Diverticulosis & Diverticulitis
To
understand diverticulosis, it is helpful to know about 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 or colon. 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 (S-shaped)
part of the colon. Liquid stool enters the right colon and, as it moves through
the colon, is dehydrated so that a formed stool eventually enters the rectum.
The Sigmoid Colon
The sigmoid colon has the specialized job of contracting vigorously to maintain
a high pressure. This action regulates the movement of stool into the rectum.
And since the sigmoid is a high pressure part of the colon, it is here that most
diverticuli occur.
Diverticulosis
Diverticulosis means that there are pockets or projections extending out from
the colon. These occur 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 within by the contracting
colon. As noted earlier, since the sigmoid colon has the highest pressure in the
colon, it is here that most diverticuli occur. Because of these balloon-like
projections, the sigmoid often becomes thickened and narrowed. When this
happens, significant changes in the bowel function can occur, such as
discomfort, diarrhea, and/or constipation.
Who Gets Diverticulosis?
Since it takes so long to develop, diverticulosis usually appears later in life.
However, it is not uncommon to see this occur in people who are in their 30s.
Eventually the colon, especially the sigmoid colon, becomes studded with these
pockets. The disorder is mostly one of Western society. It is uncommon in rural
Africa and India. The diet in these areas consists of unprocessed foods and
grains with a very high fiber content. So, increased fiber ingestion may have
great benefit.
Symtoms of Diverticulosis
As diverticuli form, few symptoms are noticeable, except perhaps for
intermittent spastic discomfort in the left lower abdomen. Usually, there are no
symptoms at all.
When
diverticulosis is far advanced, the lower colon may become very fixed,
distorted, and even narrowed. When this occurs, there may be thin or
pellet-shaped stools, constipation, and an occasional rush of diarrhea. The
problem then becomes a mechanical or structural one, and treatment is more
difficult.
Complications of Diverticulosis
It is, perhaps, remarkable that so few people have complications of
diverticulosis when compared with the number of people who have the condition.
Still, complications do occur and they can be serious. Diverticulitis is the
most common.
Diverticulitis
Like a balloon, as a diverticulum expands, it develops a thin wall compared
with the rest of the colon. The colon is home to many beneficial bacteria --
helpful as long as they stay in the colon. However, these bacteria can seep
through the thin wall of diverticuli and cause infection. This infection
around diverticuli is called diverticulitis. It can be mild with only slight
discomfort in the left lower abdomen. Or it can be quite extreme with severe
tenderness and fever. Treatment is usually needed for diverticulitis. It
requires antibiotics and resting of the bowel by avoiding food or, at times,
even liquids. For severe cases, the patient must be hospitalized.
Bleeding
At times, bleeding can occur from a ruptured blood vessel in diverticuli. This
may produce a gush of blood from the rectum or, occasionally, darker, mahogony
color stools when the bleeding is from a diverticulum in the right colon.
Perforation
This complication is the most uncommon but the most serious. Bacteria escape
into the abdomen where peritonitis, or an abscess, can develop. Abdominal
surgery usually is required to correct this problem.
Diagnosis
of Diverticulitis
The medical history is the physician's most important tool in diagnosing
diverticulitis. The physical exam may find tenderness present in the left lower
abdomen. A barium enema x-ray usually is required to determine the extent of the
disorder. Flexible sigmoidoscopy and colonoscopy are exams performed through the
rectum with a lighted, flexible endoscope. These exams view the colon from
inside and provide additional information about the problem.
Treatment of Diverticulosis
Diverticulosis may be preventable. As noted, fiber, bran and roughage should be
an important part of the diet. Certain types of fiber, such as wheat bran retain
large quantities of water. This, in turn, provides a bulkier stool. This type of
large, soft stool may help decrease the pressure in the bowel over time. Bulking
agents are available in drug stores and can be effective. The generic names for
some of these products are psyllium and methycellulose.
Bran and fiber can be found in very palatable forms in many cereals, breads
and other foods. Generally, a daily intake of 20 to 30 grams is recommended,
beginning at a young age.
It is known that emotional stress can increase spasms of the colon and,
perhaps, result in the formation of diverticuli. Stress should be controlled and
treated if necessary. Also, medications can be used to decrease spasm in the
colon.
Surgery may be needed to remove the diseased portion of the colon when
diverticulitis occurs at an early age or when there are recurrent episodes. When
surgery is done in a non- emergency situation, a colostomy is usually not
needed.
Summary
Diverticulosis is a disorder that may be preventable if treated early in life.
At any stage, there is usually effective therapy available. Diverticulitis, a
complication of diverticulosis, can be readily diagnosed by the physican and
effective therapy is available. Working with the physician, prevention and
treatment programs can be structured to obtain the best results for the patient.
![[Company Logo Image]](_borders/mgi_logo.jpg){kind=logo}
