Diverticulosis / Diverticulitis
A Problem in the Lower Intestine
Intestinal Cramps Are a Sign
Small pockets in the intestinal wall (called diverticula) can trap food and bacteria and become inflamed or infected. The resulting infection is called diverticulitis.
Diverticulosis is an intestinal disease that occurs more often in industrialized nations. The exact reasons why pockets called diverticula are formed in the colon wall is not known. Scientists believe they develop because of the low amount of fiber or roughage in the modern diet, leading to lower bulk moving through the intestines. With less bulk moving through it, the colon becomes narrower and an increase in force is then needed to move fecal material through the colon. It is thought that the thickened muscle coat in the wall of the colon that is seen in diverticulosis develops in response to the need to push fecal material through the narrow colon. This increase in force may be the cause of the bulging (herniation) of the colon wall. The left side of the colon is most often affected, at the sigmoid and descending areas, where the fecal material is most solid and the pressure needed to push it through the area is the highest. The risk of developing diverticula is greater in older people, and in Western nations the incidence may be up to 50% in those over age 50. Men are more likely to suffer from this problem than women.
Lack of Symptoms: Most people with diverticula are unaware of their presence since they have no symptoms. Often they are discovered while undergoing barium enema tests for an unrelated reason. By themselves, diverticula are not dangerous. However, they can cause complications such as inflammation and bleeding. If undigested food and bacteria get caught in a pocket of the intestine, blood flow is slowed and bacteria can invade the intestinal tissue. This can result in an infection or abscess in the area. Mild cases of inflammation can cause cramping and nausea. More severe cases may cause pain in the lower abdomen, usually on the left side, with tenderness and fever. The pain may increase when a bowel movement occurs, and constipation is often present. It is difficult to see if there is rectal bleeding except under a microscope. In more severe cases, the infected pocket may break apart, spilling the intestinal contents into the peritoneal cavity. This situation is similar to a ruptured appendix, and is a medical emergency requiring hospitalization and possibly surgery.
Diagnosis and Treatment Options: Diverticulosis is usually not diagnosed until a barium enema is done and diverticula are seen on the x-rays of the colon. Most doctors do not recommend treatment if there are no symptoms, although some will recommend a high-fiber diet. Mild symptoms, such as cramping and abdominal spasms, are treated with an antispasmodic drug. The diagnosis of diverticulitis is made by sigmoidoscopy or barium enema, often after the acute infection is healed. It is very important to rule out a cancerous tumor of the colon before beginning treatment. Mild cases of diverticulitis without rupture are treated by bed rest, stool softeners, liquid diet and oral antibiotics. If a more serious abscess has formed or diverticula have ruptured, hospitalization and intravenous antibiotics are required. Sometimes surgery is done to drain a large area of infection or to remove a severely inflamed area of the colon. If you have been diagnosed with diverticulosis or have suffered an attack of diverticulitis, follow your doctor’s instructions carefully. Your doctor or pharmacist can answer any questions you may have about fiber supplements or antispasmodic medications.