Everything you need to know about diverticulitis

Diverticulitis occurs when pouches start protruding outwards from the colon’s wall, becoming swollen which inflamed.

These sachets, however, will protrude without becoming infected. This is termed diverticulosis, and is called diverticula in the pouches. Many people have a lot of diverticula but don’t experience any ill effects. It can be very painful though, when a pouch gets infected.

It is estimated that around 50 percent of people have diverticulosis by the age of 50 years. An approximate 10-25% of diverticulose patients will continue to develop diverticulitis, although this number is being debated, and some suggest it may be as small as 1%.

Diverticulosis is estimated at 65 per cent of people by the age of 80.

One study found that diverticulitis incidence among young obese adults is growing. A study by the National Institutes of Health (NIH) estimated that the prevalence of digestive diseases in the United States currently approaches $141 billion a year.

This article in the Nccmed Information Center will investigate the causes, symptoms, risk factors, and diverticulitis treatments and related conditions.

Fast facts on diverticulitis

Here are some key points about diverticulitis. More detail and supporting information is in the main article.

  • Diverticulitis is an infected pouch in the colon.
  • Symptoms of diverticulitis include pain, constipation, and blood in the stool.
  • One of the main causes of diverticular disease is thought to be a lack of dietary fiber.
  • Most people can self-treat the condition.
  • Surgery for diverticulitis may be necessary if the condition is recurring.

Symptoms

diverticulitis-diverticulosis-diagram

The symptoms of diverticulosis and diverticulitis are different.

Diverticulosis symptoms

Most diverticulose people will never experience any symptoms at all. This is termed diverticulosis asymptomatic.

Episodes of pain can occur in the lower abdomen. Specifically, usually in the lower left abdomen. The pain also occurs when the person eats stools or passes them. There may be some relief after wind breaks.

Other symptoms include:

  • changing bowel habits
  • constipation and, less commonly, diarrhea
  • small amounts of blood in stools

Diverticulitis symptoms

When diverticulitis becomes inflamed, symptoms include:

  • constant and usually severe pain, usually on the left side of the abdomen although occasionally on the right
  • fever
  • more frequent urination
  • painful urination
  • nausea and vomiting
  • bleeding from the rectum

Causes

Why pouches start protruding outward from the colon is unknown. Nevertheless, the main cause is often believed to be a shortage of dietary fibre.

Fiber helps loosen the stools, and it leads to heavy stools not having enough dietary fibre. This can cause greater pressure or strain on the colon as muscles push down the stool. The pressure is thought to cause diverticula growth.

Diverticula occurs when weak spots in colon muscle’s outer layer give way, and the inner layer squeezes through.

While there is no strong scientific evidence to prove a correlation between dietary fiber and diverticulosis, researchers claim the circumstantial evidence is convincing. The subject is hotly debated though.

Diverticula disease is fairly uncommon in parts of the world where dietary fiber intake is high such as in Africa or South Asia. On the other hand, in Western countries, where dietary fiber intake is much lower, this is quite normal.

Other studies have however debunked the link between increased dietary fiber and prevention of diverticulitis, advising that it may simply increase the likelihood of the disease.

Historically, the ingestion of nuts, seeds, and maize was thought to be a cause of diverticula production but a 2008 study found no link.

Diet

A doctor will sometimes recommend someone with diverticulitis going on a special diet to give the digestive system a chance to rest.

Initially, only clear liquids are allowed for a few days. These include:

  • ice chips
  • fruit juice without pulp
  • broth
  • ice pops
  • water
  • gelatin
  • tea and coffee without cream

A person with diverticulitis can begin to include low-fibre foods as symptoms ease, including:

  • canned or cooked fruits and skinned, seedless vegetables
  • low-fiber cereals
  • eggs, poultry, and fish
  • milk, yogurt, and cheese
  • refined white bread
  • pasta, white rice, and noodles

Foods to avoid

A list of foods often come with gastrointestinal problems to avoid. In the past it was suggested that nuts, popcorn, and seeds can cause symptoms to flare up.

However, since the causes of diverticulitis are not understood, the National Institutes of Health advise that there are no clear foods to exclude from the diet which will boost symptoms of diverticulitis.

A recent study has shown that the high-fat, low-fibre diet that characterizes western feeding increases the risk of diverticulitis. Therefore it is best not to eat red meat, deep-fried food, full-fat dairy and refined grains.

Food should be ruled out on the basis of individual experience. If you find that a certain type of food aggravates the diverticulitis symptoms, avoid this.

Risk factors

Why diverticulitis happens isn’t fully understood. In the stool, bacteria will rapidly multiply and spread, and cause infection. A diverticulum is thought to become blocked, probably by a piece of stool, which leads to infection afterwards.

Risk factors include:

  • age, as older adults have a higher risk than younger individuals.
  • being obese
  • smoking
  • lack of exercise
  • a diet high in animal fats and low in fiber
  • some medications, including steroids, opiates, and non-steroidal anti-inflammatories (NSAIDs), such as ibuprofen

Some studies have indicated that genetics may be a factor.

Diagnosis

A number of techniques may be used to aid diagnosis
A number of techniques may be used to aid diagnosis

It can be difficult to diagnose diverticular and diverticular-related diseases, and there are a number of tests that could be carried out to ensure correct diagnosis.

There are several diseases and conditions with similar symptoms, such as irritable bowel syndrome (IBS), so it’s not easy to diagnose diverticular disease.

Having some blood tests done, a doctor can rule out other problems. We can also use the following techniques:

Colonoscopy: The doctor uses a thin tube with a camera at the end called a colonoscope, to look inside the colon. The colonoscope enters via the rectum. Hours or a day before the operation begins people get a laxative to clear their intestines.

A local anesthetic is given prior to initiation of the procedure. Usually this test is not done during an acute episode of diverticulitis, but is done about 6 weeks after resolution to ensure no signs of cancer are present.

Barium enema X-ray: A tube is placed into the rectum and squirted into the tube and into the rectum is a barium material. Barium is a element, which appears in X-rays. If barium-coated organs that don’t normally show up on an X-ray are visible. That is not a painful procedure.

Diagnosing diverticulitis

If an patient has a history of diverticular disease, the doctor may diagnose diverticulitis by doing a physical examination and asking some questions about the symptoms and their medical history.

A blood test is useful, because if it reveals a significant number of white blood cells, it means an infection is likely. Nevertheless, diverticulitis may still be present in many people without a large number of white blood cells.

People who do not have a diverticular disease history will need more testing. Other disorders, like a hernia or gallstones, can have similar symptoms.

A CT scan can be used, and is often the most useful. The X-ray enema to the barium may also be beneficial. If symptoms are serious, the CT scan can tell if the infection has spread to another part of the body, or if an abscess is present.

Treatment

Individuals can often self-treat if the case is not too severe.

Diverticulosis treatment

Most people will self-treat their diverticular disease if it is mild, mostly with painkillers and more dietary fiber consumption.

Painkillers such as aspirin or ibuprofen should be avoided as they increase the risk of internal bleeding, and can also affect the stomach. For the pain relief from diverticular disease, acetaminophen is recommended. Acetaminophen can be bought over the counter.

Eating more dietary fibre, which includes fruits and vegetables, will help relieve the symptoms by softening stool and helping to regularize stool patterns. It can often take a couple of weeks.

Bulk-forming laxatives may aid constipation sufferers. Drinking plenty of fluids with those drugs is critical. Bulk-forming laxatives can be bought over the counter.

People whose rectal bleeding is serious or regular should see their doctor.

Diverticulitis treatment

Antibiotics may be used to treat some cases of diverticulitis.
Antibiotics may be used to treat some cases of diverticulitis.

In general, mild cases of diverticulitis can be treated individually. A doctor may however prescribe antibiotics for the pain, as well as acetaminophen.

Completing the full course of antibiotics is important, even if symptoms do get better.

Most people, while taking their antibiotics, can experience drowsiness, nausea, diarrhea, and vomiting.

Ciprofloxacin (Cipro), metronidazole (Flagyl), cephalexin (Keflex), and doxycycline (Vibramycin) are all antibiotics.

It’s important to remember for those on the contraceptive pill that antibiotics can interfere with its effectiveness. This effect on the contraceptive pill lasts for about 7 days after the antibiotic has been stopped, so another form of contraception will follow this time around.

Care in hospital may be required if any of the following are applicable:

  • Normal painkillers do not alleviate the pain, or the pain is severe.
  • The individual cannot consume enough liquids to keep hydrated.
  • The person with diverticulitis cannot take oral antibiotics.
  • They have a poor state of health.
  • The doctor suspects complications, often if the immune system is weak.
  • Treatment at home is ineffective after 2 days.

Hospital patients are usually given intravenous antibiotics (IV), as well as fluids if dehydrated.

Surgery

People with at least two episodes of diverticulitis can benefit from the surgery. Studies indicate that such patients are much more likely to experience additional episodes and complications if they do not have surgery.

A colon resection removes a portion of the impaired colon and brings together the remaining healthy sections.

Patients who undergo colon resection will need to gradually introduce solid foods into their body. Other than this, usually their normal bowel functions are not affected.

Complications

Peritonitis: If one of the infected diverticula bursts, infection can spread into the lining of the abdomen. Peritonitis is serious, and can be fatal at times. It requires immediate treatment with antibiotics. Many cases require surgery for peritonitis.

Abscess: This is a pus-filled cavity that requires antibiotics. Sometimes, surgery is required to get the pus out.

Fistula: These are irregular tunnels, or tubes, which link two parts of the body, like the intestine to the abdominal wall or the bladder. When infected tissues contact each other and stick together a fistula can form; a fistula forms when the infection is over. Sometimes, it takes surgery to get rid of a fistula.

Intestinal obstruction: When infection has caused scarring the colon may become partially or totally blocked. If the colon is completely blocked it needs emergency medical attention. Absolute blockage causes peritonitis. If part of the colon is blocked, they’ll need care. It’s not as urgent though as absolute blockage.

A colon resection may be required, depending on the degree of scarring and the extent of the blockage. Often, it may involve a colostomy. On the side of the abdomen, a hole is made, and the colon is routed through the hole and attached to an external colostomy sac.

Once the colon recovers, it’s joined again. The doctors may need, in rare cases, to create an internal ileoanal pouch.

Prevention

People who eat a well-balanced diet with plenty of fruit and vegetables have a reduced risk of diverticulitis developing.

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