A diverticulum is a sac-like bulge in the wall of the colon, the section of the large intestine that extends from the small intestine to the rectum. In rare instances, diverticula are present at birth, but usually they form later in life. Most diverticula occur in the sigmoid colon, the curved part of the large intestine closest to the rectum.
Diverticulosis is the presence of many diverticula along the bowel wall; this occurs more commonly as people get older and in countries where the diet is generally low in fiber. Data from indicate that more than 50% of adults over the age of 60 have diverticula.
Diverticulitis occurs when one or more diverticula become inflamed; this inflammation may be local, confined to the area of the diverticulum, or may become more widespread to include the abdominal lining (peritoneum), called peritonitis. Small (microscopic) or large perforations (holes in the bowel wall) occur in 15% to 20% of persons who have diverticula.
Signs and SymptomsOften diverticula cause no symptoms, although a person may experience some irregularities in bowel habits. If symptoms do appear, they may include the following:
- Abdominal pain, especially pain low on the left side of the abdomen after a meal
- Either painless rectal bleeding or passing of blood in stool may occur
- Irregular bowel movements including constipation or diarrhea
Some people develop peritonitis, an inflammation of the lining of the abdomen. Symptoms of peritonitis may include sudden abdominal pain, muscle spasms, guarding (involuntary contraction of muscles to protect the affected area), and possibly sepsis, the term for an infection that has spread to the blood.
What Causes It?The cause of diverticular disease is not certain, but several factors may contribute to changes in the wall of the colon. These include aging, the movement of waste through the colon, changes in intestinal pressure, a low-fiber diet, and anatomic defects.
Who's Most At Risk?These factors increase the risk for developing diverticular disease:
- Low-fiber diet
- Advanced age
- Male gender, for diverticulitis
- High fat intake
- Lack of regular physical activity
What to Expect at Your Provider's OfficeYour healthcare provider will examine your abdomen for tenderness, swelling, and guarding and may try to detect any unusual mass around the intestines. He or she may also take your temperature and test your blood, urine, and stool for signs of infection or blood. Computed tomography, a barium enema, ultrasound, and other imaging techniques may help locate diverticula and any inflammation, fistulae, abscesses, or other abnormalities. In some cases, providers may perform a colonoscopy, in which an endoscope (a thin, lighted tube equipped with a camera) is inserted through the anus and rectum and into the colon. This procedure helps to locate diverticula, detect the presence of any polyps, and determine the source of bloody stools.
PreventionTo help prevent diverticular disease:
- Eat a high-fiber diet (15 g of fiber per day). This helps stools move through the intestines and helps maintain proper pressure in the colon.
- If you have diverticula, avoid foods such as seeds that may block the opening of a diverticulum and lead to inflammation.
- Exercise regularly to decrease the occurrence of symptoms.
Treatment PlanFor mild symptoms, healthcare providers may recommend a clear liquid diet and prescribe antibiotics. More serious cases may require hospitalization, intravenous feeding to rest the bowel, and intravenous antibiotics. Eating a high-fiber diet and taking psyllium supplements may help following an acute episode. Within six weeks, a colonoscopy or barium enema may be performed to check the condition of your intestines.
For repeated attacks, a provider may recommend surgery. Those who are younger than age 40, who have severe complications, or whose condition becomes worse within a day or two of an attack may need surgery right away.
Drug TherapiesA healthcare provider may prescribe antibiotics to fight infection, anticholinergics to relieve cramping, and analgesics to relieve pain.
Surgical and Other ProceduresIf the condition is severe or leads to complications, or if attacks recur, a healthcare provider may recommend one of the following procedures:
- Colonoscopy with electrocoagulation. Electrocoagulation involves applying electric current to an area to stop bleeding. This may be necessary if problems with the structure of any arteries or veins contribute to the condition.
- Sigmoidectomy, or removal of the sigmoid colon. Unless there are complications, a surgeon can perform this operation laparoscopically (through small incisions, using an endoscope).
- Hartman's procedure. In an emergency, this procedure may be used to detach the sigmoid colon from the rectum, close the rectum, and reconnect the sigmoid colon directly to an opening created on the surface of the body. This procedure reduces the risk of sepsis (infection of the blood) and death. The procedure is reversed in a second operation within six months.
- Angiography. This procedure may be used to inject medication directly into the arteries to control bleeding.
Complementary and Alternative TherapiesNutrition plays an important role in preventing and treating gastrointestinal disease, especially diverticulosis. Specific dietary factors have been linked to the incidence of diverticular disease and may help minimize attacks and improve treatment results.
- Population based studies suggest that eating a high-fiber diet helps prevent diverticular disease and other gastrointestinal disorders. A review of such studies reports that vegetarians are less likely to have diverticular disease, most likely because they tend to eat more fiber.
- In another study where participants completed interviews and food questionnaires, the following foods were associated with a decreased likelihood of having diverticular disease: cucumber, lettuce, spinach, and brown bread. Beef and lamb were associated with an increased risk of having diverticular disease. The authors concluded that eating more fiber and eating less red meat (particularly beef and lamb) and fewer milk products may help reduce risk.
While specific nutrients that may have an impact on diverticular disease have not been studied as thoroughly as the high-fiber diet, glutamine supplements, which are thought to confer some degree of protection to the wall of the colon, may prove beneficial.
Omega-3 Essential Fatty Acids
Omega-3 essential fatty acids found in flax and cold water fish help fight inflammation. (On the other hand, omega-6 fatty acids, found in meats and dairy products, tend to increase inflammation.) For a condition such as diverticulitis, it may be wise to eat a diet rich in omega-3 fatty acids. This type of diet may also help prevent colon cancer.
Many herbs are used for the general beneficial effects of their fiber content, specifically:
- Psyllium seed (Plantago ovata)—recommended by the World Health Organization to relieve constipation related to diverticulitis.
- Flaxseed (Linum usitatissimum)—may be helpful in treating diverticulosis. It works as a bulk-forming laxative, softening stool and speeding transit time through the intestine. It also includes high levels of essential fatty acids.
There are case reports of individuals with gastrointestinal disorders, including diverticular disease, who have been treated successfully with homeopathy. There have not been enough scientific studies to date, however, to confirm these reports. An experienced homeopath considers each individual case and may recommend one of the following treatments to address particular symptoms:
- Belladonna—used for abdominal pain and cramping that comes on suddenly and feels better with firm pressure; particularly helpful if constipation accompanies the pain
- Bryonia—used for abdominal pain that worsens with movement and is relieved by heat; particularly useful if vomiting and/or constipation with dry, hard stools accompanies the pain
- Colocynthis—used for sharp, cramping abdominal pains that improve with pressure; particularly useful if pain is accompanied by restlessness and diarrhea
Following UpIf you develop a fever, tenderness in the abdomen, or bleeding from the rectum or in the stool, you should alert your healthcare provider right away. For fever higher than 101°F, worsening symptoms, signs of peritonitis, or increased white blood cell count found in laboratory tests, hospitalization will be considered and even encouraged by your healthcare provider.
Prognosis/Possible ComplicationsAbout one-third of those who develop diverticulitis have a second episode, and of this group, half generally have a third attack. Twenty percent of patients develop complications after the first attack, 60% after a second attack. Complications may include:
- An abscess (pocket of pus)
- Blocked intestine
- A perforation (hole) in the intestine leading to peritonitis, sepsis, and even shock
- Fistulas, which may also lead to sepsis
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