What Is Diverticulitis? What Is Diverticular Disease?

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Main Category: GastroIntestinal / Gastroenterology
Also Included In: Irritable-Bowel Syndrome;  Crohn's
Article Date: 08 Jun 2009 - 9:00 PDT

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When pouches begin to protrude outwards from the colon wall the person has diverticular disease or diverticulosis. When one of these pouches becomes infected and inflamed, that infection is called diverticulitis. People may have lots of protruding pouches and feel fine. However, when one of them becomes infected it can be very painful.

Recap - What is the difference between diverticulitis, diverticulosis and diverticular disease?

• 1. Diverticulosis is just the condition of having protruding pouches (diverticular) coming out of the wall of the colon. These people have no symptoms.


• 2. One outpouching is a diverticulum; two or more are diverticula.


• 3. Diverticular disease refers to people with diverticulosis who have symptoms.


• 4. Diverticulosis generally refers to cases without symptoms.


• 5. When one of the outpouches (diverticula) becomes infected, it is known as diverticulitis.

50% of people are thought to have diverticulosis by the age of 50, while 70% probably have it by the age of 80. Experts say that three-quarters of people with diverticulosis will never experience any symptoms (asymptomatic diverticulosis). The remaining quarter who do have symptoms have diverticular disease.

A study found that the incidence of diverticulitis among young obese adults is growing. An NIH (National Institutes of Health, USA) report revealed that the costs of digestive diseases has grown to more than $141 billion a year in the USA.

What are the symptoms of diverticular disease and diverticulitis?

Diverticular disease symptoms

• There may be episodes of pain in the lower abdomen. More specifically, usually in the lower left side of the abdomen. The pain often comes when the patient eats or passes stools. There is usually some relief when the patient breaks wind.


• Bowel habits change


• Constipation


• Diarrhea (sometimes - less common than constipation)


• Small amounts of blood in stools

Diverticulitis symptoms

• Constant and usually severe pain


• Pain starts below the belly button, and moves to the lower left side of the abdomen (may move to the right side of abdomen if the patient is Asian)


• Temperature (fever)


• More frequent urination


• Painful urination


• Nausea and vomiting


• Bleeding form rectum

What causes Diverticula to occur?

Lack of dietary fiber is thought to be the main cause of diverticula (pouches protruding outwards from the colon). Fiber helps our stools remain soft. If you do not consume enough dietary fiber and the stool is hard there may be more pressure or strain on the colon as muscles push the stool down - this pressure causes diverticula to occur. Diverticula occur when weak spots in the outside layer of colon muscle give way because stuff in the inner layer has managed to squeeze through.

Although there is no clear clinical evidence to prove a link between dietary fiber and diverticulosis, experts say the circumstantial evidence is coonvincing. Studies have shown that in parts of the world where dietary fiber intake is large, such as in Africa or South Asia, diverticula disease is fairly uncommon. On the other hand, it is quite common in western countries where dietary fiber intake is much lower.

A study found no link between diverticular disease and consumption of nuts, seeds, and corn.

What causes diverticulitis (infection and inflammation of a diverticulum)?

Experts do not fully understand why diverticulitis - the infection of at least one diverticula - occurs. We do know that the bacteria in the stool rapidly multiply and spread, causing an infection. It is thought that a diverticulum becomes blocked, possibly by a piece of feces (piece of a stool), which could lead to infection. Some studies have indicated that genetics may be a factor.

How are diverticular disease and diverticulitis diagnosed?

Diagnosing diverticular disease

As there are several illnesses and conditions with similar symptoms, such as IBS (irritable bowel syndrome), diagnosis of diverticular disease is not easy. A doctor can rule out other conditions by having some blood tests done.

Colonoscopy - the doctor has a look inside the patient's colon by using a colonoscope - a thin tube with a camera at the end. The colonoscope enters the patient through the rectum. Before the procedure begins most patients are given a laxative to clear their bowels. A local anesthetic is given before the procedure starts. The aim of the colonoscopy is to see whether any diverticula are present.

Barium enema X-ray - a tube is inserted into the patient's rectum and a barium liquid is squirted into the tube and up the rectum. Barium is a liquid that shows up in X-rays. When the inside surface of organs that do not show up on X-ray are coated with barium, they become visible. The aim here is to see whether the X-ray may confirm the presence of diverticula. The procedure is not painful.

Diagnosing diverticulitis

If a patient has a history of diverticular disease, the GP (general practitioner, primary care physician) will be able to diagnose diverticulitis by carrying out a physical examination and asking the patient some questions regarding symptoms and his/her medical history. A blood test is useful, because if it reveals a high number of white blood cells it probably means there is an infection.

Patients who have no history of diverticular disease will need additional tests. There are other conditions which may have similar symptoms, such as a hernia or gallstones. A computer topography (CT) scan may be used, as well as a barium enema X-ray. If the patient's symptoms are severe the CT scan may tell whether the infection has spread to another part of the body, or whether there is an abscess.

What are the treatments for diverticulitis and diverticular disease?

Diverticular disease treatment

Most people are able to self-treat their diverticular disease, mainly with the help of painkillers and consuming more dietary fiber.

Painkillers such as aspirin, or ibuprofen should be avoided as they increase the risk of internal bleeding, and may also upset the stomach. Paracetamol (acetaminophen, Tylenol) is recommended for pain relief from diverticular disease.

Eating more dietary fiber, which includes fruits and vegetables, will help resolve the symptoms - this may sometimes take a few weeks before you see the full benefits.

Bulk-forming laxatives may help patients who have constipation. Drink plenty of fluids if you do take them.

Patients who experience heavy or constant rectal bleeding should see their doctor.

Diverticulitis treatment

Mild cases of diverticulitis can generally be treated by the patient himself/herself. A doctor may prescribe antibiotics, plus paracetamol (acetaminophen, Tylenol) for the pain. It is important that all patients complete their whole course of antibiotics; even if they feel better half-way through. Some people may experience drowsiness, nausea, diarrhea, and/or vomiting while they are taking their antibiotics. Antibiotics may include ciprofloxacin (Cipro), metronidazole (Flagyl), cephalexin (Keflex), and doxycycline (Vibramycin).

Remember that if you are on the contraceptive pill an antibiotic may interfere with the pill's effectiveness. While taking the antibiotics you should consider using an additional type of contraception, such as a condom. This effect on the contraceptive pill continues for about seven days after you stop taking the antibiotic.

Some patients are asked to consume just liquids for a few days until their symptoms get better. Solid foods are then gradually introduced.

Hospital treatment may be necessary if:

• Normal painkillers do not alleviate the pain
• The patient cannot consume enough liquids to keep hydrated
• The patient cannot take oral antibiotics
• The patient has a poor state of health
• The doctor suspects complications (often if the patient's immune system is weak)
• Treatment at home is ineffective after two days

Hospital patients are generally given antibiotics intravenously, as well as fluids if they are dehydrated.

Surgery for diverticulitis - colon resection

Patients who have at least two diverticulitis episodes may benefit from surgery. Studies indicate that such patients are significantly more likely to have subsequent episodes, as well as complications if they do not have surgery. Colon resection removes part of the affected colon, and joins the remaining healthy parts together.

Patients who undergo colon resection will have to introduce solid foods into their system gradually. Apart from this, their normal bowel functions will not usually be affected. A small study suggests that chewing gum after colon surgery may accelerate the return of normal bowel function and shorten patients' hospital stays.

What are the possible complications of diverticulitis?

• Peritonitis - infection may spread into the lining of the abdomen if one of the infected diverticula bursts. Peritonitis is serious and can sometimes be fatal. It requires immediate antibiotic treatment. Some cases of peritonitis require surgery.


• Abscess - this is a cavity which is full of puss, or a lump in the tissue. Sometimes surgery is required to get the puss out.


• Fistula - these are abnormal tunnels (tubes) that connect two parts of the body, such as the intestine to the abdominal wall or the bladder. A fistula can be formed after infected tissues touch each other and stick together; when the infection is over a fistula forms. Sometimes surgery is needed to get rid of the fistula.


• Intestinal obstruction - the colon may become partly or totally blocked if infection has caused scarring. If the colon is blocked completely emergency medical intervention is needed. Total blockage will lead to peritonitis. If the patient's colon is partially blocked he/she will need treatment - however, it is not as urgent as total blockage.

Depending on the degree of scarring and the extent of blockage, a colon resection may be needed. On occasions a colostomy may be required - a hole is made on the side of the patient's abdomen, and the colon is redirected through the hole and connected to a colostomy bag (external). As soon as the colon has healed the colon is rejoined. In rare cases the doctors may have to create an ileo-anal pouch (internal pouch).

Prevention

If you eat a well-balanced diet with plenty of fruit and vegetables your chances of developing diverticulitis are considerable lower.

Written by Christian Nordqvist


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