Introduction to Diverticulosis and Diverticulitis1
Diverticular disease is a consequence of past constipation. By managing the fiber content of your diet, you and your doctor can greatly improve the condition. The starting point is to understand the disease so that you can better communicate with your doctor and manage your diet more effectively.
What is diverticulosis?
A diverticulum is a small pocket or pouch bulging outwards from the wall of the intestine. Diverticulosis is the condition of having one or more diverticula.
Diverticula may occur anywhere in the gastrointestinal tract. They usually occur, however, in a lower part of the colon (large intestine), descending colon, sigmoid and rectum.
Diverticulosis affects about one-third of people over 50 and two-thirds of people over 80.
What is Diverticulitis?
Diverticulitis is inflammation of diverticula, small pockets of tissue, bulging outwards from the walls of the lower part of the colon (large intestine), descending colon, sigmoid and rectum. .
Causes of Diverticulosis and Diverticulitis
The most significant cause of diverticulosis is a low-fiber diet causing frequent constipation and increasing pressure in the colon. The increased pressure makes weak spots bulge and form pouches called diverticula.
Fermentation of organic food particles caught in diverticula cavities can lead to infection and inflammation of the diverticula.
Signs and Symptoms
In most cases, no symptoms develop. In fewer cases, mild abdominal pain, bloating or gas occurs. IBS (Irritable bowel syndrome), acute appendicitis, ulcerative colitis, Crohn's colitis or, in some cases, bowel cancer can have similar signs and symptoms.
Diverticulosis Symptoms
Often, there are no symptoms of diverticulosis. The noticeable diverticulosis symptoms can include:
- Mild cramps
- Bloating
- Constipation
- Thin or pellet-like stools
Some of these symptoms can be caused by other conditions such as irritable bowel syndrome (IBS) and stomach ulcers.
Diverticulitis Symptoms
- Abdominal Pain
- Tenderness in lower left side of abdomen
Infected diverticula can also cause:
Risk Factors
Pressure within the colon due to insufficient dietary fiber is the main factor leading to diverticulosis and resulting diverticulitis.
Complications of Diverticulosis and Diverticulitis
Most people with diverticulosis will not suffer diverticulitis if they correct their diet.
Diverticulitis can lead to complications such as infections, perforations or tears, blockages, or bleeding. These complications always require treatment to prevent them from progressing and causing serious illness.
Bleeding
In rare cases, a small blood vessel in one or diverticula can burst causing bleeding from the anus that may appear in the stools. If this occurs, you should see your doctor. Continued bleeding can indicate the need for surgery.
The infection causing diverticulitis usually clears up after a few days' treatment with antibiotics. If the condition worsens, an abscess may form in the colon.
An abscess is an infected area swelling with puss. The abscess can cause tissue damage. Any resulting perforations of the colon wall can leak puss into the abdominal cavity.
Infection spreading to the abdominal cavity (peritonitis)2 needs immediate surgery. Without surgery, peritonitis can be fatal.
Further use of antibiotics will usually cause the swelling to decrease. If the abscess does not clear up, a doctor will need to drain the puss from the abscess using a catheter (needle and small tube). Surgery might be necessary to clean the abscess and to remove part of the colon.
Ruptured diverticulum3
An infected diverticulum could rupture, allowing fluid from the colon to enter the abdominal cavity, requiring immediate surgery. Without surgery, the condition is fatal. See the paragraph on abscess above.
Fistula
A fistula is an abnormal tissue between two organs or between an organ and the skin. Damaged and infected tissues in contact with each other can remain stuck together and form a fistula as they heal. The fistula can allow unwanted passing of fluids and infection from one organ to another.
The most common type of fistula connects the bladder and the colon, affecting men more often than women. A fistula can cause lasting infection of the urinary tract, but surgery can remove the fistula.
Intestinal obstruction4
Infection can cause scouring and resulting blockage. If you experience blockage, you must consult a doctor to plan for surgery.
When to See a Doctor
If you experience any of the symptoms of diverticulosis or diverticulitis given earlier, seek medical advice to prevent worsening of the condition. If you suffer abdominal pain for more than four consecutive days, see your doctor immediately. In addition, see your doctor urgently if you have any of the following symptoms: fever, chills, vomiting, rigid or swelling abdomen, blood in the stools, persistent abdominal pain, pain following treatment or pain from moving. Your doctor may suggest immediate hospital treatment, and, possible preparation for surgery.5
Screening and Diagnosis
Various tests aid diagnosis. Two such tests are the barium enema ex-ray and the CT scan of the lower abdomen. Colonoscopy generally is the most useful method for ruling out cancer of the colon. The CT scan can help determine if diverticulitis has perforated the colon wall and formed an abscess.
Treatment
The treatment for diverticulosis is a high-fiber diet.6 Most doctors recommend that 20 to 35 grams of fiber per day are necessary for a healthy diet. This normally is sufficient to avoid diverticulosis, to prevent it worsening and to prevent the development of diverticulitis. Fiber foods include fresh fruits, vegetables, beans, other legumes and bran.
Diverticulitis treatment will depend on the frequency of attacks and the corresponding signs and symptoms. Rest, changing temporarily to a low fiber or liquid diet and antibiotics are usually sufficient to eliminate diverticulitis symptoms. In some instances, however, complications may require urgent surgery.
Prevention
Although your doctor may prescribe a low fiber diet until a diverticulitis attack subsides, the best diverticulitis prevention is a high-fiber diet when permitted by your doctor.
Try to:
- Maintain an intake of 20 to 35 gm of fiber a day.
- Drink at least 8 to 10 glasses of water daily (Fiber absorbs a lot of water from the intestines.).
- Go to the bathroom when having the urge to go (Do not try to force out the stools).
- Exercise regularly.
These steps will help to prevent constipation and attacks of diverticulitis.
To avoid excessive flatulence, you might wish to adjust gradually to the high-fiber diet.
Important: Tell your doctor if you are taking or intend to take any herbal products1 and follow your doctor’s recommendations2. Read the instructions on the package and be advised by your doctor regarding dosage.
Consult your doctor concerning:
- Allergies
- Possible interactions with medications
- Pregnancy and breast feeding
- Pharmaceutical alternatives
"The U.S. Food and Drug Administration does not strictly regulate herbs and supplements. There is no guarantee of strength, purity or safety of products, and effects may vary. You should always read product labels. If you have a medical condition, or are taking other drugs, herbs, or supplements, you should speak with a qualified healthcare provider before starting a new therapy. Consult a healthcare provider immediately if you experience side effects."
Psyllium (Plantago ovata)
Psyllium provides an easy way to increase your dietary fiber intake. Seed husks of psyllium are rich in mucilage. Read the instructions on the container and follow your doctor's advice.
Peppermint (Mentha piperita)
The menthol in this herb has antispasmodic properties and cools inflammation.
Cat's Claw (Uncaria tomentosa)
Many use cat's claw to treat a wide range of intestinal disorders including diverticulitis. Do not use during pregnancy or when breast-feeding. Cat's claw could reduce blood pressure and fertility.
Wild Yam (Dioscorea villosa)
Wild yam is thought by many to have antispasmodic and anti-inflammatory properties. Consult your doctor before using wild yam if you are pregnant, breast-feeding, suffer from liver disease or any type of cancer or diabetes.
1. The National Digestive Diseases Information Clearinghouse (NDDIC).December 2, 2003. Refer, also, to Sarin S, Boulos PB. Long-term outcome of patients presenting with acute complications of diverticular disease. Annals of the Royal College of Surgeons of England. 1994; 76: 117-120. [RETURN]
2. Zeitoun G, Laurent A, Rouffet F, et al. Multicentre, randomized clinical of primary versus secondary sigmoid resection in generalised peritonitis complicating sigmoid diverticulitis. British Journal of Surgery. 2000; 87: 1366-1374. [RETURN]
3. Kronborg O. Treatment of perforated sigmoid diverticulitis: a prospective randomized trial. British Journal of Surgery. 1993; 80: 505-507. [RETURN]
4. Haglund U, Hellberg R, Johnsen C, et al. Complicated diverticular disease of the sigmoid colon: an analysis of short and long term outcome in 392 patients. Annales Chirurgiae et Gynaecologiae. 1979; 68: 41-46. [RETURN]
5. Larson DM, Masters SS, Spiro HM. Medical and surgical therapy in diverticular disease: a comparative study. Gastroenterology. 1976; 71: 734-737. Refer, also, to Farthmann EH, Ruckauer KD, Haring RU. Evidence-based surgery: diverticulitis - a surgical disease? Langenbeck's Archives of Surgery. 2000; 385: 143-151. [RETURN]
6. Wolever TM, Jenkins DJ. What is a high-fiber diet? Adv Exp Med Biol. 1997,427: 35-42. [RETURN]
Bibliography
British National Formulary. Bulk-forming laxatives. September 2006. BNF 52. Section 1.6.1. Also available at http://bnf.org (accessed on 12 December 2006)
British National Formulary. Osmotic laxatives. September 2006. BNF 52. Section 1.6.4. Also available at http://bnf.org (accessed on 26 May 2006).
Hodgson WJ. The placebo effect: is it important in diverticular disease? Journal of Gastroenterology 1977; 67: 157-162.
Kellum JM, Sugarman HJ, Coppa GF, et al. Randomized, prospective comparison of cefotoxin and gentamicin-clindamycin in the treatment of acute colonic diverticulitis. Clinical Therapeutics. 1992; 14: 376-384.
Latella G, Pimpo MT, Sottili S, et al. Rifaximin improves symptoms of acquired uncomplicated diverticular disease of the colon. International Journal of Colorectal Diseases. 2003; 18: 55-62.
National Cancer Institute. Action Guide for Healthy Eating. http://rex.nci.nih.gov/NCI_Pub_Interface/ActionGd_Web/Actiongd.html. Accessed September 6, 199
National Heart Lung and Blood Institute. Step by step: Eating to Lower your High Blood Cholesterol. NIH Pub No. 94-2920.
Ornstein MH, Littlewood ER, Baird IM, et al. Are fiber supplements really necessary in diverticular disease of the colon? A controlled clinical trial. BMJ. 1981; 282: 1353-1356.
Papi C, Ciaco A, Koch M, et al. Efficacy of rifaximin in the treatment of symptomatic diverticular disease of the colon: a multicentre double-blind, placebo-controlled trial. Alimentary Pharmacology and Therapeutics. 1995; 9: 33-
39.
Smits BJ, Whitehead AM, Prescott P. Lactulose in the treatment of symptomatic diverticular disease; a comparative study with high-fiber diet. British Journal of Clinical Practice. 1990; 44: 314-318.
Trespi E, Colla C, Panizza P, et al. Therapeutic and prophylactic role of mesalazine (5-ASA) in symptomatic diverticular disease of the colon: 4-year follow-up results. Minerva Gastroenterologica e Dietologica 1999; 45: 245-252.
Links
www.nlm.nih.gov/medlineplus/druginfo/natural/
Diverticulitis (Diverticulosis) Symptoms and Treatment Information at MedicineNet.com
http://www.medicinenet.com/diverticulosis/article.htm
Diverticulosis and Diverticulitis
http://www.emedicinehealth.com/diverticulosis_and_diverticulitis/article_em.htm
Diverticulitis-Treatment Overview
http://www.webmd.com/digestive-disorders/tc/diverticulitis-treatment-overview
Diverticular Disease: Diagnosis and Treatment - October 1, 2005 - American Family Physician
http://www.aafp.org/afp/20051001/1229.html
Diverticulitis: Treatment - MayoClinic.com
http://www.mayoclinic.com/health/diverticulitis/DS00070/DSECTION=7
Abdomen: The space between the chest and pelvis containing the stomach, appendix, colon, rectum, kidneys, bladder gallbladder, spleen, liver and pancreas. [RETURN]
Abscess: An accumulation of puss. [RETURN]
Anus: The end of the rectum opening outside the body. [RETURN]
Colon: The part of the large intestine extending from the cecum to the rectum. [RETURN]
Constipation: Infrequent and often incomplete bowel movements characterized by dry or hard fecal matter. [RETURN]
Diarrhea: The opposite of constipation. Unusually frequent or liquid bowel movements. [RETURN]
Diverticula: Plural of diverticulum. Small pockets of tissue bulging outwards from the walls of the sigmoid colon, mostly towards the end near the anus. Caused with aging by pressure within the colon.[RETURN]
Diverticulitis: Inflammation of diverticula, small pockets of tissue, bulging outwards from the walls of the colon. [RETURN]
Diverticulosis: Condition of having small pockets of tissue called diverticula bulging outwards from the walls of the sigmoid colon. [RETURN]
Fistula: An abnormal connection between two parts inside of the body. [RETURN]
IBS (irritable bowel syndrome): Abnormal intestinal contractions (motility) involving abdominal pain, mucous in stools, bloating and alternating constipation and diarrhea. [RETURN]
Inflammation: A type of nonspecific immune response by the body reacting to infection, irritation or injury. Characterized by redness, swelling and pain. [RETURN]
Nausea: The urge to vomit. [RETURN]
Peptic ulcer: Corrosion of the lining of the stomach, duodenum, or esophagus by stomach digestive acids. [RETURN]
Peritonitis: Inflammation of the cells lining the inner walls of the abdomen and pelvis. [RETURN]
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The information in this web site is not personal medical advice or instruction. Take no action solely on the contents of this web site. Consult appropriate health professionals on any matter relating to your health and well-being. We believe the information and opinions provided here are accurate and sound, based on the best judgement available to the authors, but readers who fail to consult appropriate health authorities assume the risk of any injuries. The publisher and the authors are not responsible for errors or omissions. [RETURN]Copyright © 2008 Stratford Publishing Ltd