Intestinal Disorders Diverticular Disease

Diverticular disease describes a condition in which weakened areas of the intestine, usually the colon, develop pouches that push through the muscle wall of the intestinal tract. The presence of these pouches, or diverticula, is called diverticulosis. When diverticula become irritated and inflamed, the condition is known as diverticulitis. Both diverticulosis and diverticulitis are classified as diverticular diseases.

Causes of Diverticular Disease

Ten percent of Americans over the age of forty have diverticulosis, a percentage that rises to fifty percent by age 65. The cause of diverticulosis is suspected to be a long-term low fiber diet. Some reports indicate that diverticular disease is rare in Asia and Africa, where high fiber vegetable-based diets are the norm.

Diverticulitis occurs when partially digested food or fecal matter becomes trapped in diverticula causing infection. Approximately ten to 25 percent of diverticulosis cases progress into diverticulitis.

Diverticulosis and Diverticulitis Symptoms

Diverticular disease usually produces symptoms only if diverticulitis is present. Diverticulosis may occasionally cause mild symptoms of bloating, constipation and cramping, but often no symptoms are present.

Symptoms of diverticulitis include moderate to severe abdominal pain, usually located in the lower left abdomen. Localized spasms may occur in severe cases. Other diverticulitis symptoms vary depending on the severity of the inflammation and infection, but can include:

  • fever
  • chills
  • nausea
  • vomiting
  • cramping
  • constipation.

In rare cases diverticulitis symptoms can include rectal bleeding. Blood may be observed in the stool or on toilet paper. Rectal bleeding can indicate a serious medical condition and should always be reported to a medical professional.

Severe Diverticulitis Symptoms

Diverticulitis can create intestinal abscessessacs of infected intestinal material and pus. A diverticulitis abscess can perforate: Holes develop in the abscess and the abscess may rupture into the abdomen. If this occurs, peritonitis, or infection of the abdominal cavity, can result. Peritonitis is a life-threatening condition requiring immediate medical attention, so report any sudden changes in diverticulitis symptoms to your doctor.

Diverticular Disease Complications

Peritonitis is not the only possible complication of diverticular disease. Intestinal obstructions can also develop. Like peritonitis, intestinal obstructions are medical emergencies and are often accompanied by a sudden worsening of diverticular disease symptoms.

Diverticular disease can also cause fistulas, abnormal tracts leading from diverticula to other areas of the body. Diverticular disease fistulas may terminate in a variety of locations, including:

  • abdominal wall
  • small intestine
  • thigh
  • uterus
  • vagina.

Fistulas may become infected and cause abscesses. They often require removal by surgical intervention.

Diverticular Disease Diagnosis

As diverticulosis causes few or no symptoms, diverticular disease is often revealed by diagnostic tests for unrelated conditions. Barium enemas and colonoscopies can sometimes reveal diverticulosis in places where it was not previously suspected.

Diverticulitis symptoms are more likely to suggest a diagnosis of diverticular disease than the often asymptomatic diverticulosis. A diverticulitis diagnosis begins with a medical history, and a gathering of any possible symptoms.

The risk of diverticular disease is highest in the elderly, so age is taken into account during diagnosis. Certain medications such as corticosteroids and immunosuppressants increase the risk of diverticulitis, so provide your doctor with a list of all current medications taken.

A physical examination for diverticular disease will usually involve a digital rectal exam. The doctor inserts a gloved, lubricated finger into the rectum to check for abnormalities.

A physical examination of the abdomen, as well as blood test to evaluate white blood cell counts and CT scans of the abdomen are often used to diagnose diverticular disease. Colonoscopies, sigmoidoscopies, and barium enemas are not used for diagnosis if diverticulitis symptoms are present, as these tests could cause abscesses to rupture.

Diverticular Disease Treatment: The Diverticulosis Diet

As diverticulosis causes few or no symptoms, treatment attempts to prevent diverticular disease from progressing into diverticulitis and to reduce the risk of further diverticula developing. These goals are best accomplished by following a diverticulosis diet.

The diverticulosis diet is a high fiber, high roughage diet designed to prevent constipation and undue colon pressure, which can cause diverticula. A diverticulosis diet may include fiber supplements such as bran and psyllium.

Certain food items are more likely to stick in diverticula than others, irritating existing diverticular disease and possibly triggering diverticulitis. People on a diverticulosis diet should avoid eating:

  • caraway seeds
  • nuts
  • popcorn hulls
  • pumpkin seeds
  • sesame seeds
  • sunflower seeds.

If diverticulosis causes mild abdominal pain, painkillers may be used to relieve symptoms.

Treatment of Diverticulitis Symptoms

Unless diverticulitis symptoms are severe, diverticulitis treatment does not require hospitalization. Rest, a liquid diet and antibiotics are usually sufficient to relieve diverticulitis symptoms and cure infection. Once symptoms subside, the diverticulosis diet can be phased in and the liquid diet phased out.

Serious diverticular disease symptoms requiring hospitalization include severe pain, localized spasms and symptoms of peritonitis or intestinal obstruction. In-patient hospital treatment includes bed rest, intravenous fluids, antibiotics and no food by mouth.

Only twenty percent of hospitalizations require surgical intervention. Large abscesses produced by diverticulitis may have to be surgically drained. Peritonitis requires emergency surgery to clean the abdominal cavity of infected material and remove the portion of the intestine damaged by the abscess rupture.

Severe diverticulitis and intestinal obstructions also require surgery. Known as a colon resection, surgery for severe diverticular disease removes the affected area of the intestine and then rejoins the two sections of intestine.

Resources

Beers, M.H.