Diverticulosis & Diverticulitis
A Complete Overview
Diverticulosis is the term used to describe the presence of diverticula in the colon. Diverticula are saclike external protrusions that are formed in areas of greatest weakness of the intestinal wall. The intestinal wall of the colon is thinner in places where nerves and blood vessels pass through it. Then, when there is an increased pressure inside the colon, diverticula are usually formed.
Because the intestinal wall becomes more fragile with age, diverticulosis is more common in older people. Approximately 10% of Americans over age 40 have diverticulosis and almost a half of those over 60 years old.
Diverticula may become inflamed and infected, especially if there are strong contractions of the colon and by this way, the diverticula are filled with feces and then become infected. Infection and inflammation of the diverticula are called diverticulitis. Approximately, 10 to 25% of people who suffer from diverticulosis develop diverticulitis at least once in their lives. Diverticulosis and diverticulitis together is called diverticular disease.
Symptoms Of Diverticular Disease
Diverticulosis usually does not cause symptoms. Many people with this disease have constipation. In fact, it is thought that treatment of constipation prevents diverticulitis. If symptoms are present, they include:
These symptoms may also occur in other gastrointestinal diseases such as irritable bowel syndrome (IBS) therefore, you should always consult a doctor, who will make a correct diagnosis.
Symptoms of diverticulitis may include:
- Abdominal pain
- Constipation or diarrhea
Symptoms vary in intensity according to the spread of infection and the presence or absence of other complications.
Inflamed and infected diverticula can dump its contents into the lumen and cause more severe complications such as;
Bleeding is a rare complication of diverticulitis. It is usually caused by a ruptured blood vessel passing through the inflamed diverticulum. Blood can be seen in the stool and usually stops by itself without treatment. However, it is always important to consult a doctor. Faced with heavy bleeding may require surgery as a treatment.
Complications: Abscess, Perforation And Peritonitis
Infection in the diverticula usually subsides with antibiotic treatment for seven days. However, if the condition worsens an abscess can develop. This is formed by bacteria that infect other areas with pus formation and tissue destruction. Infected diverticula usually cause bowel perforations. These perforations facilitate the formation of abscess. According to the size of the lesions, abscesses can remain with antibiotic treatment.
Otherwise, the doctor will need to drain them. In this case, draining is performed by percutaneous catheter drainage. The doctor inserts a needle through the skin and drain pus from the abscess. If this is not possible, doctor will indicate a surgery or removal of the affected colon.
If the abscess is not treated, it may be that the pus-forming bacteria invade other parts of the intestine or other organs, causing abdominal infection and inflammation called peritonitis. Peritonitis is a complication of diverticulitis that consists of the infection of the peritoneum that covers the abdominal cavity. In this case, surgery is needed urgently as it can be fatal if is not treated early.
Fistula is another complication of diverticulitis. It constitutes an abnormal connection between two organs or between an organ and the skin. If an organ’s infection is connecting with another organ or with the skin, the infection spreads and the fistula is formed. Then the colonic content takes place in another organ. The most common fistulas are formed from the colon to the bladder, small intestine and skin. Fistula that is formed between the colon and bladder occurs more in men than in women. The main consequence is the development of urinary infections. Fistulas are closed through a surgery that removes the affected organ.
Complications: Intestinal Obstruction
Intestinal obstruction is another complication that can occur in patients with diverticulitis. When infection is cured, the affected part of the colon heals. Scarring causes narrowing (stenosis) of the intestinal lumen. If this process is repeated, there may be a bowel obstruction, which is the difficulty or impossibility of passage of intestinal contents with the bowel movements. Obstructions are always resolved through surgery, and if it is total, surgery is urgent.
Causes Of Diverticular Disease
There is no definite and proved cause of diverticulosis. However, a low-fiber diet contributes to its development because it reduces the volume of stool and increases its consistency. Thus, the pressure increases within the intestine and when a peristaltic wave which propels the stool forward, the areas in which the intestinal wall is weaker may herniate into small “bags” which are the pouches.
In addition, diverticular disease has been diagnosed since processed foods were introduced into the diet in early 1900. Processed foods are low in fiber and water. The most typical example is the refined flour.
Diverticulosis is more common in Western countries due to low-fiber diet and high consumption of processed food. In the eastern countries, the amount of fiber consumed is higher and for this reason the prevalence of diverticulosis is less common.
Fiber is the indigestible portion of plant foods like fruits, vegetables and grains. There are two types of fiber:
- Soluble: is dissolved easily in water and when ingested forms a gel in the gastrointestinal tract. This type of fiber allows simple sugars in foods to be slowly absorb. In addition, it sets the dietary cholesterol and facilitates its elimination in the stools. For these reasons, it is recommended as a diabetes and high-cholesterol treatment.
- Insoluble: is not soluble in water and passes unchanged through the gastrointestinal tract. It favors the formation of stools, increasing its volume and diminishes its consistency. Insoluble fiber stimulates contractions of the colon and prevents constipation. Constipation favors the development of diverticulosis because of increased intraluminal pressure in the colon.
Diverticula may become inflamed and infected when it filled with fecal matter. This creates a favorable environment for bacterial colonization. Bacteria thrive and infect the diverticula.
Diagnosis Of Diverticular Disease
Most of the time diagnosis of diverticulosis is done through an incidental finding in people with no symptoms. In symptomatic patients, the doctor will perform an exhaustive anamnesis and physical examination. The doctor will also order some diagnostic tests. The health history is a questioning about bowel habits, diet and medication you take.
Moreover, the doctor will ask about other symptoms such as pain, bloating, cramps, among others. Physical examination includes abdominal palpation and rectal examination, which is the introduction of the doctor’s fingers into the anus to detect obstructions or other abnormalities. Further tests performed to confirm the diagnosis of diverticulosis are stool examination and blood test. The doctor may also order X-rays.
Treatment Of Diverticular Disease
Diverticulosis is treated through a high-fiber diet (25-30 grams per day) and medication to relieve symptoms. If an acute attack of diverticulitis occurs, you may require hospitalization and surgery if there is any complication.
The rise in the amount of fiber and water in the diet increases the intestinal transit time improving constipation and decreasing the risk of diverticulosis. This results in a reduction in pressure inside the colon with the passage of stool more easily. Water intake is important to keep intestines and colon hydrated because that is where the greater absorption of water and mineral salts occur.
To achieve the recommended 25-30 grams of fiber per day is important to eat whole grains and flours, add wheat bran or oatmeal to fruit juices, soups and purees, eating whole bread and grains, and finally, consume at least 5 servings of fruits and vegetables per day, especially those with higher fiber content.
Foods That Contain More Fiber Are:
- Fruits: apple, peach, pear, tangerine.
- Vegetables: asparagus, broccoli, Brussels sprouts, cabbage, carrot, cauliflower, romaine lettuce, spinach, summer squash, tomato, and winter squash.
- Starchy Vegetables: baked beans, kidney beans, lima beans and potato.
- Grains: whole-wheat bread, brown rice, cereal, oatmeal, white rice.
Your doctor or dietitian will prescribe the adequate diet for diverticulosis and will also advise you to incorporate a dietary supplement rich in fiber as Citrucel or Metamucil. These nutraceutical products are concentrated in fiber (2 to 3.5 grams per tablespoon) without chemicals or additives. They should be ingested in small amounts accompanied by a glass of water. Proper diet for diverticulosis must exclude some foods that contain seeds that may fall within the diverticula and promote inflammation and infection (diverticulitis). These foods are tomatoes, zucchini, cucumbers, strawberries, and raspberries, as well as poppy seeds. However, this measure has no scientific support.
It is recommended to eat high-fiber foods because it is proven that they improve constipation often experienced by patients with diverticulosis, and because it helps keep the colon empty. According to individual tolerance of each person, the nutritionist will adapt the diet. Patients can keep a journal of what they consume in a day in order to identify possible intolerances.
If the patient with diverticulosis has symptoms such as cramping, abdominal pain, bloating and constipation, the doctor may prescribe a medication such as antispasmodics, but due to side effects that they can cause, they may be avoided in order to improve symptoms with diet.
Treatment for diverticulitis focuses on eliminating inflammation and infection to rest the digestive system and prevent complications. To achieve this, antibiotics are prescribed for seven days or so and given a liquid diet to prevent digestive work. Most patients are treated well and recover without complications in seven to ten days. A low proportion of patients with diverticulitis, develop complications and may require surgery.
When Is Surgery Necessary?
Surgery is an indication in patients with diverticulitis who do not respond to antibiotic therapy or who have complications such as fistula, perforation, intestinal obstruction. The surgeon performs a surgery that removes the affected area and connects the healthy parts of the colon. This surgery is called colon resection. In some cases, surgery may be an emergency.
The reasons for emergency surgery in patients with diverticulitis include:
- Large abscess
- Continuous bleeding
Surgery involves two operations. One is done to remove the infected colon placing a “stoma” (colostomy). The colostomy bag allows the patient to move the bowel and to eliminate stool. The bag is placed on a temporary basis as it is not safe to join the two parts of the colon during the first operation. In the second surgery, the doctor connects the healthy parts of the colon and removes the colostomy bag. During postoperative period, intolerance and malabsorption of nutrients with diarrhea may occur. Therefore, it is important that the nutritionist provide for an adequate diet.
Long Distance Telephone Appointments
If you are not local to the clinic, Michelle Honda PhD Holistic Doctor can conduct telephone appointments with you very easily. So if you are anywhere in North America, you can now successfully receive high end, specialized help for your Crohn’s disease or ulcerative colitis. If you are local to the clinic in Hamilton, Toronto or Mississauga Ontario – by all means come in for your appointment. If not, telephone appointments are very popular and convenient.