Divertticulosis & Diverticulitis
What is Diverticulosis & Diverticulitis?
Diverticulosis is a condition that affects the colon, or large intestine. Normally the colon is strong and has a smooth wall. A colon affected by diverticulosis has weak spots in the walls that out-pouch into balloon like sacs or pockets. Diverticulae can occur anywhere in the colon, although they primarily affect the left, or sigmoid colon. The presence of these pockets in the colon is called diverticulosis; when these pockets become inflamed or infected it is called diverticulitis. The pockets develop from excessive pressure being exerted within the colon. This occurs from straining with bowel movements and chronic constipation. Diverticulosis usually appears later in life. It affects over 50% of adults over 60 years old. It can occur in younger people, and when it does it is usually a more intense problem.
Symptoms of Diverticulosis
Usually diverticulae do not cause any symptoms unless they become inflamed or infected. When diverticulae become more advanced they can cause abdominal pain, bleeding and diverticulitis. Because the colon can become fixed, distorted and narrowed by the diverticulae, the stools may become thin or pellet-like and you may experience constipation.
Bleeding can occur from a ruptured blood vessel in one of the pouches. Usually the bleeding is self-limiting, but still requires careful evaluation and usually a brief hospital stay. In severe cases surgery may be necessary.
When one of the diverticular pouches becomes too thin it can rupture, allowing the normally healthy colon bacteria to seep outside of the colon. This is called diverticulitis. Diverticulitis can be mild, with only slight discomfort in the left lower abdomen; or diverticulitis can be more severe, with extreme abdominal tenderness, fever and possible abscess formation. It is believed that diverticulosis advances to diverticulitis when the bacteria seeps through the thin wall of the diverticuli.
Diagnosis of Diverticulosis and Diverticulitis
Diverticulosis (just the presence of diverticulae) is usually discovered during an intestinal exam done for other reasons, such as a barium enema, sigmoidoscopy or colonoscopy.
Diverticulitis is usually diagnosed based on your physical exam. Your doctor may order x-ray tests to confirm the diagnosis. It is not usually recommended to perform a colonoscopic evaluation during the acute phase of diverticulitis.
Treatment of Diverticulitis
Diverticulosis does not require treatment other than the prevention of the formation of additional diverticulae and the prevention of complications. This is done by increasing your fiber intake to decrease the pressure in the colon and keeping your bowel movements regular and soft. It used to be thought that large seeds and nuts should be strictly avoided. There is actually no medical evidence to support this. It is however recommended to chew all nuts well and avoid popcorn altogether.
Diverticulitis almost always requires treatment. Treatment may be as simple as bowel rest and oral antibiotics. In severe cases hospitalization may be necessary along with intravenous antibiotics. Surgery may be needed to remove the diseased portion of the colon when diverticulitis occurs at an early age or when there are recurrent episodes. During the acute phase of a diverticulitis flare-up your doctor may recommend an easily digested, low residue diet. This includes low fiber, low roughage foods such as soups, cooked cereals, pasta, mashed potoatoes, chicken and meat if you chew it well.