When the pouches become infected or inflamed, the condition is called diverticulitis. This happens in 10 to 25 percent of people with diverticulosis. Diverticulosis and diverticulitis are also called diverticular disease.
2) WHAT ARE THE SYMPTOMS? Diverticulosis:
Most people with diverticulosis do not have any discomfort or symptoms. However, symptoms may include mild cramps, bloating, and constipation. Other diseases such as irritable bowel syndrome (IBS) and stomach ulcers cause similar problems, so these symptoms do not always mean a person has diverticulosis. You should visit your doctor if you have these troubling symptoms.
Diverticulitis:
The most common symptom of diverticulitis is abdominal pain. The most common sign is tenderness around the left side of the lower abdomen. If infection is the cause, fever, nausea, vomiting, chills, cramping, and constipation may occur as well. The severity of symptoms depends on the extent of the infection and complications.
3) WHAT CAUSES DIVERTICULAR DISEASE? Doctors believe a low-fiber diet is the main cause of diverticular disease. The disease was first noticed in the United States in the early 1900's. At about the same time, processed foods were introduced to the American diet. Many processed foods contain refined, low-fiber flour. Unlike whole-wheat flour, refined flour has no wheat bran. Diverticular disease is common in developed or industrialized countries--particularly the United States, England, and Australia--where low-fiber diets are common. The disease is rare in countries of Asia and Africa, where people eat high-fiber vegetable diets. Fiber is the part of fruits, vegetables, and grains that the body cannot digest. Some fiber dissolves easily in water (soluble fiber). It takes on a soft, jelly-like texture in the intestines. Some fiber passes almost unchanged through the intestines (insoluble fiber). Both kinds of fiber help make stools soft and easy to pass. Fiber also prevents constipation.
Constipation makes the muscles strain to move stool that is too hard. It is the main cause of increased pressure in the colon. The excess pressure causes the weak spots in the colon to bulge out and become diverticula.
Diverticulitis occurs when diverticula become infected or inflamed. Doctors are not certain what causes the infection. It may begin when stool or bacteria are caught in the diverticula. An attack of diverticulitis can develop suddenly and without warning.
4) HOW IS IT DIAGNOSED? To diagnose diverticular disease, the doctor asks about medical history, does a physical exam, and may perform one or more diagnostic tests. Because most people do not have symptoms, diverticulosis is often found through tests ordered for another ailment.
Medical History and Physical Exam:
When taking a medical history, the doctor may ask about bowel habits, symptoms, pain, diet, and medications. The physical exam usually involves a digital rectal exam. To perform this test, the doctor inserts a gloved, lubricated finger into the rectum to detect tenderness, blockage, or blood. The doctor may check stool for signs of bleeding and test blood for signs of infection. The doctor may also order x-rays or other tests.
5) WHAT IS THE TREATMENT? A high-fiber diet and, occasionally, mild pain medications will help relieve symptoms in most cases. Sometimes an attack of diverticulitis is serious enough to require a hospital stay and possibly surgery.
DIVERTICULOSIS: Increasing the amount of fiber in the diet may reduce symptoms of diverticulosis and prevent complications such as diverticulitis. Fiber keeps stool soft and lowers pressure inside the colon so that bowel contents can move through easily. The American Dietetic Association recommends 20 to 35 grams of fiber each day. Table 1 shows the amount of fiber in several foods that you can easily add to your diet.
The doctor may also recommend drinking a fiber product such as Citrucel or Metamucil once a day. These products are mixed with water and provide about 4 to 6 grams of fiber for an 8-ounce glass.
Until recently, many doctors suggested avoiding foods with small seeds such as tomatoes or strawberries because they believed that particles could lodge in the diverticula and cause inflammation. However, this is now a controversial point and no evidence supports this recommendation.
If cramps, bloating, and constipation are problems, the doctor may prescribe a short course of pain medication. However, many medications affect emptying of the colon, an undesirable side effect for people with diverticulosis.
DIVERTICULITIS: Treatment for diverticulitis focuses on clearing up the infection and inflammation, resting the colon, and preventing or minimizing complications. An attack of diverticulitis without complications may respond to antibiotics within a few days if treated early.
To help the colon rest, the doctor may recommend bed rest and a liquid diet, along with a pain reliever or a drug such as propantheline (Pro-Banthine) to control muscle spasms in the colon.
An acute attack with severe pain or severe infection may require a hospital stay. Most acute cases of diverticulitis are treated with antibiotics and a liquid diet. The antibiotics are given by injection into a vein. In some cases, however, surgery may be necessary.
6) WHEN IS SURGERY NECESSARY? (Diverticulitis and Diverticulosis)
If attacks are severe or frequent, the doctor may advise surgery. The surgeon opens the abdomen and removes the affected part of the colon. The remaining sections of the colon are rejoined. This type of surgery, called colon resection, aims to keep attacks from coming back and to prevent complications. The doctor may also recommend surgery for complications of a fistula or intestinal obstruction.
If antibiotics do not correct the attack, emergency surgery may be required. Other reasons for emergency surgery include a large abscess, perforation, peritonitis, or continued bleeding.
Emergency surgery usually involves two operations. The first surgery will clear the infected abdominal cavity and remove part of the colon. Because of infection and sometimes obstruction, it is not safe to rejoin the colon during the first operation. The surgeon creates a temporary hole, or stoma, in the abdomen during the first operation. The end of the colon is connected to the hole, a procedure called a colostomy, to allow normal eating and bowel movement. The stool goes into a bag attached to the opening in the abdomen. In the second operation, the surgeon rejoins the ends of the colon.
7) POINTS TO REMEMBER:
1.Diverticulosis occurs when small pouches, called diverticula, bulge outward through weak spots in the colon (large intestine).
2.The pouches form when pressure inside the colon builds, usually because of constipation.
3.The main cause of diverticulosis is a low-fiber diet because it increases constipation and pressure inside the colon.
4.Most people with diverticulosis never have any discomfort or symptoms.
5.Diverticulitis occurs when the pouches get infected or inflamed and cause pain and tenderness around the left side of the lower abdomen.
6.For most people with diverticulosis, eating a high-fiber diet is the only treatment needed.
7.You can increase your fiber intake by eating these foods: whole grain breads, cereals, and other products; fruit such as berries, apples, and peaches; and vegetables such as broccoli, cabbage, spinach, carrots, asparagus, and squash; and beans.
JEAN
"If we give all, but don't have love, we gain nothing"
>----- Original Message -----
From: "Kathryn" <PocaNC@aol.com>
To: "Multiple recipients of list ADHESIONS" <adhesions@mail.medispecialty.com>
Sent: Monday, July 02, 2001 4:25 PM
Subject: Re: Karen- Crohn's Disease
Jean, thanks for all the great information. My son is having some serious problems with his intestines and I was going to look up Crohn's on the internet but you have saved me the time and trouble. The other thing I'm concerned about is Diverti. Disease, my Mom, Grandmother and Brother have all lost part of their colons to this. My son was diagnosed with IBS since he was about 12 years old, he is now 20. Thanks again for the info.
-- Kathryn W