Before beginning a discussion of diverticular disease, it is important to define diverticula. Diverticula is the name for tiny pockets that can form in the lining of the bowel.
Diverticula form as a result of increased pressure on weakened spots of the intestinal walls. They can occur while straining during a bowel movement as with constipation, and are a result of gas, waste or liquid. They can range from pea-sized to much larger and are most common in the lower portion of the large intestine, also called the sigmoid colon.
Diverticular diseases include: diverticulosis and diverticulitis. Each of these conditions defines a different effect on a person's diverticula.
Diverticulosis is the formation of diverticular or numerous tiny pockets in the lining of the bowel.
Diverticulosis can cause complications in about 20 percent of people affected. One of these complications is rectal bleeding, called diverticular bleeding. This occurs with chronic injury to the small blood vessels that are adjacent to the diverticula.
Another complication is diverticulitis or the inflammation of diverticula.
Diverticulosis is very common and occurs in 10 percent of people over age 40 and in 50 percent of people over age 60. The occurrence of diverticulosis increases with age and affects almost everyone over age 80.
Usually diverticulosis does not cause any troublesome symptoms. Some people may feel tenderness over the affected area or abdominal cramps.
Because most people with diverticulosis do not have any symptoms, it is usually found through tests ordered for an unrelated reason.
People who have diverticulosis without symptoms or complications do not need treatment, yet it is important to adopt a high-fiber diet. Laxatives should not be used to treat diverticulosis, and enemas should also be avoided or used infrequently.
Good bowel hygiene is most important to prevent diverticular disease or reduce any of its complications. It is important to have regular bowel movements and avoid constipation and straining. Eat appropriate amounts of the right types of fiber to maintain good bowel hygiene. Also, it is important to drink eight 8-ounce glasses of water each day, monitor changes in bowel movements (from constipation to diarrhea), exercise regularly and get enough rest.
Diet plays a very important role in preventing diverticular disease. The American Dietetic Association recommends 20 to 35 grams of fiber a day. Every person, regardless of the presence of diverticula, should try to consume this much fiber every day. Fiber is the indigestible part of plant foods.
High-fiber foods include:
- Whole grain breads
- Cereals and crackers
- Berries and fruit
- Vegetables, including broccoli, cabbage, spinach, carrots, asparagus and squash
- Brown rice
- Bran products
- Cooked dried peas and beans
A high-fiber diet helps prevent constipation and provides a number of other health benefits. It lowers blood pressure, reduces blood cholesterol, improves blood sugar and reduces the risk of developing certain intestinal disorders.
Diverticulitis is a condition resulting from inflammation and infection in one or more diverticula. This usually happens when outpouchings become blocked with waste, allowing bacteria to build up causing infection.
- Painful cramps or tenderness in the lower abdomen
- Chills or fever
If you are experiencing the symptoms of diverticulitis, it is important to see your doctor for the correct diagnosis. Some symptoms of irritable bowel syndrome and stomach ulcers may be similar to those of diverticular disease.
Your doctor will ask you questions about your medical history (such as your bowel habits, symptoms, pain, diet and current medications) and perform a physical exam, including a digital rectal exam.
One or more diagnostic tests may be ordered to help diagnose your condition as well as check for signs of infection or bleeding. Tests may include:
- CT scanning
- Ultrasound testing
- Barium enema
- Blood tests
In people with rapid, heavy rectal bleeding, the doctor may perform a procedure called angiography to locate the source of the bleed. During this test, doctors insert the patient’s arteries with a harmless dye that allows the doctor to view the source of the bleeding.
Diverticulitis sometimes resolves without medical treatment, but it frequently requires antibiotics. Sometimes the infection is so severe that it is necessary to be admitted to a hospital for intravenous antibiotics and other supportive care. Rarely, a surgeon may need to remove the affected part of the bowel.
During the active stage of the infection, many experts recommended eating a low fiber diet and drinking plenty of water. A month or so after the infection resolves, fiber should be back on the menu.
Emergency treatment including surgery may be needed when the antibiotics do not work, and in cases of a large abscess, perforation, peritonitis or continued rectal bleeding.
Serious complications can occur as a result of diverticulitis. Most of them are the result of the development of a tear or perforation of the intestinal wall. If this occurs, intestinal waste material can leak out of the intestines and into the surrounding abdominal cavity causing the following problems:
- Peritonitis, a painful infection of the abdominal cavity
- Abscesses, which become "walled off" infections in the abdomen
- Obstruction or blockages of the intestine
If an abscess is present, the doctor will need to drain the fluid by inserting a needle into the infected area. Sometimes, surgery is needed to clean the abscess and remove part of the colon. If the infection spreads into the abdominal cavity, called the peritonitis, surgery is needed to clean the cavity and remove the damaged part of the colon. Without proper treatment, peritonitis can be fatal.
Infection can lead to scarring of the colon, and the scar tissue may cause a partial or complete blockage. A partial blockage does not require emergency surgery. However, complete blockage does require emergency surgery.
Another complication of diverticulitis is the formation of a fistula.
A fistula is an abnormal connection between two organs, or between an organ and the skin. The most common type of fistula is between the bladder and colon. This requires surgery to remove the fistula and affected part of the colon.