Important Things To Know
About Diverticulitis
Diverticula is pouch or sac in the lining of the mucous membrane of the intestinal wall. They are a herniation of the intestinal mucosa at points where blood vessels pass through the submucosa (intestinal wall areas with less resistance). Diverticular disease is a consequence of a low-fiber diet typically of the Western hemisphere.
Symptoms of Diverticulitis
Diverticulosis is an asymptomatic disease. 80% of patients are diagnosed by incidental findings and the remaining 20% develop signs and symptoms. The most common symptoms of diverticulosis are;
- Abdominal pain in lower quadrants (usually left) that gets worse after eating and is often relieved by bowel movement or removal of gas
- Bloating
- Feeling of incomplete defecation
- Additional symptoms of diverticulitis include;
- Pain in lower left quadrant
- Diarrhea or constipation
- Gastrointestinal hemorrhage
- Leukocytosis
Diverticular disease can lead to;
- Abscesses
- Fistulas
- Peritonitis
- Perforation
In most cases with some of these complications, surgery is not required and patients respond well to treatment with antibiotics.
Of the total people with diverticular disease who develop symptoms, 10 to 20% progress to diverticulitis. Diverticulitis is inflammation and infection of the diverticula. Diverticula can be filled with fecal matter, which accumulates until there is an infection of the diverticulum. This condition is called diverticulitis.
Diagnosis of Diverticulitis
Diagnosis of diverticular disease is made by barium enema and endoscopy. This test can show the inside of colon and detect small lesions and abnormalities in the mucosa. These tests help determine whether symptoms are caused by diverticular disease or have other causes. In the case of patients with any of the above complications, further tests are usually performed to detect leukocytosis (increase in white blood cells by infection) and confirm the disease.
Treatment of Diverticulitis
In the case of patients with diverticular disease without severe symptoms, a diet of high fiber is given and a laxative such as psyllium. Wheat bran can be added to soups, fruit juices and purees. Fluid intake should be increased to 2 liters per day in order to avoid constipation. In case of inflammation (diverticulitis), a soft diet and a dose of antibiotics are indicated. About 70-90% of patients recover well.
Treatment at the hospital is indicated if the patient shows signs of peritoneal inflammation or infection and fever. In this case, the liquid diet treatment consists of intravenous serum and antibiotics. The 10 to 15% of patients with diverticulosis usually end up having surgery. Surgical treatment of diverticular disease is indicated in case of perforation, abscess with poor response to medical treatment, obstruction, fistulas or gastrointestinal bleeding.
Patients treated electively by surgery usually have the diseased area removed without a temporary colostomy. It is very rare for a patient to need a permanent colostomy. Bowel function and general health return to normal after operation and recurrence of symptomatic diverticular disease or complications are rare.
While diverticula usually do not shrink or disappear, most patients have no symptoms or have symptoms of mild intensity which are controlled with medication.
Incidence of Diverticulitis
Diverticulitis does not usually occur before the age of 30. Diverticular disease presents a clear prevalence with age; 5-10% of cases occur in people over 45 years and 80% in older than 85 years, perhaps due to the gradual decrease in tensile strength of the intestinal mucosa. Women are more likely to develop the disease than men.
Pathology of Diverticulitis
Diverticular disease is developed for two reasons:
- Weakness of the intestinal wall: the places that are weak points where it is more easily herniated, nerves and blood vessels protrude through the muscle of the intestinal wall.
- Increased pressure inside the colon: exaggerated contractions of the colon together with a diet low in fiber produce an increase in intraluminal pressure.
Long Distance Telephone Appointments
If you are not local to the clinic, Michelle 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.
