Diverticulosis & Diverticulitis

To help understand diverticulosis, let’s review the anatomy and function of the intestine. The small intestine is the long, thin segment of bowel that begins at the stomach and ends at the large intestine. The large intestine, also called the colon, starts in the right lower abdomen and forms a large question mark across the entire abdomen, ending in the rectum. Just above the rectum is the sigmoid (5 shaped) part of the colon. Liquid waste (stool) enters the colon from the small intestine. As it moves through the colon, stool is dehydrated and shaped. By the time the stool enters the rectum, it is semi-solid and well-formed.

What is Diverticulosis?

Diverticuli are pockets or pouches extending out from the colon. These develop very gradually over a long period of time. They occur along the natural weak points in the bowel wall. The pockets develop because of the pressure exerted inside the colon as it contracts. Diverticulosis is the condition of having diverticuli (singular=diverticulum).

Since the highest pressure in the colon occurs in the sigmoid colon, it is here that most diverticuli occur. Because of these high pressure and balloon like projections, the sigmoid often becomes thickened, twisted and narrowed. This thickening and narrowing may cause changes in the bowel function, such as discomfort, diarrhea, and /or constipation in some people.

The Sigmoid Colon:

The sigmoid colon is designed to contract vigorously to maintain a high pressure. This action pushed the stool into the rectum. Since the sigmoid is a high pressure part of the colon, it is here the diverticuli occur.

Who gets Diverticulosis?

Since it takes so long to develop, diverticulosis usually appears later in life. However, it can occur in people as early as their 30’s. It is less common in people and societies around the world whose diet consists of less processed foods and more fruits and grains with very high fiber content.

Symptoms of Diverticulosis:

Most patients do not feel diverticuli forming. Occasionally they may feel cramps or discomfort in the lower left abdomen. Usually, there are no symptoms at all. When diverticulosis is far advanced, the lower colon may become more rigid, distorted or narrowed. This makes it more difficult for stool to move through. The patient may experience thin or pellet-shaped stools, constipation and an occasional rush of diarrhea. At this point, the problem is mechanical or structural one and treatment is more difficult.

Complications of Diverticulosis:

Many people have diverticulosis but few have complications from it. But when complications do occur, they can be serious. Diverticulitis is the most common complication.

*Diverticulitis:

Like a balloon, an expanding diverticulum develops a thinner wall than the rest of the colon. The bacteria in the colon-which are normally helpful as long as they stay in the colon-can seep through the thin walls of diverticuli and cause infection (called diverticulitis).

This infection can be mild with only slight discomfort in the left lower abdomen. Or it can be extreme with severe tenderness and fever. Antibiotics are usually required to treat the infection. The patient should also allow their bowel to rest by avoiding food or sometimes even liquids. For severe cases, the patient must be hospitalized.

*Bleeding:

Bleeding sometimes occurs from a ruptured blood vessel around a diverticulum. This may produce a gush of blood from the rectum. If the bleeding diverticulum is located in the right-side colon, the stool will be dark and mahogany colored.

*Perforation:

The complication is the most uncommon but the most serious. If an infected diverticulum breaks open (perforates), bacteria can escape into the abdomen. This can lead to local infection or a widespread infection throughout the lining of the abdomen requiring abdominal surgery or placement of a drainage catheter.

Diagnosis of Diverticulitis:

The medical history is the physician’s most important tool in diagnosing diverticulitis. The physician may also perform other exams to provide additional information:

*The physical exam may find tenderness in the left lower abdomen.

*A CT-scan is sometimes required to determine the extent of the diverticulitis.

*Flexible sigmoidoscopy and colonoscopy use a lighted, flexible endoscope put through the rectum and into the colon, to view the colon from inside.

*A patient’s medical history is the physician’s most important tool in diagnosing diverticulitis.

Treatment of Diverticulosis:

Diverticuli may be preventable or their progression limited with a high-fiber diet. Certain types of fiber, such as wheat bran, retain large quantities of water. This provides a bulkier, softer stool that is easier to pass and may help decrease the pressure in the bowel over time.

Bran and fiber can be found in many cereals, breads and other foods. Additional bulking agents, such as psyllium and methylcellulose are available in drug stores. Generally, a daily intake of 20 to 30 grams of fiber is recommended, beginning at a young age. Also, medications can be used to reduce colon spasms. When diverticulitis occurs at an early age or when there are recurrent episodes, surgery may be necessary to remove the diseased portion of the colon. In years past, people were advised to avoid popcorn, peanuts and other seed products. We now know that these foods do not need to be avoided in people with diverticulosis.

Summary:

Divertculosis is a disorder that may be preventable with a high fiber diet starting at a young age but can usually be treated. Diverticulitis is a potentially serious complication of diverticulosis but effective therapy is available.

Disclaimer: This information was taken directly from a pamphlet from Meducate by GI Supply and I give them full credit for the information from the pamphlet. Please consult with a doctor if you are feeling any symptoms.