Diverticulosis and Diverticulitis
Diverticulosis and diverticulitis are also called diverticular disease. Diverticulum, or diverticula (plural), is a small pouch in the colon that bulges outward in weak spots. Many people have these pouches, which is a condition called diverticulosis, and it becomes more common as they age. Diverticulitis is the condition in which those pouches become infected or inflamed. Approximately 50 percent of people over the age of 60 have diverticulosis.Ten to 25 percent of people with diverticulosis will develop diverticulitis.
Symptoms
Although most people with diverticulosis are asymptomatic, some may experience mild cramps, bloating, and constipation. With diverticulitis, the most common symptom is abdominal pain with tenderness around the left side of the lower abdomen. Fever, nausea, vomiting, cramping, chills, and constipation may occur if infection is the cause.
Complications
Diverticulitis may cause bleeding, infections, tears, or blockages and require treatment to keep them from progressing. Bleeding is a rare complication that may show up in your stool or the toilet. Bleeding diverticula are believed to be caused by weak, small blood vessel that eventually burst. A doctor’s attention should be brought to any bleeding from the rectum.
If diverticulitis is left untreated or gets worse, an abscess may form in the colon. When the abscess is small and remains in the colon, it may clear up after antibiotics. If it does not, the doctor may need to drain it using a catheter. Percutaneous catheter drainage is the procedure in which a doctor inserts a needle through the skin and drains the fluid through a small tube. Surgery may be needed with some patients to clean the abscess and remove part of the colon, if necessary.
The abscess may also cause swelling, destroy tissue, or develop perforations which allow puss to leak out of the colon into the abdominal cavity. This is called peritonitis and it requires immediate surgery as it can be fatal.
Another possible complication is a fistula, which is an abnormal connection of tissue between an organ and the skin or between two organs. During an infection, damaged tissues may come in contact and stick together. A fistula forms when they heal that way. The organs most commonly involved are the skin, small intestine, and the bladder. The most common type of fistula is between the colon and the bladder. It happens more often in men and can result in long-lasting infections of the urinary tract. Surgery can be performed to correct this by removing the fistula and the affected part of the colon.
Intestinal obstructions may occur when scarring from the infections causes the large intestine to become partially or fully blocked. The colon cannot make normal bowel movements. Surgery is required to correct the obstruction.
Causes
There is no proven cause of diverticular disease. However, a low-fiber diet is widely accepted as the main cause. The disease was first noticed in the United States around the same time processed foods, which contain low-fiber flour, were introduced. The disease is more common in industrialized countries and not often found in countries where people eat high-fiber vegetable diets.
Fiber prevents constipation by making the stool soft and easier to pass. Constipation makes the muscles in the colon work strenuously to move the hard stool, which increases pressure. That excess pressure can cause the weak spots in the colon to bulge and become diverticula. The cause of the diverticulitis is not known but may be from stool or bacteria being caught in the diverticula.
Diagnosis
Since most people with diverticulosis are asymptomatic, it is usually diagnosed through tests ordered for another health concern. Medical history, a physical exam, diagnostic tests, and x rays assist in determining the disease. The physical exam usually involves a digital rectum exam. Stool may be checked for bleeding and blood tests may be performed to look for signs of infection.
Treatment
Increasing the amount of fiber in the diet may reduce symptoms of diverticulosis. The American Dietetic Association recommends 20 to 35 grams of fiber each day. Fiber products such as Citrucel or Metamucil may also help. There is no scientific data supporting the elimination of certain foods from the diet. Adding fiber is the only highly emphasized recommendation. Doctors may prescribe mild pain medications if symptoms such as bloating, cramps, or constipation exist. However, many medications are counterproductive as they may cause constipation.
When treating diverticulitis, the focus is on clearing up the infection, resting the colon, and avoiding complications. Doctors may recommend bed rest, a liquid diet, and a pain reliever to rest the colon.
Surgery
If diverticulitis attacks are frequent or severe, a surgery called colon resection may be necessary. This involves a surgeon removing the affected part of the colon and rejoining the remaining sections. Surgery may also be needed for complications of a fistula or intestinal obstruction. Emergency surgery may be required if antibiotics do not correct the attack, or if there is a large abscess, peritonitis, perforation, or continued bleeding.
When emergency surgery is involved, a full colon resection cannot be performed because of the risk of infection and sometimes obstruction. Instead, two operations will be necessary. The first clears the infected abdominal cavity and removes part of the colon. Since it’s not safe to rejoin the colon, a temporary hole called a stoma is created in the abdomen. A procedure, known as a colostomy, connects the end of the colon to that hole to allow normal eating and bowel movements. The stool goes into an attached bag in the opening of the abdomen. During a second operation, the surgeon will rejoin the sections of the colon.