Diverticular Disease
Diverticula are small pouches in the lining of the colon, or large intestine. Although they are found most often in the left side of the colon, diverticula can be found in nearly all parts of the digestive tract.
The reason diverticula form in the wall of the colon is not completely understood. However, it is believed that the high pressures inside the colon push against weak spots in the colon wall. A diet with adequate fluid and fiber produce bulky stools which are easily moved down the gastrointestinal tract. If a diet is low in fluids and fiber, the colon needs to work extra hard to push its contents along, thus exerting more pressure. This high pressure within the colon is believed to be responsible for the development of diverticula. It is in weak spots in the colon, where the blood vessels traverse the muscle layer, that diverticula develop. Uncoordinated movements of the colon may also play a part in the development of diverticula.
Diverticulitis develops when faeces become trapped in these diverticula pouches, allowing bacteria to grow and cause an infection or inflammation. Occasionally this may lead to a small perforation or tear in the wall of the intestine. Peritonitis (the infection of the lining of the abdominal wall - the peritoneum), may develop if infection spills into the abdominal cavity.
What Are The Symptoms & Complications?
Most patients have few or no symptoms, and the presence of diverticula are found incidentally during tests for intestinal problems. The following symptoms are associated with diverticular disease.
• Abdominal cramps, or pain (usually in the lower left side but may occur on the right) diverticular disease
• Constipation or diarrhoea
• Nausea, vomiting or loss of appetite
Diverticular disease may result in the following complications:
• Diverticulitis (infection and inflammation)
• Peritonitis and peritoneal abscesses
• Colon obstruction
• Fistula formation (the inflammed diverticula may erode into the urinary bladder or vagina, and may present with air or faeces in the urine or vagina)
• Bleeding into the colon (occurs when the expanding diverticulum erodes into a blood vessel at the base of a diverticulum)
What Are The Risks For Developing Diverticular Disease?
Diverticular disease is common in the Western world but is rare in areas such as Asia and Africa. Diverticular disease increases with age and is uncommon before the age of forty. You are also at higher risk if you are constipated and eat a low fibre diet. Having a family history of diverticular disease also increases your risk of developing it.
How is Diverticular Disease Diagnosed?
Your doctor will ask you questions about your symptoms, risk factors etc. This is followed by a thorough physical examination of your abdomen. A rectal examination may also be performed. To confirm the diagnosis, some tests may be ordered.
Barium X-rays (barium enemas) are done to visualize the colon. Diverticula are seen as barium filled pouches protruding from the colon wall.
Direct visualization via a sigmoidoscope or a colonoscope may be used to assist in the diagnosis and to exclude other diseases that can mimic diverticular disease.
In patients suspected diverticular disease complicated by abscess formation, ultrasound and CT scan examinations of the abdomen and pelvis can be done to detect collections of pus fluid.
Treatment of Diverticular Disease
Most patients have minimal or no symptoms, and do not require any specific treatment. Although a diet high in fibre is advisable to prevent constipation and potentially prevent further diverticula formation.
Patients with mild symptoms of abdominal pain due to muscular spasm in the area of the diverticula may benefit from anti-spasmodic drugs. If there is suspicion of infection (diverticulitis), then antibiotics will be required. Liquid or low fiber foods are advised during acute attacks of diverticulitis. This is done to reduce the amount of material that passes through the colon, which may aggravate the diverticulitis. If symptoms are mild, oral antibiotics will often suffice. However, if symptoms are more severe, then one may often require hospitalization, with intravenous antibiotics.
Diverticulitis that does not respond to medical therapy requires surgical intervention. Surgery may involve the following:
• Drainage of any collections of pus and resection (surgical removal) of the segment of the colon containing the diverticula.
• Surgical removal of the bleeding diverticula for those with persistent bleeding.
• Sometimes, diverticula can erode into the adjacent urinary bladder (forming a "fistula), causing severe recurrent urine infection and passage of gas during urination. This situation also requires surgical intervention.
• Sometimes surgery to remove the part of colon which contains the diverticula, may be suggested for patients with frequent, recurrent attacks of diverticulitis, with the aim of preventing future recurrences.
The article above is meant to provide general information and does not replace a doctor's consultation.
Please see your doctor for professional advice.