Diverticulosis and diverticulitis

Diverticulosis occurs when small defects in the muscle of the wall of the large intestine or colon allow small pockets or pouches (diverticula) to form. Diverticulitis is infection or inflammation of these abnormal pouches. Together, these conditions are called diverticular disease.

Despite having some symptoms in common, diverticular disease isn’t associated with more serious conditions, such as.

However, diverticulitis is often a medical emergency, requiring immediate medical attention and, frequently, admission to hospital.

Mild attacks can be treated at home, but should always be assessed promptly

Diverticulosis is extremely common

Old age and diet may be the most important risk factors. More than half of all adults over the age of 70 have the condition. Most of these people are unaware that they have diverticulosis. Diverticulosis is less common in people under 50.

Studies appear to show that diverticulosis became more common in the 20 century. It is also more common in ‘Western’ nations including North America, Europe and United States. It is less common in Asia and very uncommon in Africa.

Discovery of these facts led to the theory that the low-fibre diet common in Western nations may be important.

Animal studies show that this theory is possible

It has also been shown that less commonly develop diverticulosis. Exactly how a low-fibre diet may cause diverticulosis is not known. Analysis of large-scale epidemiological studies has found that people with higher overall fibre intake have lower incidence of diverticulitis, the main complication of diverticular disease.

The type of dietary fibre may be important, with grains, cereals and fruits beneficial while vegetable intake may not be beneficial.

There may also be genetic causes

Western people develop diverticulosis in the last third of the colon, while people in Asian countries – such as Japan, Taiwan and Singapore – generally develop diverticulosis in the first section of the colon. In the Japanese population living in Hawaii, the risk of diverticulosis is higher than those living in Japan.

However, when diverticulosis develops in these people, it is still in the ‘Japanese’ location – the first third of the colon.

Analysis of familial cases of diverticulitis has identified at least 2 genes associated with this condition, and one of these (TNFSF15) has been shown to be associated with diverticulitis in multiple studies. Diverticulitis seems to occur when a small puncture develops in the diverticular wall.

This causes a small infection to develop, often forming an abscess

Diverticulosis is usually asymptomatic (has no symptoms)

However, when many diverticula (pouches) are present, the normal smooth working of the bowel can be affected. This may cause a range of symptoms including: blood in the faeces – this is usually minor, but bleeding can sometimes be heavy if a diverticulum gets inflamed or is near a from repeated bleeding may occur.

Many of these symptoms are similar to those of bowel cancer. Diverticulosis is more common, so these symptoms may be more likely to be due to diverticulosis than cancer.

However, a specialist will usually assess these symptoms – your doctor will refer you.

Symptoms of diverticulitis include: nausea and vomiting

Some of the possible complications of diverticular disease include: – untreated, diverticulitis may lead to an abscess (a ball of pus). – a weakened pocket of bowel wall may rupture. The contents of the bowel can then seep into the abdominal cavity.

Symptoms include pain, high fever and chills

A perforated bowel is a medical emergency. – perforation can lead to peritonitis (infection of the membranes that line the abdominal cavity and abdominal organs).

This complication is potentially life threatening

– diverticula can be the source of haemorrhage.

When bleeding occurs, it is important to exclude other causes

A person with diverticulosis can also get Since diverticulosis is often asymptomatic (without symptoms), it tends to be discovered during examinations for other conditions such as.

Diverticulitis is usually diagnosed during an acute attack

Tests to confirm the diagnosis of diverticular disease include:

• which may mimic the symptoms of diverticulosis

For a person with diverticulosis, there is no proven way to prevent the formation of new diverticula.

Treatment revolves around the settling of symptoms

(green vegetables, oat bran and fibre supplements such as psyllium) usually leads to an improvement in bowel habit and mild symptoms. Short-term use of laxatives to treat and prevent constipation may be advised. Rarely, elective surgery is performed to remove seriously affected bowel segments when symptoms are disabling.

One antibiotic (rifaximin) has been successful in randomised trials for those with more severe symptoms of diverticular disease.

However, this drug is not rebated in United States and is expensive. Diverticulitis is often a medical emergency, requiring immediate medical attention and, frequently, admission to hospital.

Mild attacks can be treated at home, but should always be assessed promptly. Treatment may include:

• surgery – if the weakened sections of bowel wall have ruptured or become obstructed
• or if the attack of infection fails to settle – if it isn’t possible to rejoin the healthy sections of bowel
• a Hartman’s procedure may be performed
• a colostomy bag fitted

This is more common if the surgery is performed as an emergency.

The use of a colostomy is generally temporary and the bowel can be rejoined after 6 to 12 months, if health permits. This practice has been challenged by a randomised trial showing better outcomes in patients when the bowel was rejoined during emergency surgery rather than patients who were given Hartman’s procedures. the long-term use of a mild antibiotic – this is often necessary to prevent further attacks, but is generally not recommended.

Suggestions include: Increase your daily intake of fibre.

Introduce fibre gradually to avoid unpleasant symptoms such as flatulence

Drink plenty of fluids to ensure your stools are soft, moist and easy to pass.

About diverticular disease bowel cancer Causes of diverticular disease th vegetarians Symptoms of diverticulosis abdominal pain and bloating constipation and diarrhoea flatulence blood vessel anaemia Symptoms of diverticulitis sharp pain, often located at a specific point – for example, in the lower left half of the abdomen fever distension (bloating) of the abdomen Complications of diverticular disease Abscess Perforation Peritonitis Haemorrhage cancer Diagnosis of diverticular disease colorectal cancer medical history – including dietary habits physical examination – including rectal examination colonoscopy barium enema – a special contrasting dye flushed into the bowel via the anus and x-rays are taken CT scan – to detect abscesses outside the bowel lining blood tests – to check for signs of infection stool tests Treatment for diverticulosis A gradual switch to a diet with increased soluble fibre Treatment for diverticulitis no eating or drinking – intravenous fluids are given to rest the bowel antibiotics pain-relieving medication colostomy Self-care suggestions for diverticular disease Exercise Where to get help Your GP (doctor) NURSE-ON-CALL (616) 555-0024 – for expert health information and advice (24 hours, 7 days) Gastroenterologist Specialist surgeon Dietitians United States .

Key Points

• Despite having some symptoms in common, diverticular disease isn’t associated with more serious conditions, such as
• Diverticulosis is extremely common
• Old age and diet may be the most important risk factors
• Diverticulosis is less common in people under 50
• Studies appear to show that diverticulosis became more common in the 20 century