develops from diverticulosis, which involves the formation of pouches (diverticula) on the outside of the colon.

    Diverticulitis results if one of this diverticulum becomes inflamed. In complicated diverticulitis, bacteria may subsequently infect the outside of the colon if an inflamed diverticulum bursts open.

    If the infection spreads to the lining of the abdominal cavity, (peritoneum), this can cause a potentially fatal peritonitis.

    Sometimes inflamed diverticula can cause narrowing of the bowel, leading to an obstruction.

    In addition, the affected part of the colon could adhere to the bladder or other organ in the pelvic area, causing a fistula, or abnormal communication between the colon and an adjacent organ.

    Diverticulitis most often affects middle-aged and elderly persons, though it can strike younger patients as well.

    Causes of Diverticulitis

    Its development is thought to be a result of raised intraluminal colonic pressures.

    Low dietary fibre, particularly non-soluble fibre is a risk causative factor in diverticular disease.

    It is thought that mechanical blockage of a diverticulum can lead to infection of the diverticulum.

    Symptoms of Diverticulitis

    Patients may experience:
  • Nausea
  • Diarrhoea
  • Constipation
  • Abdominal pain
  • Tenderness around the left side of the lower abdomen.
  • Fever
  • Chills

    Diverticulitis Diagnosis

    Patients with the above symptoms are commonly studied with a computed tomography, or CT scan.

    The CT scan is very accurate in diagnosing diverticulitis. It may also identify patients with more complicated diverticulitis, such as those with an associated abscess.

    CT also allows for radiologically guided drainage of associated abscesses, possibly sparing a patient from immediate surgical intervention.

    Treatment of Diverticulitis

    Acute diverticulitis is usually treated with measures such as bowel rest, IV fluid resuscitation, and broad-spectrum antibiotics that cover anaerobic bacteria and gram-negative rods.

    Recurring acute attacks and complications such as peritonitis, abscess, or fistula may require surgery.

    Upon discharge, patients are placed on a high-fibre diet. There is evidence that this lowers the recurrence rate.

    Likely Diverticulitis Complications

    Likely complications include:
  • Obstruction
  • Peritonitis
  • Abscess
  • Fistula
  • Bleeding
  • Strictures
  • Perforations or tears

    A fistula is an abnormal connection of tissue between two organs or between an organ and the skin.

    When damaged tissues meet 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 and 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.

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