Download Diverticulosis and Diverticulitis

Diverticulosis and Diverticulitis
By gi health
The Normal Colon
To understand diverticulosis, it is first necessary to know a bit about the anatomy and
function of the intestine. Food is digested and nutrition absorbed in the 20 feet of small
intestine. This is the long, thin segment of bowel that begins at the stomach and ends in the
right lower abdomen. After the digestive process is complete, the liquid waste enters the 5
feet of large intestine, or colon, which ends in the rectum. Just above the rectum is the
sigmoid (s-shaped) part of the colon where diverticulosis usually occurs. About two gallons
of liquid stool enters the right colon each day where excess water is purified and recycled
back into the blood stream. The remaining solid waste, or stool, eventually enters the
rectum where the waste is stored until it is convenient to have a bowel movement.
What is Diverticulosis?
Diverticulosis is a condition, rather than a disease. It affects the large intestine, or colon. A
normal colon is strong and relatively smooth. A colon affected by diverticulosis has weak
spots in the walls. These defects allow the development of balloon-like sacs or outpouches much like a bubble forming on a worn inner tube. These hollow pouches, - about the size of
a large pea - called diverticulae, occur when the inner intestinal lining has pushed through
weakened areas of the colon wall. A single pouch is called a diverticula. Although
diverticulosis can occur anywhere in the colon, 80% are found in the lower left side - called
the sigmoid colon - because that is where the colon is the narrowest and the inner pressure
the highest. The presence of these pouches on the colon is called diverticulosis. When the
pouches are inflamed or infected, it is called diverticulitis.
Who Gets Diverticulosis?
Diverticulosis is a common condition affecting both men and women. Since diverticulosis
takes so long to develop, it usually appears later in life. It affects over 50 percent of those
over age 60. Occasionally it occurs in much younger individuals where it is usually a more
aggressive problem. This disorder is mostly one of Western society. It is very rare in rural
Africa or India where the diet consists of grains very high in dietary fiber. Many researchers
feel that our typical low fiber American diet is responsible for the high incidence of
diverticulosis in this country. A diet low in fiber promotes constipation and straining at bowel
movements that may worsen diverticulosis.
Complications of Diverticulosis
Considering how many millions of Americans have diverticulosis, it is remarkable that so few
people are affected by complications. Diverticula usually don't cause any symptoms unless
they become inflamed or infected. In fact, most people with diverticulosis experience no
symptoms at all. However, complications do occur and can be serious. These may include
abdominal pain, rectal bleeding, and diverticulitis.
Abdominal Pain
Most diverticular pouches are painless. But, if you have enough of them, they can cause
thickening and narrowing of the sigmoid colon. This results in painful spams in the lower left
part of the abdomen. When diverticulosis is far advanced, the lower colon may become
narrowed and distorted. When this occurs, there may be thin or pellet-shaped stools,
persistent bouts of constipation, and an occasional rush of diarrhea.
Rectal Bleeding
Bleeding occurs from a ruptured blood vessel in one of the pouches. This may produce a
gush of red blood from the rectum or maroon-colored stools. The bleeding is usually selflimited and stops on its own, but requires careful evaluation and usually a brief
hospitalization. Occasionally, emergency surgery is necessary to stop the loss of blood.
Diverticulitis
Diverticulitis is a complication of diverticulosis. The colon is home to many beneficial
bacteria - helpful as long as they stay within the colon. Sometimes, one of the diverticular
pouches becomes thin and ruptures allowing bacteria normally contained inside the colon to
seep out through the wall and cause infection on the outside of the colon. When this occurs,
it is called diverticulitis. Diverticulitis can be mild with only slight discomfort in the left lower
abdomen - or it can be extreme with abscess formation, severe tenderness and fever.
Nobody knows why "osis" becomes "itis," but is probably because bacteria normally present
in the colon penetrate the thin walled pouches.
Diagnosis of Diverticulosis
Because diverticulosis usually causes no symptoms, it is usually discovered during an
intestinal examination performed for other reasons. This may include tests such as a barium
enema X-ray, flexible sigmoidoscopy, or colonoscopy examination. The later two tests are
performed through the rectum with a lighted flexible "scope" and can directly view the colon
from the inside providing additional information about the problem. Sometimes,
diverticulosis is an incidental finding at surgery or autopsy. Click here to see what
diverticulosis looks like during an autopsy.
Does Diverticulosis Require Treatment?
Treatment of diverticulosis varies. If there are no symptoms, treatment is usually not
necessary, but a fiber-rich diet is advisable. When diverticulitis occurs, simple bowel rest
and antibiotics can usually abort a mild attack. In severe cases, patients may need
hospitalization and intravenous antibiotics. While most people recover from diverticulitis
without surgery, sometimes it is necessary to remove the affected portion of the colon - the
healthy ends are then rejoined. The most common reason for surgery is to stop repeated
episodes of pain, bleeding, or diverticulitis.
High Fiber Diet
As mentioned earlier, an inadequate diet is considered the leading cause of diverticulosis.
Most health experts agree that the lack of fiber and bulk in the diet is the major cause of
chronic constipation and diverticular disease. As our foods are becoming more highly
refined, more of us are suffering from symptoms of diverticular disease. Once diverticula
have formed there is no way to reverse the process. The pouches are there for the rest of
your life.
Chances are you are not getting enough fiber in your diet. In fact, most people in the United
States average only 10 to 15 grams of dietary fiber a day. Most dietitians, however, use 35
grams of fiber a day as the minimum benchmark for a high-fiber diet.
Adding fiber and bulk to your diet helps promote regular bowel function and is very
important in controlling and minimizing this disease. Foods rich in fiber, such as bran
cereals, whole wheat breads, a variety of beans, and fresh fruits and vegetables help keep
the stools soft and bulky. We all should make an effort to include more fiber, or roughage,
in our diet. But, don't be too enthusiastic. That is, do not add too much fiber too soon.
Otherwise, troublesome side effects, such as increased gas and bloating, may occur. The
golden rule regarding fiber is to go slow. Start with small amounts and gradually increase
the extra fiber in your diet.
Many patients ask about seeds. For many years it has been suspected that large seeds
(apple seeds, orange pits, watermelon seeds, grape pits, etc.) may become trapped in the
pouches and can occasionally cause problems. There is no medical evidence to support this
theory, but is has not been studied in a scientific fashion. We tell paients that these fruits
may be still enjoyed, but we suggest that they remove the seeds. Smaller soft seeds seem
to be harmless. Foods such as nuts and popcorn should be chewed very well to avoid
problems.
The following list shows various categories of foods that are high in dietary fiber. The
examples given for each category are not all inclusive and similar foods may be substituted.
You should try to include foods from each group in your daily diet:
Grains
Bran cereals
Shredded Wheat
Grape Nuts
Ry-Krisp
Whole wheat
Whole rye bread
Graham crackers
Oatmeal
Puffed Wheat
Wheatina
Vegetables
Green peas
Carrots
Winter squash
Broccoli
Brussel sprouts
String beans
Sweet potatoes
Artichokes
Lima beans
Fruits
Pears
Apples
Tangerines
Prunes