Diverticulosis is a condition where pockets (pouches) form in the large intestine (colon).
The large intestine is a long tube-like structure that stores and eliminates waste material. During normal lower intestinal function, the waste material (stool or feces) is slowly pushed along the large intestine to the rectum by the muscular bands in the colon. As a person ages, this continuous pressure can cause a bulging pocket of tissue or sac (called a diverticulum) that pushes out from the colon wall. More than one sac is called diverticula. Diverticula can occur throughout the large intestine, but are most commonly found near the end of the left intestine (called the sigmoid colon). The condition of having diverticula in the large intestine is called diverticulosis.
When a diverticulum ruptures or becomes infected, this condition is called diverticulitis. Diverticulitis develops when a mass of hardened waste matter (called a fecalith) forms in the pouch and reduces the blood supply to the thin walls of the pouch (by means of pressure against the wall), making them susceptible to infection by the bacteria of the colon.
Diverticulosis is rare before the age of 40, but the likelihood of developing this condition increases with passing decades. It is estimated that 30 percent of all people over the age of 45 have diverticulosis; at the age of 60, 50 percent of all people will develop this condition; and by the age of 85, 65 percent of all people will have diverticulosis.
Researchers believe that diverticulosis may be age related, genetically based and most importantly, caused by not enough fiber in the diet. A diet low in fiber can lead to small, hard stools that are difficult to pass and require more pressure to push them through the large intestine. Over time, these vigorous contractions in the large intestine push the inner intestinal lining outward, causing diverticula.
Most people with diverticulosis have few or no symptoms. Doctors refer to diverticulosis with no symptoms as asymptomatic diverticulosis. For people who experience symptoms, the condition is called symptomatic diverticulosis. Symptomatic diverticulosis is categorized into three types – painful diverticulosis, inflammatory diverticulitis (inflamed and infected diverticula) and bleeding diverticulosis (the blood vessel in the wall of the diverticulum ruptures).
Symptoms of painful diverticulosis are:
- abdominal pain (usually located in the lower left abdomen) that subsides after a bowel movement or passing gas
- constipation, followed by bouts of diarrhea
Symptoms of inflammatory diverticulitis are:
- abdominal pain
Symptoms of bleeding diverticulosis are:
- sudden, mild cramps
- urge to have a bowel movement
- bright red blood clots and maroon-colored stool
If sufficient blood is lost in a short amount of time, the person may experience:
- increased thirst
- rapid heart beat
Diverticulosis is often unsuspected and discovered by an x-ray or intestinal examination performed for an unrelated reason. The doctor may see the diverticula through a flexible tube (a colonoscope) that is inserted through the anus. Through this scope, the diverticula may be seen as dark passages leading out of the normal colon wall.
The doctor also may do a barium enema (an x-ray that reveals outpouchings in the walls of the colon). If rectal bleeding occurs, the doctor may take a special x-ray (an angiography). In this procedure, dye is injected into an artery that goes to the colon so that the site of the bleeding problem can be located.
If the patient has diverticulosis with no symptoms, no treatment is needed. Some doctors advise eating a special high fiber diet, consisting of fresh vegetables, fresh fruits, whole-grain breads, cereals and bran.
Additionally, adding a fiber supplement (such as Metamucil or Hydrocil) to the diet, and avoiding certain foods with small seeds, such as strawberries, raspberries, whole cranberries and nuts is helpful in treating diverticulosis.
Patients experiencing bloating or abdominal pain may benefit from anti-spasmodic drugs, such as Librax, Bentyl, Donnotal and Levsin.
If this condition turns into diverticulitis, bedrest, antibiotics or hospitalization may be needed. The vast majority of patients will recover from diverticulitis without surgery. Sometimes, patients need surgery to drain an abscess that has resulted from a ruptured diverticulum and to remove that portion of the colon. Surgery is reserved for patients with very severe or multiple attacks. In such cases, the involved segment of colon can be removed and the colon can then be rejoined.
Once formed, diverticula are permanent. No treatment has been found to prevent the complication of diverticulosis, however, there are some guidelines that can be followed to manage the condition. They are as follows:
1. Eat a high fiber diet, consisting of fresh fruits and vegetables, whole grain bread, cereals and bran.
2. Avoid foods containing indigestible roughage, such as celery and corn, and use bran to prevent constipation.
1. Avoid straining during bowel movements.
4. Establish a normal bowel routine. Try to have a bowel movement at approximately the same time every day and spend at least 10 minutes in the attempt.
5. Add bulk to stools by eating fruits and vegetables with a high fiber content, such as seedless grapes, fresh peaches, carrots and lettuce.
6. Avoid extremely hot or cold foods and fluids (which cause gas).
7. Avoid alcohol (which irritates the bowel).
8. Lose weight if you are overweight.
9. Exercise moderately.
10. Use natural laxatives (only when needed).
11. Drink at least three (3) to five (5) glasses of water or other liquid per day.
12. Do not smoke (it irritates the gastric mucosa).