| What Is Diverticulitis? |
Nearly half of Americans older than age 60 have small, bulging pouches (diverticula) in their digestive tracts — a condition known as diverticulosis. Although diverticula can form anywhere, including your throat, stomach and small intestine, most occur in your large intestine (colon) — especially on the left side of the colon just above the rectum. Because these pouches seldom cause any problems, you may never know you have them.
Sometimes, however, one or more pouches may become inflamed or infected, causing severe pain, fever and nausea. When diverticula become infected, the condition is called diverticulitis. Mild cases of diverticulitis can be treated with changes in your diet, rest and antibiotics. But more serious cases may require surgery to remove the diseased portion of your colon. Occasionally, you may develop complications that require emergency surgery.
Fortunately, only 15 percent to 20 percent of people with diverticulosis ever develop diverticulitis. Best of all, you can help prevent both types of diverticular disease simply by including more high-fiber foods in your diet.
|
| Signs and Symptoms |
Diverticulitis can feel like appendicitis, except you'll have pain in the lower left side of your abdomen, instead of the lower right. The pain is usually severe and comes on suddenly, but sometimes you may have mild pain that becomes worse over several days, fluctuating in intensity. You may also have abdominal tenderness, fever, nausea, and constipation or diarrhea.
Less common symptoms of diverticulitis may include:
- Vomiting
- Bloating
- Bleeding from your rectum
- Frequent urination
- Difficulty or pain while urinating
|
| Causes |
Diverticula gradually develop when naturally weak places in your colon give way under pressure. This causes marble-sized pouches to protrude through the colon wall. Pouches are most common in your sigmoid and descending colon — the lower portions of your large intestine just above the 10 inches of your rectum — and often occur as a result of straining during bowel movements over a number of years. The pouches are small at first but become larger with time.
Sometimes a bit of stool may become lodged in one of the pouches, leading to infection. A small tear can also develop in a pouch. This can cause an infection within your abdomen (peritonitis). If the infection is limited to the wall of your colon where the diverticula are inflamed, you may develop a collection of pus known as an abscess.
| Risk Factors |
These factors may increase the pressure on the wall of your colon:
- Aging. As you age, the outer muscular wall of your colon thickens, causing the inside
passageway to narrow. The narrowing increases pressure in your colon and makes it more likely pouches
will form. Thickening of the outer wall also makes it more difficult for your colon to move waste
through to your rectum. This means waste stays in your colon longer, becoming harder and dryer and
exerting additional pressure on weak areas.
- Too little fiber. Diverticulitis is rare in countries where people eat a high-fiber diet that helps keep stools soft. But it's common in industrialized nations, such as the United States, where the average diet is high in refined carbohydrates and low in fiber. In fact, diverticular disease emerged after the introduction of steel rolling mills, which greatly reduced the fiber content of flour and other grains. The disease was first observed in the United States in the early 1900s, around the time processed foods became a mainstay of the American diet. Too little fiber contributes to small, hard stools that are difficult to pass, which increases pressure in your colon.
|
| Screening and Diagnosis |
Because diverticula by themselves usually don't cause problems, most people learn they have diverticulosis during routine screening exams for colorectal cancer or during tests for other intestinal problems. Diverticula may show up during colonoscopy — a test in which your doctor examines the entire length of your large intestine using a flexible, lighted tube — during sigmoidoscopy — a diagnostic test in which your doctor examines the lower part of your colon, the sigmoid, with a flexible, lighted tube — or on a colon X-ray.
|
Diverticulitis, on the other hand, is usually diagnosed during an acute attack. Your doctor will likely examine your abdomen for tenderness. You may also have a blood test to check your white blood cell count and an imaging test such as a computerized tomography (CT) scan to help visualize the pouches that are inflamed or infected. A CT scan uses a series of computer-directed X-rays to provide a comprehensive view of your internal organs.
Diverticulitis can range from minor inflammation to a massive infection. Because diverticulitis can be serious, see your doctor right away if you suspect you're having an attack.
| Complications |
In rare cases, an infected or inflamed pouch may rupture, spilling intestinal waste into your abdomen. This can lead to peritonitis — an inflammation of the lining of your abdominal cavity. Peritonitis is a medical emergency and requires immediate care.
Other complications of diverticulitis may include a blockage in your colon or small intestine, an abscess, or a fistula. A fistula is an abnormal passageway that occurs between different parts of your intestine, your intestine and your bladder or vagina, or your intestine and skin. Sometimes fistulas themselves become infected — a condition that can be life-threatening if left untreated.
Although there is no evidence that diverticular disease increases your risk of colon or rectal cancer, it can make cancer more difficult to diagnose. Because of this, your doctor may recommend a colonoscopy after you've recovered from a bout of diverticulitis along with more frequent cancer screening tests.
| Treatment |
In general, your treatment depends on the severity of your symptoms and whether this is your first attack of diverticulitis. If your symptoms are mild, a liquid or low-fiber diet and antibiotics may be all you need. But if you're at risk of complications or have recurrent attacks of diverticulitis, you may need more advanced care.
Home-care
If your condition calls for home treatment, expect to remain quiet for a few days. You'll also temporarily need to avoid all whole grains, fruits and vegetables, so your colon can rest and heal. Once your symptoms improve — often in 2 to 4 days — you can gradually start increasing the amount of high-fiber foods in your diet.
In addition, your doctor will likely prescribe antibiotics to help kill the bacteria causing your infection. Even if you start feeling better, be sure to finish your entire course of medication. Stopping too soon could cause your infection to come back. It also helps create strains of bacteria that are resistant to antibiotics. If you have moderate or severe pain, your doctor may recommend an over-the-counter pain reliever such as acetaminophen (Tylenol, generics) or prescription pain medication.
Hospitalization
About half of all people with diverticulitis require hospitalization and many need intravenous antibiotics. You're more likely to be hospitalized if you have vomiting, a fever above 100 F, a high white blood cell count, or are at risk of complications such as a bowel obstruction or peritonitis. You're also likely to need additional care if you're older, have another disease or a weakened immune system.
Surgery
If you have recurring diverticulitis, your doctor may recommend surgery to remove the diseased part of your colon. There are two types of surgery:
- Primary bowel resection. This is the standard surgery for people with diverticulitis. Your
surgeon will remove the diseased part of your intestine and then reconnect the healthy segments of your
colon (anastomosis). This allows you to have normal bowel movements. Depending on the amount of
inflammation, you may have open or laparoscopic surgery. In open surgery, your surgeon makes one long
incision in your abdomen, while laparoscopic surgery is performed through 3 or 4 tiny incisions. You'll
heal faster and recover more quickly with laparoscopic surgery. Unfortunately, it may not be an option
if you're very overweight or have extensive inflammation.
- Bowel resection with colostomy. This surgery may be necessary if you have so much inflammation in your colon that it's not possible to rejoin your colon and rectum. During a colostomy, your surgeon makes an opening (stoma) in your abdominal wall. Your colon is then connected to the stoma, and waste passes through the opening into a bag. A colostomy may be temporary or permanent. Several months later — once the inflammation has healed — your surgeon may be able to perform a second operation to reconnect your colon and rectum.
| Prevention |
The following measures can help prevent or slow the progression of diverticular disease:
- Eat more fiber. High-fiber foods, such as fresh fruits and vegetables and whole grains,
soften waste material and help it pass more quickly through your colon. This reduces pressure inside
your digestive tract. Aim for 25 to 30 grams of fiber each day. Try to substitute fruits, vegetables
and grain products for foods high in fat. Be sure to add fiber gradually to avoid bloating, abdominal
discomfort and gas. If you have a hard time consuming 25 to 30 grams of fiber every day, consider using
a fiber supplement such as psyllium (Metamucil, Perdiem) or methylcellulose (Citrucel, Cologel).
- Drink plenty of fluids. Fiber works by absorbing water and increasing the soft, bulky waste
in your colon. But if you don't drink enough liquid to replace what's absorbed, fiber can be
constipating. Try to drink at least eight 8-ounce glasses of water or other beverages that don't
contain caffeine or alcohol every day.
- Respond to bowel urges. When you need to use the bathroom, don't delay. Delaying bowel
movements leads to harder stools that require more force to pass and increased pressure within your
colon.
- Exercise regularly. Exercise promotes normal bowel function and reduces pressure inside your colon. Try to exercise for at least 30 minutes on most days.
|
— September 19, 2001 —
|