Diverticular Disease

June 19th, 2013 by Eduardo Krajewski, MD, FACS, FASCRS

Maybe you have heard the term before but don’t really know what it means. There is diverticular disease, diverticulosis, diverticulitis and diverticular bleeding. Are these all the same thing? Well the short answer is no. However, all of these problems come from the same source.

What is a Diverticulum?

Let´s start with the basics. A diverticulum is a pouch that forms in the colon. It is formed from the inside of the colon and grows outwards. So from the inside of the colon you see a hole or the opening of the pouch, and from the outside you see a pouch or grape-like structure. Nobody is really sure what causes diverticula to develop, but it might be related to the lack of fiber in the diet.

What is Diverticular Disease?

Diverticular disease is the presence of diverticula in the colon. They may be present without causing any symptoms at all, and this is called diverticulosis. If a diverticulum becomes inflamed and causes pain, then you have developed diverticulitis. The diverticula can also bleed, and this is referred to as diverticular bleeding. Simple, right?

Diverticulosis

This is the presence of diverticula with no symptoms. This disorder is usually detected coincidentally when someone is screened for colon cancer or has a large bowel study done for another reason. Nobody is sure what causes diverticulosis to develop, but some believe that it is due to the lack of fiber in the diet.

No specific treatment is needed in this case; however, increasing the fiber in your diet might help avoid more serious problems. Some doctors recommend the avoidance of seeds, corn and nuts because of the concern that particles of these foods can get lodged in the diverticula. There is no evidence though that avoiding these foods makes any difference.

Diverticulitis

If the wall of a diverticulum becomes thin for any reason, then inflammation can set in. Some of the causes of this could be increased pressure inside the colon or hard stool particles that get stuck inside the diverticulum. Symptoms can include:

  • Abdominal pain, especially in the left lower abdomen
  • Nausea, vomiting
  • Constipation or diarrhea
  • Urinary symptoms

Seventy five percent of the time, diverticulitis has no complications, and this is referred to as simple diverticulitis. This usually responds to medical treatment alone such as clear liquids and oral antibiotics.

Complicated diverticulitis, however, is a much more serious disease. It can be associated with fever, severe pain and the inability to eat or drink. Some potential complications are:

  • Abscess formation
  • Fistula: An abnormal tract or small tunnel connecting two spaces that normally don’t communicate, such as the bowel and bladder
  • Obstruction of the colon
  • Peritonitis: Generalized infection of the abdominal cavity
  • Sepsis: Infection that has spread through the blood to the entire body

In the majority of these cases, surgery is required to remove the part of the colon that is affected. Intravenous antibiotics are also given to you.

In the case of peritonitis, more than one surgery is needed. The first operation is done to cut out the diseased area and also to create a colostomy which involves using an external bag to collect waste. This is done to promote complete healing. About three months later, the colostomy is reversed, and your intestines are reconnected again.

Diverticular Bleeding

Diverticular bleeding occurs when an artery in a diverticulum breaks. The bleeding is almost always painless, and you see maroon or bright red blood with bowel movements.

Most of the time diverticular bleeding resolves on its own. However, some cases require special studies and treatments to find and stop source of bleeding. These treatments can include colonoscopy or surgery. Sometimes a procedure called angiography is used. This locates the bleeding blood vessel using a special dye in your blood that can then be seen on x-ray. Once the bleeding source is detected it can be blocked.

Conclusion

Diverticular disease covers a spectrum of problems that can be essentially harmless or very serious, even life threatening. Fiber in the diet might make a difference. However, if you have any of the signs or symptoms mentioned above, you should seek medical attention right away.

Take a look around The H Doctor website. Here you will find the most current information about hemorrhoid treatment and other digestive health topics.

Take charge of your health.

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