For some people with diverticular disease, the pain can seem unbearable. The abdominal cramps, bloated feeling, and alternating bouts of diarrhea and constipation, can become so uncomfortable that you just want to stay home instead of going out to do errands or visit friends. But don't let this medical condition limit you or your everyday activities. Treatment options are available to prevent this disease, or if you already have it, keep it under control.In this article, we will discuss the causes and symptoms of diverticular disease. We also will look at various treatments available, from traditional medicine to alternative cures. Let's get started by reviewing the fundamentals of this medical condition.DefinitionDiverticular disease most often affects the colon. It's two stages are 1) diverticulosis, the abnormal presence of tiny pockets called diverticula, that bulge out from the wall of the colon, and 2) diverticulitis, in which body wastes and bacteria become trapped in the pockets, leaving them inflamed and sometimes pierced with holes. Many people who have the first stage never progress to the second.For diverticulosis, the little pouches or diverticula form when the inner lining of the large intestine is forced, under pressure, through weak spots in the muscular outer layer of the colon. Diverticulosis grows more common with age. Some 10 percent of Americans over age 40 have diverticulosis, and about half of those over age 60 do, too. Diverticulitis occurs when the little pouches become inflammed or infected, which can trigger constipation or diarrhea, gas, abdominal pain, fever, and mucus and blood in the stools. Diverticulitis occurs in 10 to 25 percent of people with diverticulosis.CausesAlthough there is no definitive answer to why the little pouches develop in the first place, many experts believe diverticula form as a result of the increased pressure needed to eliminate the small, hard stools characteristic of a low-fiber diet. The abnormal movement of the colon (possibly because of too little bulk in the diet) produces intense pressure, which forces the intestinal lining through weak spots in the muscular layer.Most people with simple diverticulosis have no discernable symptoms. Occasionally, however, a pouch next to a blood vessel may ulcerate, causing it to bleed. If the vessel is an artery, severe bleeding can result, which can become visible as bleeding from the anus. Shock and even death may result if the condition is not promptly given medical attention.
Diverticulitis is the inflammation of diverticula (small pouches that balloon out from the colon wall when the inner lining is forced through weak spots in the muscular lining). Inflammation often develops when a mass of hardened feces becomes trapped in a diverticulum, reducing the blood supply to the pouch wall and making it more susceptible to infection by bacteria in the colon.It has been estimated that about one-fifth to one-fourth of those who have diverticulosis will suffer from diverticulitis. Diverticulitis develops when a mass of hardened waste matter (called a fecalith) forms in a pouch and reduces the blood supply to the thin walls of the pouch (by means of pressure against the wall), making them more susceptible to infection by the bacteria of the colon. The inflammation that follows can lead to perforation, formation of an abscess (an enclosed sac of pus around the perforation), or peritonitis (infection of the lining of the abdominal cavity).Not infrequently, the inflamed section of bowel becomes attached to the urinary bladder or vagina, burrowing out from the colon to create a fistula (abnormal channel), which leaks infectious material into the other organ. Repeated inflammation can cause thickening of the wall of the colon. This thickening narrows the colon, which in turn may lead to partial or even total obstruction of the colon.SymptomsSymptoms of diverticulitis include intermittent crampy abdominal pains and tenderness, usually on the lower left side of the abdomen. Pain can also occur in other areas of the lower abdomen, sometimes resembling the pain of appendicitis. Pain that worsens during urination may indicate that the inflamed colon has become attached to the bladder. Stool (feces) or air in the urine may indicate a colon-to-bladder fistula. Constipation or constipation alternating with diarrhea is common. Fever is usually present with acute attacks.DiagnosisThe diagnosis of diverticulitis is usually made if there is a history of pain in the left lower section of the abdomen, accompanied by fever and a change in bowel habits. A physical examination may reveal a mass in that area, along with extreme tenderness. After the acute episode has subsided, the doctor may insert a proctosigmoidoscope (a lighted, tubelike instrument) through the anus and into the lower part of the colon to see if there is any evidence of cancer that might be causing the symptoms. X-ray examinations with a contrast medium are usually done to further rule out cancer and to locate diverticula, obstructions, and fistulas.TreatmentIf diverticulosis progresses to diverticulitis, bed rest, pain relievers, and antibiotics for the infection are usually the order of the day. The pain may come on suddenly and mimic appendicitis, although diverticulitis pain usually occurs on the left side, or the pain may build up slowly over a period of days. If you suspect your diverticulosis has progressed to diverticulitis, call your doctor and stick with a liquid or very low-fiber diet.The real danger with diverticulitis is that pouches may rupture and spill bowel contents into the pelvic cavity. This can cause serious bodywide infection. More often, however, the pouches become inflamed without actually rupturing and disrupt your normal bowel function.Occasionally, diverticulitis leads to obstruction, hemorrhage, abscess, or a leak through the bowel wall. These are serious conditions requiring immediate medical and perhaps surgical treatment. (If you have been diagnosed with diverticulosis, be sure you discuss with your doctor what to do in the event of a flare-up and what symptoms signal the need for immediate medical attention.)Treatment of severe diverticulitis begins with bed rest in a hospital and intravenous feeding; no food is given by mouth, to give the intestines a rest. Antibiotics are given if there is evidence of infection. (Less severe cases can be treated at home -- with bed rest, fluids, and antibiotics.) If peritonitis develops, it may be necessary to operate. The inflamed section of the colon may simply be cut out and the remaining sections joined. More often, a temporary colostomy (a surgically created opening in the abdominal wall, which allows the colon to empty to the outside of the body) is necessary. Later, after all inflammation and infection have subsided, the redirected portion of the colon is reconnected to the remaining portion of the colon or to the rectum.PreventionChoosing a diet with plenty of bulk may help prevent diverticulosis. People who have diverticulosis should eat a relatively high-fiber diet. Food supplements, such as psyllium, that serve to increase bulk may be recommended to move the stool through the colon at a normal rate.In the next section, we will show you how to gradually add fiber to your daily diet and the foods that you need to avoid.This information is solely for informational purposes. IT IS NOT INTENDED TO PROVIDE MEDICAL ADVICE. Neither the Editors of Consumer Guide (R), Publications International, Ltd., the author nor publisher take responsibility for any possible consequences from any treatment, procedure, exercise, dietary modification, action or application of medication which results from reading or following the information contained in this information. The publication of this information does not constitute the practice of medicine, and this information does not replace the advice of your physician or other health care provider. Before undertaking any course of treatment, the reader must seek the advice of their physician or other health care provider.
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