Health - Conditions
By: - at August 12, 2013

Diverticular Disease and Diverticulitis

stomach acheThe large intestines play two important roles in digestion: extracting nutrients from food and removing undigested food materials from the body as stool. The colon is a section of the large intestines. Like a car tire, the colon has an inner soft tissue covered by a firmer, tougher muscle layer. Moving the stool forward can be difficult especially if it is hard. The colon uses high pressure that causes its internal wall to wear. After many years of wear and tear, the internal wall of the colon can develop swellings called diverticula. The diverticula can cause inflammation and pain. The patient experiences pain in the lower abdomen and a bloated feeling. This health problem of the colon is called diverticular disease. The disease can progress to a more severe case if bacteria infect the swellings. Diverticulitis is the name of the serious condition that results from infection of the bulges. Its symptoms include severe abdominal pain and high fever. Diverticular disease is associated with a low fiber diet. Therefore, it is most prevalent in western countries where traditional diets have low fiber content. This article describes the symptoms, causes, diagnosis, treatment, and prevention of diverticular disease and diverticulitis.

Overview of Diverticular Disease and Diverticulitis
Diverticula disease is associated with aging. As one advances in age, the high pressure required to move hard stool weakens parts of the internal wall of the colon. Consequently, inner layer splits the weak points and form bulges called diverticula. The size of diverticula range from 5 to 10 millimeters. Majority of people with diverticula do not develop the symptoms of diverticula disease. Usually, one in four people with diverticula experience the symptoms including abdominal pains. Diverticulitis occurs when bacteria infects one or more diverticula. A diverticulitis patient experiences more severe symptoms of diverticular disease.

Large and small intestine

The patient of diverticular disease can ease the symptoms by adopting a high-fiber diet. Furthermore, the patient can take paracetamol to relieve the symptoms. However, ibuprofen or aspirin can cause stomach upsets. You can treat mild diverticulitis at home with antibiotics. Nevertheless, you should consult your doctor to prevent complications if your case is serious. To prevent serious complications, the doctor can recommend surgery to remove the affected part of the colon.

Diverticular disease and diverticulitis affect women and men equally. However, it affects more men under the age fifty than women. Medical professionals describe the disease as a western disease because it is more prevalent in North American and Western Europe. It is associated with the low fiber diets that are traditional in these areas. Usually, one in two people in western countries have the disease at the age of fifty and seventy percent at the age of eighty. Nevertheless, the disease is rare in Asian and African countries where people traditionally eat high-fiber diets.

Diverticular Disease and Diverticulitis Symptoms
Intermittent pain in the lower abdomen is the main symptom of diverticular disease. The patient usually experiences the pain in the left side of the abdomen. The pain intensifies during meals or shortly after. However, flatulence or passing stool can relieve the pain. The other symptoms are diarrhea, constipation, episodes of constipation followed by diarrhea, bleeding from the rectum, and bloating.

Rectal bleeding can occur because the hard stool damages the colon blood vessels already weakened by the disease. Although the bleeding is usually painless, it can be serious to loose too much blood. Therefore, consult your doctor to stop the bleeding urgently. Symptoms of heavy bleeding include short breath, dizziness, pale clammy skin, and confusion.

Human digestive system

The main symptom of diverticulitis is persistent severe abdominal pain. The pain usually begins just below the belly button then moves to the left of the abdomen. However, it moves to the right of the abdomen in Asian people because of genetic predisposition. Diverticulitis inflammation can cause bowel obstruction. Besides abdominal pain, the patient can also experience fever of over 100.4F, bleeding from the rectum, sick feeling and constipation. Other symptoms of diverticulitis include abdominal bloating or swelling, diarrhea, and thin stools. To avoid complications, you should consult your doctor as soon as you notice the symptoms of diverticulitis.

Functions of the Colon That Can Lead To Diverticular Disease
highlighted colon human bodyThe colon has five main motor functions: different sections play specific roles. First, it mixes its contents to enhance absorption of short chain fatty acids, electrolytes, water, and bacterial metabolites. Therefore, it extracts useful fluids from the food residues and can dehydrate the feces. The feces can become too dry and cause constipation if it stays long in the colon. Second, it maintains the right intraluminal bacterial mass. Third, it moves its contents towards the anus. Portions of the feces enter the colon from the small intestines and exit into the rectum. It moves the feces forward with wavelike movements generated by contraction of its muscles. The muscles contract and relax to apply pressure for the movement. They contract and relax at regular intervals to achieve propulsion.

The brain generates the contractions by sending impulses to special colon cells called interstitial cells of Cajal. The cells convey the impulses to the colon smooth muscles. A portion moves for a short distance then stops for nutrients extraction to take place. This motion-and-rest process recurs several times until the portion exits the colon. The sections of the colon that propel the feces towards the rectum are the sigmoid, descending, and transverse colons. Fourth, it stores the fecal material to await defecation. The ascending colon functions as a storage chamber for feces. Fifth, it rapidly removes its contents during defecation

Causes of Diverticular Disease and Diverticulitis
The colon extracts water from its contents, which can become hard and difficult to move. Therefore, the colon uses high pressure to move hard stool especially small pieces. The high pressure can create weak spots in the internal wall of the colon. This enables the inner tissue of colon wall to protrude through the weak spots and form diverticula. Diverticula are associated with low fiber diet, which makes the stool soft and easy to move through the colon. Cases of the disease are very low in places such as South Asia and Africa where the traditional diet is high in fiber.

High in fiber foodsOn the other hand, cases of the disease are high in places such as North America and Western Europe where the traditional diet is low in fiber. Nevertheless, there is no clinical evidence that supports the relation between diverticular disease and high fiber diet. Only one out of four people with diverticula develop the symptoms. Use of NSAIDs such as naproxen and ibuprofen, smoking, obesity, lack of exercise or frequent constipation may cause the symptom to develop.

Diverticulitis develops when bacteria infects one or more of the diverticula. Bacteria from a piece of stool can multiply and infect the diverticula when a pouch in the colon traps it.

Location of the Diverticula
The colon extends from the ileum of the small intestines to the rectum. It bends three times to frame the small intestines. Between the bends, it has four distinct sections distinguished by their positions in the abdominal cavity. First, the ascending colon joins the small intestines. It is at the right side of the cavity. Second, the traverse colon is horizontal and extends from the right to the left of the cavity. Third, the descending colon lies on the left of the cavity. Fourth, the sigmoid colon is s-shaped. It joins the rectum.

Small intestine map

The average length of the colon of an adult person is 60 inches. Ascending colon is eight, traverse colon is 18, descending colon is12, and sigmoid colon is 18 inches long. Diverticula can form in any section of the colon. Nevertheless, they are most common in the sigmoid and descending colon sections. These are the last sections of the colon. The feces usually reach these sections when it is harder because the first sections extract water from it.

Diverticular Disease and Diverticulitis Diagnosis
The symptoms alone cannot confirm diverticular disease because there are other health problems with similar symptoms. For instance, irritable bowel syndrome (IBS) and coeliac disease have similar symptoms. Therefore, diagnosis of diverticular disease involves carrying out tests that rule out these health conditions. Doctors usually use two tests to diagnose diverticular disease. First, colonoscopy involves taking photographs of the inside of the colon with a small camera. The doctor mounts the camera at the end of a tube and inserts the tube into the colon. Prior to the procedure, the doctor gives the patient a laxative to empty the bowel, a local anesthetic to numb pain, and a sedative to help the patient relax. However, the patient may feel slight discomfort during the procedure.

Monitoring Gastrointestinal Endoscope:
Monitoring Gastrointestinal Endoscope

Lastly, barium enema x-ray involves taking a series of x-ray images of the internal wall after spraying it with barium solution. Soft tissue such as diverticula can show on x-ray images when coated with barium solution. The doctor inserts a tube into the rectum and uses it to spray the colon with barium solution. Prior to the procedure, the doctor gives the patient a laxative to empty the bowel, a local anesthetic to numb pain, and a sedative to help the patient relax. For sometime after the procedure, the barium solution passes out in the stool, which appears white and discolored.

The doctor can diagnose diverticulitis by physical examination and from the symptoms if the patient had a previous history of diverticular disease. A blood test showing a high number of white blood cells can confirm infection. However, for a patient with no history of diverticular disease, the doctor can perform further tests to rule out other problems, such as a hernia or gallstones, which have similar symptoms. The doctor can perform the barium enema x-ray or colonscopy as explained above. Alternatively, the doctor can perform a computerized tomography (CT) scan that uses a computer to create detailed 3-D images from a series of x-ray images. The CT scan can reveal spread of infection to other parts. Furthermore, the CT scan can show complications such as an abscess.

Treatment of Diverticular Disease
over the counter pain medicationConsult your doctor if it is your first time to experience the symptoms of diverticular disease. The doctor can rule out health problems such as irritable bowel syndrome that have similar symptoms. You can also consult your doctor to subscribe a laxative if you have constipation. However, you can treat the disease at home with painkillers, high fiber diet, and antibiotics if you had a previous diagnosis. You can use over-the-counter paracetamol to manage the symptoms and incorporating fiber in your diet. Nevertheless, do not use non-steroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen and aspirin, because they can increase risk of bleeding and cause stomach upset. A high fiber diet helps control the symptoms because fiber makes the stool soft. You should eat between 0.6 oz and 1 oz per day depending on individual weight and height. Gradually increase the amount of fiber you take to avoid bloating and flatulence. The full benefits of high fiber diet will show after one month.

Treatment of Diverticulitis
Home Treatment - You can treat mild diverticulitis at home. The doctor can prescribe antibiotics to treat the infection and you can use paracetamol to manage the pain. You should finish the full dose of antibiotics even after the symptoms have subsided. The antibiotics may cause side effects such as diarrhea and vomiting. Furthermore, the doctor may prescribe a fluids only diet because solid food may worsen the symptoms. Later you can reintroduce solid food gradually over a period of two to three days.

Hospital Treatment You should go for in-patient hospital treatment if you have severe diverticulitis. You should also seek hospital treatment if paracetamol does not control the pain, the symptoms do not improve after two days treatment at home, the doctor suspects complications, your immune system is weak, you have poor state of health, you are unable to take antibiotics orally, or you are unable to drink fluids. At the hospital, you can get antibiotics injections and intravenous drip nourishment. Most patients respond quickly to hospital treatment and the symptoms improve after two to three days.

Surgery Treatment - Doctors usually recommend surgery for the following three cases. First, the patient had previous serious diverticulitis complications. Second, the patient had diverticular disease symptoms since childhood. A patient with a long history of diverticular disease will most likely have diverticulitis complications. Lastly, the patient is vulnerable to infections or has a weak immune system. You should understand the risks and benefits before you consent to the surgery. The doctor can use the following surgery procedures depending on the severity of the disease.

Colectomy is the surgery procedure to remove the affected part of the intestine. There are two methods of colectomy. First, in open colectomy, the doctor incises the abdomen to access and remove the affected part of the colon. Lastly, in laparoscopic colectomy, the doctor makes a small hole in the abdomen through which to insert an instrument for removing the affected part of the colon. The instrument has a camera to guide the surgeon.

Ileostomy Right After Surgery:
Ileostomy Right After Surgery
By Sejj86 , via Wikimedia Commons

Another surgery procedure is stoma surgery. The surgeon can perform stoma surgery to make a stool bypass to enable the affected or incised part of the colon to heal. Stoma surgery enables removal of the stool before it reaches the affected part of the colon. A stoma is a small hole the surgeon makes in the abdomen for the bypass. The patient wears a bag to collect the stool. There are two methods of stoma surgery. First, the surgeon can perform ileostomy if the affected part of the colon is near the end of the small intestines. The surgeon cuts off the end of the small intestines from the colon and passes it out through a stoma in the right of the abdomen. The surgeon then seals the colon. Lastly, the surgeon can perform a colostomy if the affected part of the colon is near end of the rectum. The surgeon cuts the colon and passes the upper end out through a stoma in the lower abdomen.

A stoma bypass is temporary and the surgeon removes it once the colon heals: it usually takes at least nine weeks. However, the surgeon can make a permanent stoma bypass if the affected section of the colon is large. A few cases of diverticular disease and diverticulitis treated with surgery recur.

Diverticular Disease and Diverticulitis Complications
If diverticulitis is not treated early, serious complications that require surgery can develop. Patients of diverticulitis who are less than 50 years old have a high risk of developing complications. Diverticulitis usually causes the following complications.

Detailed digestive system

An abscess is a lump or pus-filled cavity in the tissue. It is the most common diverticulitis complication. The doctor can use computerized tomography (CT) scans to locate an abscess. Percutaneous abscess drainage (PAD) is the procedure for treating abscesses. The doctor uses a small needle connected to a tube. The doctor passes the needle through the abdomen into the abscess and uses it to drain the pus from the abscess. The procedure is not painful because the doctor uses a local anesthetic. The doctor can repeat the procedure several times to remove all the pus from a large abscess. However, instead of PAD antibiotics can treat a small abscess of about 1.5 inches.

Fistula is another common diverticulitis complication. A fistula is an abnormal tunnel that connects two parts of the body. For instance, a fistula can connect the colon and the bladder. Therefore, the fistula can enable bacteria from one part of the body to infect another part. For instance, fistula connecting the colon and the bladder can enable diverticulitis bacteria to infect the bladder and cause cystitis, a serious bladder disease. Doctors usually used surgery to remove the part of the colon with a fistula.

Peritonitis is an infection of the lining of the abdomen by bacteria from ruptured diverticula. The complication should be urgently treated with antibiotics because it can be life threatening. Alternatively, the doctor can perform surgery to repair damaged parts of the colon and drain pus.

Intestinal obstruction is blockage of the colon caused by serious scarring. You should urgently seek treatment for a fully blocked colon to prevent colon tissues from decaying and rupturing. The complication can cause peritonitis if it ruptures. A partially blocked colon is not a medical emergency. However, it you should treat it to relieve pain and prevent it from interfering with digestion. The doctors use antibiotics to treat the obstruction or surgery to remove the blocked part. Alternatively, the doctor can use temporary or permanent colostomy if the scarring is extensive. Another diverticulitis complication is severe bleeding. The doctor can perform a blood transfusion to replace lost blood.

How to Prevent Diverticular Disease and Diverticulitis
You should eat a high fiber diet to prevent diverticular disease. Furthermore, a high fiber diet can improve the symptoms of the disease. Dietary fiber is the indigestible part of food of plant origin. Eating high fiber content food has many health benefits. One of its benefits is that it makes stool easy to pass through the colon. It increases the volume of stool and makes it soft. Therefore, it helps shorten the transit time of stool in the colon. To prevent diverticular disease, women should consume at least 0.9 oz and men at least 1.2 oz per day.

Rice Salad with Tomatoes- Example of High Fiber Meal
Rice Salad with Tomatoes- Example of High Fiber Meal

There are two types of fiber: water-soluble and water-insoluble. Insoluble fiber makes the feces bulky. It absorbs water in the digestive tract and makes the feces soft and easy to move. Therefore, insoluble fiber tends to make food move faster in the colon. Both types of fiber readily ferment in the colon and produce gases and other byproducts. Increase the amount of fiber you eat gradually over a period to prevent its side effects such as flatulence and bloating. Furthermore, drink plenty of fluids, including water, to prevent the fiber side effects.

Good sources of fiber are fresh fruits such as apples, oranges, and mangoes; dried fruits such as prunes and apricots; vegetables such as peas, kidney beans, and baked beans; nuts such as peanuts and almonds; breakfast cereals such as high-fiber flakes; and starchy foods such as pasta, rice, popcorn, and bread. You can also use fiber supplements from health food stores and pharmacists that are usually in sachets to mix with water. Preventive medicine is the best medicine and diverticular disease can be easily avoided by ensuring that you consume enough fiber in a day. All of the procedures and surgeries involved with treating advanced diverticular disease are mostly horrible, invasive, and sometimes require a decent amount of recovery time.





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