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Diverticular disease consists of diverticulosis and diverticulitis.
Diverticulosis is the formation of numerous tiny pockets, or diverticula, in the
lining of the bowel. Diverticula, which can range from pea-size to much larger,
are formed by increased pressure on weakened spots of the intestinal walls by
gas, waste or liquid. Diverticula can form while straining during a bowel
movement, such as with constipation. They are most common in the lower portion
of the large intestine (called the sigmoid colon).
Complications can occur in about 20% of people with diverticulosis. One of
these complications is rectal bleeding, called diverticular bleeding, and the
other is diverticulitis.
Diverticular bleeding occurs with chronic injury to the small blood vessels
that are adjacent to the diverticula. Diverticulitis occurs when there is
inflammation and infection in one or more diverticula. This usually happens when
outpouchings become blocked with waste, allowing bacteria to build up causing
infection.
Diverticulosis is very common and occurs in 10% of people over age 40 and in
50% of people over age 60. The occurrence of diverticulosis increases with age
and affects almost everyone over age 80.
What are the symptoms of diverticulosis?
Usually diverticulosis does not cause any troublesome symptoms. Some people
may feel tenderness over the affected area or abdominal cramps.
How is diverticulosis diagnosed?
Because most people with diverticulosis do not have any symptoms, it is
usually found through tests ordered for an unrelated reason.
How is diverticulosis treated?
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.
How can diverticulosis be prevented?
Good bowel hygiene is most important to prevent diverticular disease or
reduce the complications from it. This means having regular bowel movements and
avoiding constipation and straining. Eating appropriate amounts of the right
types of fiber are important to maintain good bowel hygiene. Drinking plenty of
water and exercising regularly are also important.
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;
fruit; vegetables, such as broccoli, cabbage, spinach, carrots, asparagus,
squash and beans; brown rice; bran products; and cooked dried peas and beans,
among other foods.
A high-fiber diet helps prevent constipation and provides a number of other
health benefits, including lowering blood pressure, reducing blood cholesterol,
improving blood sugar and reducing your risk of developing certain intestinal
disorders.
Drinking eight 8-ounce glasses of water a day, monitoring changes in bowel
movements (from constipation to diarrhea) and getting enough rest and sleep, are
other ways to prevent diverticular disease.
What are the smptoms of diverticulitis?
Diverticulitis
- Painful cramps or tenderness in the
lower abdomen
- Chills or fever
How is diverticulitis diagnosed?
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.
Tests may include X-rays, CT scanning, ultrasound testing, a sigmoidoscopy,
colonoscopy, barium enema, and blood tests to look for signs of infection or the
extent of bleeding.
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 will
allow the doctor to view the source of the bleeding using a special.
How is diverticulitis treated?
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.
What complications are associated with diverticulitis?
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)
- Abcesses ("walled off"
infections in the abdomen)
- Obstruction (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 (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.
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